Although there is a higher chance of developing anxiety and depression in patients with HS, it is unclear if the severity of the illness is a possible risk factor in and of itself. Thus, this study evaluated the risk of both new-onset and recurring anxiety and depression in HS patients, as well as its correlation with the severity of the condition when compared to the general population.
Danish HS patients who were age and sex matched 1:4 with the individuals without HS from the Danish national registries were included in this population-based cohort research, which ran from 1997 to 2022. Analysis of the data took place between July 18, 2024, and May 20, 2025. First diagnoses of anxiety or depression, as well as the first diagnoses of both as distinct outcomes after the index date, were the primary outcomes.
Using Cox regression models that controlled for socioeconomic and demographic characteristics as well as comorbidities, incidence rates (IRs) and hazard ratios (HRs) were computed for the first episode of anxiety or depression after baseline. Treatments (systemic nonbiologics, topicals, or biologics) and hospitalizations for HS-related surgical operations (0, 1, 2, or ≥3) were used to determine the severity of the disease.
There were 40,125 controls and 10,206 HS patients in total. Of those who got HS-related therapies throughout the research period, 12.0% received just topical, 55.5% received systemic nonbiologic, 6.5% received biologic, and 25.9% did not get any. The adjusted HRs for new-onset anxiety and depression were 1.48 (95% CI, 1.38-1.56; P <.001) and 1.69 (95% CI, 1.57-1.81; P <.001), respectively.
When therapy was stratified, the HRs for anxiety or depression were 1.38 (95% CI, 1.01-1.87; P <.05) for biologics, 1.62 (95% CI, 1.41-1.85; P <.001) for topicals, and 1.61 (95% CI, 1.51-1.72; P <.001) for systemic non-biologics. The HRs were 1.44 (95% CI, 1.36-1.53; P <.001), 1.66 (95% CI, 1.53-2.17), 1.59 (95% CI, 1.33-1.90; P <.001), and 1.60 (95% CI, 1.40-1.85; P <.001) by 0, 1, 2, or 3 hospitalizations for HS-related surgical operations, respectively.
When compared to controls, HS patients had higher rates of anxiety (5.9% vs 0.5%; P <.001) and depression (7.0% vs 0.3%; P <.001), but there was no difference in the risk of recurring anxiety (HR, 1.22 [95% CI, 0.89-1.66]; P =.22) or depression. Overall, clinicians should be aware of mental disease at all severity levels and treat patients in a multidisciplinary environment, since this research highlights that anxiety and depression can manifest independently of the severity of the disease.
Source:
Holgersen, N., Rosenø, N. A. L., Nielsen, V. W., Hjorthøj, C., Nordentoft, M., Garg, A., Strunk, A., Thyssen, J. P., Nilsson, S. F., Egeberg, A., & Thomsen, S. F. (2025). Risk of new-onset and recurrent depression and anxiety among patients with hidradenitis suppurativa. JAMA Dermatology (Chicago, Ill.). https://doi.org/10.1001/jamadermatol.2025.2298
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