Acne Severity, Not Acne Medications, May Explain Increased Suicidal Ideation in Older Adolescents
by Caroline Cassels, Medscape
September 24, 2010

Older adolescents with severe acne think about committing suicide almost twice as often as their counterparts with little or no acne, new research shows.

Investigators suggest that suicidal thoughts and depression that have previously been linked to acne medication, specifically isotretinoin, might in fact be due to disease severity and its subsequent psychological toll.

A large cross-sectional study showed that 25.5% of girls and 22.6% of boys 18 or 19 years of age with severe acne considered suicide, compared with 11.9% of girls and 6.3% of boys with little or no evidence of the disease.

"Acne is frequently found in late adolescence and is associated with social and psychological problems. Adverse events, including suicidal ideation and depression, that have been associated with therapies for acne may reflect the burden of substantial acne rather than the effects of medication," say the study authors, led by Lars Lien, PhD, from the Institute of Psychiatry, University of Oslo, Norway.

The study was published online September 16 in the Journal of Investigative Dermatology.
According to the authors, findings from studies looking at the association between isotretinoin therapy and increased risk for depression, suicidal ideation, and suicide have been conflicting, and "results from controlled studies are lacking."

When considering the controversy over the possible negative psychological effects of isotretinoin, it is important to consider the effect of severe acne on the mental health of teens, the authors note.

"Social isolation and insecure attachments have been linked to suicidal ideation. The appearance of the skin is important in social interaction and for self-image. Acne is the most frequent visible skin disease in adolescents. This makes it relevant to study the relations between acne, social functioning, and suicidal ideation," they write.

To examine these potential associations, the investigators recruited 3775 older adolescents to participate in the cross-sectional study.

Of the total cohort, 493 (13.5%) had substantial acne. The prevalence in boys was 14.4% and in girls was 12.8%.

The overall prevalence of suicidal ideation was 10.9%. However, suicidal ideation was noted significantly more often in those with substantial acne than in those with less acne (adjusted odds ratio [OR], 1.80; 95% confidence interval [CI], 1.30 - 2.50).

The researchers also found that the teens (both sexes) with substantial acne were significantly more likely to report mental health problems, measured by the Strengths and Difficulties Questionnaire, than their counterparts with less acne (OR, 2.25; 95% CI, 1.69 - 3.00).
Social impairment was more common with increasing acne, and analyses revealed that adolescents with substantial acne had less attachment to friends and did not thrive at school. They were also less likely to report romantic and sexual relationships.

"Especially relevant," write the authors," is the 80% higher level of suicidal ideation in adolescents with substantial acne than among those with no/little acne, independent of symptoms of depression, ethnicity, and family income in this population with low use of isotretinoin."

"Our results are helpful for clinicians, as subjective complaints are important when choosing treatment. Furthermore, these findings have public health implications because they underscore the need of appropriate healthcare for adolescent boys and girls in the community," they conclude.

The authors have disclosed no relevant financial relationships.

J Invest Dermatol. Published online September 16, 2010. Abstract