Adolescent atopic dermatitis (AD) patients have more frequent and more prevalent bullying experiences versus those without AD, according to new findings, and the same group reports having decreased academic involvement and fewer friends than those without AD.1
Summary of Study Findings
- Adolescents with atopic dermatitis (AD) are susceptible to bullying due to their skin condition, which can lead to depression, suicidality, and reduced quality of life.
- This cross-sectional study investigated the link between AD and the prevalence and frequency of bullying among US adolescents. The hypothesis was that AD would be linked with an increased incidence of bullying experiences.
- The study used data from the 2021 National Health Interview Survey, and it found that adolescents with AD had a higher prevalence and frequency of experiencing bullying, including cyberbullying.
- Adolescents with AD not only faced an increased risk of being bullied but also reported fewer friendships and reduced school and extracurricular involvement, highlighting the need for further research.
These findings, among others, were the results of a recent research letter exploring the social ramifications of AD among adolescent patients with the skin disease. The new data adds to the growing literature on the downstream effects of AD on younger patients.
This research was led by Howa Yeung, MD, MSc, from Emory University School of Medicine’s Department of Dermatology in Atlanta, Georgia. Yeung and colleagues noted that there is existing data suggesting appearance-based bullying of adolescent patients with skin diseases, as well as well-known links between bullying, suicidality, and depression.2,3
“This cross-sectional study aimed to examine the association between AD and prevalence and frequency of bullying among US adolescents,” Yeung and colleagues wrote. “We hypothesized that AD would be associated with increased prevalence and frequency of bullying experiences.”
Background and Findings
The investigators utilized cross-sectional data which was derived from caregivers of adolescents in the age range of 12 - 17 years and located in the United States. The team’s data was drawn from the 2021 National Health Interview Survey (NHIS), and the information they used was openly accessible and categorized as non-human participant research.
Information regarding the adolescent subjects of the study who were aged 17 years or younger was from 1 randomly-selected adolescent within each household. This background information was provided by an adult caregiver who was aware of the subject’s general health status.
The elements which were under consideration by the investigators included the existence of AD, bullying encounters—both in-person and through online interactions—and involvement in bullying perpetration. The determination of AD was based upon the caregiver's response to the question regarding whether the subject had dealt with an itchy rash resulting from eczema or AD.
The research team assessed bullying encounters by looking into how often the adolescent subject was picked on, bullied, or excluded by other adolescents. They assessed cyberbullying by asking about the subject’s experiences being electronically bullied.
Furthermore, bullying perpetration was looked into by the investigators by inquiring about how often the subject picked on others, bullied, or excluded others. The team examined prevalence of 1 or more bullying experiences in the previous year and the frequency of bullying by utilizing logistic regression and ordinal logistic regression.
Among a total of 3,207 adolescent subjects, the investigators found that 11.9% (95% CI, 10.7%-13.3%) were noted as having current AD. The team added that those with the skin disease—versus those without—were linked to greater numbers of current asthma (21.1% [95% CI, 16.6%-26.4%] versus 7.0% [95% CI, 5.9%-8.3%]) and respiratory allergies (58.6% [95% CI, 52.7%-64.4%] versus 36.3% [95% CI, 34.2%-38.6%]), respectively.
Additionally, the investigators reported that the prevalence of experiencing bullying was shown to be substantially greater in subjects with AD (33.2% [95% CI, 27.3%-39.7%]) versus without (19.0% [95% CI, 17.3%-20.8%]; P < .001). This was also shown to be the case with cyberbullying (9.1% [6.1%-13.4%] versus 5.8% [4.9%-6.9%]).
The research team adjusted for demographics and atopic comorbidities, finding that adolescent subjects that had the skin disease were shown to have greater odds of reporting bullying experiences. The team also noted greater odds of experiencing cyberbullying among those with AD, though this link diminished when adjusting for atopic comorbidities.
The team reported that AD was found not to lead to a major association with bullying perpetration after adjusting for demographics and adjusting for atopic comorbidities. Lastly, the investigators noted that adolescents with the skin disease were found to have greater odds of being bullied at a greater frequency.
The team did also note that the design meant that causal connections could not be established, adding that caregiver reports may diminish reports of bullying by the subjects themselves.
“Larger, future studies using clinical AD diagnoses and adolescent self-report can advance understanding of bullying and AD,” they wrote. “Clinicians, families, and schools should address and monitor bullying among adolescents with AD.”
References
- Cheng A, Wan J, Chen SC, Yeung H. Atopic Dermatitis and Bullying Among US Adolescents. JAMA Dermatol. Published online October 25, 2023. doi:10.1001/jamadermatol.2023.4138.
- Kelly KA, Balogh EA, Kaplan SG, Feldman SR. Skin disease in children: effects on quality of life, stigmatization, bullying, and suicide risk in pediatric acne, atopic dermatitis, and psoriasis patients. Children (Basel). 2021;8(11):1057. doi:10.3390/children8111057.
- Wolke D, Lereya ST. Long-term effects of bullying. Arch Dis Child. 2015;100(9):879-885. doi:10.1136/archdischild-2014-306667.
