Prevalence and comparative risk of mental health disorders in persons with vitiligo: a retrospective matched cohort study using claims data with expert-informed case validation.

OBJECTIVES

To estimate the prevalence and comorbidity patterns of mental health disorders (MHDs) in persons with vitiligo and compare relative risks (RRs) with dermatological diseases (atopic dermatitis and psoriasis) and non-vitiligo comparator cohorts using claims data.

DESIGN

Retrospective matched cohort study using nationwide statutory health insurance claims data.

SETTING

German statutory health insurance claims (DAK-Gesundheit), 2016-2020.

PARTICIPANTS

A 40% anonymised sample of insured persons (N=2 885 984). In 2020, persons with vitiligo (International Statistical Classification of Diseases, Tenth Revision, German Modification L80) were compared with cohorts with atopic dermatitis (L20), psoriasis (L40) and persons without vitiligo. Cohorts were propensity score matched (1:3) by age and sex.

PRIMARY OUTCOME MEASURES: Prevalence of MHDs and RRs across comparator cohorts.

SECONDARY OUTCOME MEASURES: Internal plausibility of expert-informed claims-based MHD case definitions using diagnosis-only versus diagnosis-plus-care criteria.

RESULTS

In 2020, 4 631 persons were diagnosed with vitiligo. Affective disorders and neurotic, stress-related and somatoform disorders showed the highest prevalence, with depressive episodes ranging from 8.9% to 19.2% and somatoform disorders from 5.3% to 17.9% across definitions. In matched comparisons with atopic dermatitis, only a few and inconsistent differences were observed. In contrast, more pronounced and consistent differences were identified in comparisons with psoriasis. Emotional disorders in childhood showed higher risks under the most sensitive case definition (RR=2.29, 95% CI 1.14 to 4.61), whereas hyperkinetic disorders showed consistent effects across all definitions (RR range=1.58-1.93). Compared with persons without vitiligo, risks were higher for social phobia (RR range=2.10-2.81) and anxiety disorders (RR range=1.64-1.93).

CONCLUSIONS

Persons with vitiligo show a substantial burden of affective and stress-related MHDs. The mental health comorbidity profile was largely comparable to that of atopic dermatitis, whereas more pronounced differences were observed in comparisons with psoriasis. Claims-based prevalence estimates were sensitive to case definition, highlighting the importance of transparent operationalisation.