- Tracking nearly 2 million people, a new study confirms acne patients are more likely to suffer depression.
- The social and psychological effects of acne can impact a sufferer’s well-being more severely than the condition itself.
- Emotional scars resulting from adolescent acne can follow some into adulthood.
How many times have you awoken on the morning of an important event — be that a first date with an online romantic acquaintance or perhaps a crucial job interview – only to look in the mirror and discover a shiny crop of whitehead pimples suddenly dotting your face?
It’s long been suspected that stress sometimes serves as a virtual invitation for acne to break-out, which might partially explain why it feels like pimples somehow always manage to develop at the very worst times.
Regardless of the cause, there’s little getting around acne. And for some, as a recently published study shows, it’s the catalyst that leads them down the road to serious clinical depression.
Acne-Related Stress Has a Long History
“There is no single disease which causes more psychic trauma and more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums of psychic assessment than does acne vulgaris” (Sulzberger, 1948).
This statement comes from an 1948 academic article entitled Psychogenic Factors In Cutaneous Disorders, by renowned dermatologists M.B Sulzberger and S.H Zaidems. A lot has changed since 1948, certainly in the field of medicine, but not the link between acne and depression, which remains every bit as predictable and ubiquitous as it was 70 years ago. Perhaps even more so.
Acne can have profound social and psychological effects, causing more harm than to a person’s well-being than the actual condition itself. Approximately 85% of the population between the ages of 12 and 25 develop varying intensities of acne over that period, with 40% to 55% of adults aged between 20 and 40 years old still experiencing persistent low level break-outs long after they’ve passed through adolescence.
And while teenagers are especially prone to depression and anxiety stemming from the condition, studies show that as a group it’s the adult population that experience it the most.
There are any number of theories as to why this is the case, but in many instances adult acne is a condition carried over from adolescence, with sufferers growing increasingly despondent as the years go on, concerned they’ll be burdened with this problem their entire lives.
“It is important to remember that depression is a multi-factorial problem,” states Michael G. Keene PA-C, a dermatologist associated with Raleigh Dermatology Associates in North Carolina. “There are psychosocial stresses, biochemical/physical as well as developmental factors all in play to varying degrees. I highly encourage mental health referral in the presence of major depression. Although acne may be one situational factor, rarely is managing it alone likely to have a lasting impact on controlling an associated major depression.”
Teenage Acne’s Lifelong Effect on Personality
While the link between adult acne and depression is a serious concern, the psychological and social impacts of acne on teenagers are not to be underestimated. This is a time of life when peer acceptance is crucially important, and fair or not, among teenagers physical attractiveness is a major factor determining one’s status.
Nobody is more aware of this than the shy insecure 15-year-old girl who is relentlessly teased because her face is always spotted with acne, or the boy who skips gym class because he’s too ashamed to change clothes in front of his classmates and reveal the blemishes on his back.
At a time when one’s primary fear in life is being negatively appraised by others, having severe acne makes an already difficult time of life that much more arduous. Studies have clearly shown that young people presenting with acne are at increased risk of depression, anxiety and suicide attempts.
Acne turns certain kids into easy targets for bullies, who single them out for abuse. For a child already embarrassed by the condition of their skin, a bully’s taunts can further contribute to their feelings of self-loathing and hopelessness, potentially leading to social withdrawal. Acne also makes it difficult for some kids to form new relationships, particularly with the opposite sex.
Adolescence is a time when teenagers are still learning to form relationships, and a child burdened by severe acne can lack the confidence to make these bonds.
As challenging as this experience can be to teenagers while they’re actually living it, it’s important to remember that both personality and one’s sense of self are largely formed during adolescence. Consequently these feelings of shame, embarrassment, insecurity around the opposite sex, lack of confidence and low self-esteem can become deeply ingrained and follow some people into adulthood, long after their acne has cleared up.
For those who haven’t outgrown the condition by their mid-twenties, a profound depression can eventually set in – and often does – with sufferers coming to believe they will be burdened with acne their entire lives.
Acne = Depression: Depression = Acne?
While the link between acne and depression has long been documented, in recent years researchers have started to question if there is an element to the actual acne itself that lends itself to depression.
According to a major new study published in the British Journal of Dermatology in February, 2018, there is a clear scientific link between acne and depression.
Drawing from an enormous database of British medical records, researchers tracked nearly 2 million people, both men and women, over the course of 15 years. Among these participants, 134,427 patients had acne while 1,731,608 did not.
The study concluded that the probability of developing serious clinical depression was 18.5% for those patients with acne, but only 12% for those who didn’t share the condition.
The incidence of depression appears to be most prevalent in the first year following diagnosis.
“In the first year following an acne diagnosis, we were most surprised to find that these patients have a 63% increased risk of developing depression compared to patients who did not have acne,” Isabelle Vallerand, lead author of the study, recently explained to Allure magazine.
Researchers also found that even as the severity of subjects’ acne improved, when compared to the control group, their risk of depression was significantly higher and remained so for five years after first being diagnosed with the condition. However, for most, once their acne had been successfully treated and was no longer a threat, their likelihood of falling into depression was no greater than the average person.
Psychodermatology: The Interaction Between Skin and Mind
Another factor to consider is while acne often leads to emotional distress, emotional distress in turn leads to acne break-outs. People have known for a long time that stress is often the determining factor spawning cold sores, acne, and other skin conditions like eczema or psoriasis. To this end, in recent years an entire new field of study/medicine has evolved called psychodermatology.
Psychodermatology is based around this theory, that emotional distress leads to skin problems, which in turn exacerbates the emotional distress that spawned the outbreak. Perhaps acne leads to emotional distress; perhaps it’s the other way around.
So while some researchers are beginning to theorize there could be a causal relationship between acne and depression that is not brought on by external factors, they appear to be in the minority.
Dr. Keene, for one, isn’t convinced that acne alone brings on depression. “Yes, I’d say acne is not uncommonly associated with depression,” remarks Keene, “but I really don’t see how it would be causative.”
Regardless of the extent acne influences negative emotions, it’s now conclusively been shown to be a significant factor leading to clinical depression in some people. While the vast majority of acne sufferers persevere through what can sometimes be a more challenging adolescence because of their skin condition, there is a substantial minority of people to whom acne effects their entire being.
So while researchers have yet to determine if there’s something about the skin itself which triggers an emotional response when compromised by acne (and/or other skin diseases), with the publication of the British Journal of Dermatology study last winter there’s no longer any question acne sufferers are more vulnerable to depression than the rest of the population.