Global VALIANT Study reports high prevalence of depression among vitiligo patients in India

Findings from the Global VALIANT Study published in JAMA Dermatology have suggested prioritizing the patients' psychosocial health in managing and treating vitiligo. The population-based qualitative study revealed that 3541 patients with vitiligo across 17 countries reported a substantial burden on psychosocial health, daily life, emotional well-being, and quality of life, with a greater burden seen among patients with more than 5% affected body surface area, facial involvement, Fitzpatrick skin types IV to VI (ie, darker skin), and hand involvement vs their counterparts.

"Survey findings indicate that patients reported having expressed evident discontent, altered their behaviour, and have symptoms consistent with depression, which may be underdiagnosed," the researchers wrote.

Vitilogo is a chronic autoimmune disease with characteristics of melanocyte destruction, leading to white or pale skin patches. Vitiligo patients encounter significant QoL (quality-of-life) impairment in routine activities, psychosocial health, and employment. Previous studies have suggested that patients with greater involvement of body surface area (BSA) and visible lesions experience greater psychosocial burden. Also, vitiligo patients are more likely to have anxiety and depression than those without vitiligo. Psychosocial stressors are associated with vitiligo onset or flares.

There is a need to further understand the global vitiligo burden from the patient's perspective. Therefore, Kristen Bibeau, Incyte Corporation, Wilmington, Delaware, and colleagues aimed to explore the global association of vitiligo with QOL and mental health from the patient's perspective. The patients were surveyed in the VALIANT (Vitiligo and Life Impact Among International Communities) study from May to June 2021. For this qualitative study, potential participants were recruited from an online panel in 17 countries.

Of 5859 surveyed adults (aged ≥18 years) who reported a diagnosis of vitiligo, 3919 completed the survey, and 3541 were included in the analysis. The median age of the 3541 patients was 38 years, and 54.6% were male. The patients were asked questions regarding their emotional well-being, including mental health and quality of life.

Scores from the Vitiligo Impact Patient Scale (VIPs) ranged from 0 to 60, and higher scores indicated more psychosocial burden.

The study led to the following findings:

• 45.2% had more than 5% affected body surface area (BSA; Self-Assessment Vitiligo Extent Score assessed), and 40.8% of patients had Fitzpatrick skin types IV to VI (i.e., darker skin).
• The mean global short-form VIPs score was 27.3 overall; patients from India (mean, 40.2) reported the highest scores (i.e., most burden).
• The QOL burden according to the scale was profound for patients with more than 5% affected BSA (mean score, 32.6), darker skin (mean score, 31.2), and lesions on the face (mean score, 30.0) or hands (mean, 29.2).
• At least 40% of patients globally reported that vitiligo frequently affected aspects of their daily lives, including choosing clothes to wear (55.2%).
• Most patients (59.4%) reported concealing their vitiligo frequently.
• More than half of patients (58.7%) reported diagnosed mental health conditions, including anxiety (28.8%) and depression (24.5%).
• The Patient Health Questionnaire–9 depression screener showed that 55.0% of patients had moderate to severe depressive symptoms; the highest rates were in India (89.4%) and among patients with more than 5% affected BSA (72.0%) and darker skin (68.3%).

"Findings highlight the need to prioritize reduction in the vitiligo's psychosocial burden and increase efforts to educate health care professionals and patients on vitiligo, specifically in countries where patients experience the highest burden (eg. in India)," the researchers concluded.

Reference:

Bibeau K, Ezzedine K, Harris JE, et al. Mental Health and Psychosocial Quality-of-Life Burden Among Patients With Vitiligo: Findings From the Global VALIANT Study. JAMA Dermatol. Published online August 30, 2023. doi:10.1001/jamadermatol.2023.2787