Do patients with skin allergies have higher levels of anxiety than patients with allergic respiratory diseases? Results of a large-scale cross-sectional study in a French population.
BACKGROUND
Psychological comorbidity is a known aspect of allergic disease. However, there is recent evidence that a large proportion of allergic patients remains undiagnosed and untreated for psychological disease. In addition, the complexities of the anxiety-allergy relationship, i.e. differences for current and past disease, or differences among allergic disease types, are not well understood.


OBJECTIVE
To measure the level of anxiety in a large allergic population in France using a standardized measure, the State/Trait Anxiety Inventory (STAI).


METHODS
Allergy patients in France (n = 3939) who visited their allergy specialists participated in the study. The patients completed a questionnaire which was then linked to the questionnaire completed by their physician. Only patients with both subject and physician questionnaire were kept in the analyses. Mean STAI scores for the State (S) and Trait (T) scales were obtained for each allergic disease. ANCOVA models testing group differences on the mean scores, using the categories "current disease", "past disease" and "allergic disease ever", were assessed along with relevant confounders.


RESULTS
Allergic rhinitis (AR), asthma and atopic dermatitis (AD) were the most prevalent conditions of the 12 allergic diseases assessed in the study. Women had higher mean STAI S/T scores than men and age was also found to be associated with higher S scores; therefore, both age and gender were included as covariates where relevant. A single ANCOVA model for each STAI scale showed a statistical difference among the various allergic diseases. Using the category "current disease" each allergic disease was assessed separately regarding the presence or absence of that disease. Higher, statistically significant mean STAI scores were found for AD and allergic urticaria on the S scale and for AD on the T scale. Similarly, for the category "allergic disease ever", AD and allergic urticaria reached statistical significance on the S scale, while on the T scale only AD was statistically significant. When patients were assessed for anxiety based on their past disease, asthma, AR and sinusitis were significant on the S scale while asthma and nasal polyps were statistically significant on the T scale. When asthma and AD were tested simultaneously, only the latter was significant.


CONCLUSIONS
High mean scores for State and Trait anxiety were mostly associated with AD.
Annesi-Maesano
I
I
INSERM, UMR-S 707, Medical School Saint-Antoine, University Pierre et Marie Curie-Paris 6, 75012 Paris, France.
Beyer
A
A
Marmouz
F
F
Mathelier-Fusade
P
P
Vervloet
D
D
Bauchau
V
V
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001007:Anxiety / Q000209:etiology*; D001249:Asthma / Q000523:psychology; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012130:Respiratory Hypersensitivity / Q000523:psychology*; D012220:Rhinitis / Q000523:psychology; D012737:Sex Factors