title: Acne, anxiety, depression and suicide in teenagers: a cross-sectional survey of New Zealand secondary school students.
abstract: OBJECTIVE
  To examine the associations between acne and depressive symptoms, anxiety and suicidal behaviours.
  
  
  METHODS
  This was a secondary analysis of a cross-sectional survey -'Youth2000' (New Zealand national survey of youth health). A total of 9567 secondary school students aged 12-18 years participated in the survey. The main outcome measures were self-reported acne, depressive symptoms (Reynolds Adolescent Depression Scale > 77), anxiety (Anxiety Disorder Index from Multidimensional Anxiety Scale for Children) and self-reported suicide attempts.
  
  
  RESULTS
  'Problem acne' was associated with an increased probability of depressive symptoms, odds ratio 2.04 (95% confidence interval 1.70-2.45); anxiety, odds ratio 2.3 (1.74-3.00); and suicide attempts, odds ratio 1.83 (1.51-2.22) in a logistic model that included age, gender, ethnicity, school decile and socio-economic status. The association of acne with suicide attempts remained after controlling for depressive symptoms and anxiety, odds ratio 1.50 (1.21-1.86).
  
  
  CONCLUSIONS
  Young people presenting with acne are at increased risk of depression, anxiety and suicide attempts. Attention should be paid to their mental health, and the importance of asking directly regarding suicide is emphasised.
authors.affiliation: Department of Dermatology, Great Ormond Street Hospital for Sick Children, London, United Kingdom. djpurvis@slingshot.co.nz
authors.forename: Diana
authors.initials: D
authors.lastname: Purvis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.forename: Sally
authors.initials: S
authors.lastname: Merry
authors.forename: Peter
authors.initials: P
authors.lastname: Watson
mesh_terms: D000152:Acne Vulgaris / Q000453:epidemiology* / Q000523:psychology; D000293:Adolescent; D001008:Anxiety Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D012574:Schools; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires