Highlight
• Patients with hidradenitis suppurativa (HS) have a significantly higher risk of developing new-onset depression and anxiety than the general population.
• This elevated mental health risk persists regardless of HS treatment modality or severity based on hospitalizations for surgical procedures.
• No increased risk for recurrent depression or anxiety episodes was found among patients with a history of these conditions.
• Findings emphasize the importance of psychiatric screening and intervention for all HS patients, not only those with severe disease.
Study Background and Disease Burden
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful nodules, abscesses, and sinus tracts predominantly affecting intertriginous areas such as the axillae and groin. HS often causes significant pain, scarring, malodorous discharge, and impaired quality of life. Beyond the physical manifestations, HS has been increasingly recognized as a disease profoundly associated with psychosocial burden, including depression and anxiety.
Previous research has established that patients with HS have higher rates of psychiatric disorders compared with the general population, although the extent to which disease severity independently influences this risk was unclear. Comorbid depression and anxiety can worsen patient outcomes through poor treatment adherence, social isolation, and increased healthcare utilization. Understanding risk profiles stratified by HS severity is critical to optimizing integrated care approaches.
Study Design
This was a large population-based cohort study conducted using Danish national registries spanning 1997 to 2022. The study included 10,206 patients with hospital-diagnosed HS who were matched by age and sex to 40,125 individuals without HS at a 1:4 ratio. Patients were followed prospectively for new diagnoses of depression or anxiety after the index date.
Key exposures included hospital-diagnosed HS, with disease severity operationalized through treatments received (topical agents only, systemic nonbiologic therapies, biologics, or no treatment) and the number of hospitalizations for HS-related surgical procedures (categorized as 0, 1, 2, or 3 or more procedures).
The primary outcomes were first diagnoses of depression or anxiety (including separate analyses for each) following baseline. Recurrent episodes in patients with prior histories of these disorders were also examined. Cox proportional hazards models estimated hazard ratios (HRs) adjusted for confounders including demographics, socioeconomic variables, and comorbidities.
Key Findings
The mean age of the cohort was 38.0 years with approximately 70% female representation in both HS patients and controls. Over the study period, treatment distribution among HS patients was 12.0% topical only, 55.5% systemic nonbiologics, 6.5% biologics, and 25.9% received no HS-specific treatments.
The incidence of new-onset depression and anxiety was markedly higher in the HS group compared to controls. Adjusted hazard ratios were 1.69 (95% CI, 1.57-1.81; P < .001) for depression and 1.48 (95% CI, 1.38-1.56; P < .001) for anxiety, indicating a 69% and 48% increased risk respectively.
When stratified by HS treatment category, the increased risk persisted across groups. HRs for either depression or anxiety were 1.62 (95% CI, 1.41-1.85) for topical treatment only, 1.61 (95% CI, 1.51-1.72) for systemic nonbiologics, and 1.38 (95% CI, 1.01-1.87) for biologics indicating no consistent gradient of risk with presumed severity markers.
A similar pattern was observed when stratifying by hospitalizations related to HS surgery. HRs ranged from 1.44 (no surgeries) to 1.66 (one surgery), 1.59 (two surgeries), and 1.60 (three or more surgeries), with all comparisons showing statistically significant elevated risk compared to controls.
Patients with HS also had a substantially higher historical prevalence of depression (7.0% vs 0.3%) and anxiety (5.9% vs 0.5%) compared to controls (P < .001). However, no statistically significant difference was observed in the risk of recurrent depression or anxiety in patients with prior diagnoses (depression HR 0.90, anxiety HR 1.22; both nonsignificant).
Expert Commentary
The findings from this comprehensive Danish cohort study confirm that HS is strongly associated with an increased risk of new-onset depression and anxiety. The large sample size, population-based design, and adjustment for multiple confounders add robustness to these conclusions.
The absence of a clear dose-response relationship between disease severity — as inferred by treatment intensity or surgical interventions — and mental health risk challenges assumptions that only patients with severe HS are vulnerable to psychological comorbidities. This may reflect pervasive psychosocial impacts of even mild to moderate HS symptoms such as chronic pain, stigma, and discomfort.
Limitations include reliance on registry-based hospital diagnoses, which may omit milder psychiatric cases managed in primary care, and surrogate markers of disease severity instead of validated clinical scoring systems like Hurley staging. Despite this, the study’s insights align with prior smaller studies linking HS to mental health disorders.
Clinically, this study advocates for routine psychiatric screening and multidisciplinary management for all HS patients, rather than restricting mental health vigilance to those with severe or surgically managed disease. It also underscores the need for future research elucidating biological and psychosocial mechanisms linking HS inflammation and mental health biology.
Conclusion
In summary, patients with hidradenitis suppurativa demonstrate a substantially increased risk of new-onset depression and anxiety compared to the general population, independent of disease severity markers. No increased risk of recurrence was observed among those with prior psychiatric disorders.
These findings emphasize the critical importance of integrating psychiatric assessments and interventions into HS management for all patients. Clinicians should maintain high awareness for mental health symptoms in this population and facilitate timely referral to psychological support services as needed. Further research is warranted to understand causal pathways and develop targeted strategies to improve holistic outcomes in HS.
References
Holgersen N, Rosenø NAL, Nielsen VW, et al. Risk of New-Onset and Recurrent Depression and Anxiety Among Patients With Hidradenitis Suppurativa. JAMA Dermatol. Published online July 30, 2025. doi:10.1001/jamadermatol.2025.2298
Garg A, et al. Psychiatric comorbidities in hidradenitis suppurativa: A systematic review. J Am Acad Dermatol. 2020;82(2):381-389.
Mabrouk M, Wilken R. Depressive symptoms and quality of life in patients with hidradenitis suppurativa. Int J Dermatol. 2018;57(1):28-34.
Jemec GBE. Clinical Practice. Hidradenitis Suppurativa. N Engl J Med. 2012;366(2):158-164.