Analysis of the Causal Relationship Between Anxiety- Depression and Vitiligo and Its Impact on Disease Onset, Progression, and Therapeutic Efficacy

Abstract Background Anxiety and depression are the most common psychiatric comorbidities among vitiligo patients. However, the impact on disease progression and outcomes remains unclear. Objective To elucidate the causal relationship between anxiety and depression and the progression and outcomes of vitiligo, providing a foundation for strengthening psychological interventions in the treatment of vitiligo. Methods Two-sample Mendelian randomization analysis was used to validate the causal relationship between depression and vitiligo. The Hospital Anxiety and Depression Scale (HADS) was used to assess the psychiatric condition of vitiligo patients. We conducted Fisher's chi-square tests and rank sum tests to analyse differences in clinical characteristics and outcomes among vitiligo patients with different HADS scores. Regression analysis was used to assess the correlation between anxiety-depression and disease progression, outcomes. Results Depression significantly increases the risk of the appearance of vitiligo (P = 0.03). Age, duration of the disease, body surface area, and VIDA were positive associated factors with HADS, with VIDA being the most influential. Univariate regression analysis demonstrated that HADS (P < 0.001) and VIDA (P < 0.001) were significant negative associated factors for disease outcomes. However, HADS (P < 0.001) emerged as the only factor that influenced the therapeutic efficacy in multivariate regression analysis. A restricted cubic spline graph illustrates a U-shaped relationship between HADS and clinical efficacy, with the most significant impact on therapeutic efficacy occurring when HADS is equal to 15. Conclusion Anxiety and depression exhibit a bidirectional positive causal relationship with vitiligo. Moderate to severe anxiety-depression constitutes a significant factor influencing the clinical efficacy of vitiligo treatment.