People living with vitiligo experience substantial levels of mood- and stress-related mental health disorders, with risk patterns broadly comparable to atopic dermatitis but differing more from psoriasis, according to a retrospective matched cohort study.
Published in the BMJ Open, the study sought to estimate the prevalence and comorbidity patterns of mental health disorders among people with vitiligo and to compare relative risks  (RRs) with cohorts of patients with atopic dermatitis, psoriasis and individuals without vitiligo.
A secondary aim was to develop and assess expert-informed case definitions for identifying mental health disorders within administrative claims datasets.
The analysis used a 40% anonymised sample of German statutory health insurance data, covering 2,885,984 insured individuals between 2016 and 2020.
Within this population, 4,631 people were recorded as having vitiligo in 2020, corresponding to a prevalence of 0.19%. For comparative analyses, cohorts of patients with atopic dermatitis, psoriasis and individuals without vitiligo were created using propensity score matching at a 1:3 ratio based on age and sex.
Prevalence of mental health disorders in vitiligo
Across all case definitions applied in the study, affective disorders and neurotic, stress-related and somatic symptom disorders represented the most frequently recorded psychiatric conditions among individuals with vitiligo.
Depressive episodes were the most commonly identified disorder, with prevalence estimates ranging from 19.15% under the least stringent definition to 8.85% under the strictest definition. Somatic symptom disorders were also frequently observed, with prevalence estimates between 17.90% and 5.27% depending on diagnostic criteria.
When compared with individuals without vitiligo, several anxiety-related conditions occurred more frequently in the vitiligo cohort. Social phobia showed the strongest association, with RRs ranging from 2.10 to 2.81 across case definitions, while anxiety disorders overall were associated with RRs between 1.64 and 1.93.
Comparative analyses with other dermatological diseases produced mixed findings. The mental health comorbidity profile of people with vitiligo was largely similar to that observed in patients with atopic dermatitis, with only limited and inconsistent differences between the two groups.
By contrast, comparisons with psoriasis demonstrated more pronounced variation. For instance, there was a 129% higher risk of emotional disorders of childhood in individuals with vitiligo under the most sensitive definition than in those with psoriasis (RR=2.29, 95% CI 1.14–4.61), while hyperkinetic disorders showed consistently increased risks across definitions (RR range 1.58–1.93).
Limitations and clinical data requirements
The authors highlighted several limitations related to the use of administrative claims data. As these datasets are primarily collected for reimbursement purposes, this may introduce misclassification or incomplete diagnostic coding. In addition, inpatient medication data were unavailable and mental health conditions that did not lead to healthcare utilisation would not be captured, potentially resulting in underestimation of true prevalence.
Future investigations could improve accuracy by linking claims data with primary clinical data, conducting additional validation studies and incorporating patient-reported information, the authors said.
Overall, the findings indicated that psychiatric comorbidity patterns vary across dermatological diseases – with a particularly high burden of mood- and stress-related mental health disorders in vitiligo – and emphasised the importance of clearly defined case definitions when analysing mental health outcomes in administrative datasets.
A large pan-European study previously revealed the psychological burden and subsequent impact on quality of life of skin diseases such as vitiligo, acne, hidradenitis suppurativa and urticaria.
Reference
Klinger T et al. Prevalence and comparative risk of mental health disorders in persons with vitiligo: a retrospective matched cohort study using claims data with expert-informed case validation. BMJ Open 2026;16(3):e106687.