The Psychological Burden of Vitiligo: Investigating the Depressive Symptoms in Patients with Vitiligo: A Case–Control Study

Abstract

Background and Objectives: Vitiligo is a chronic autoimmune skin disorder characterized by the loss of pigmentation, resulting in depigmented patches due to the destruction of melanocytes. This condition can lead to considerable psychological distress, and research indicates a possible connection with major depressive disorder (MDD). Nonetheless, the depth and nature of this association, particularly within the Saudi population, have not been thoroughly investigated. This case–control study seeks to explore the relationship between vitiligo and depressive symptomatology, evaluate the severity of depressive symptoms in vitiligo patients compared to control subjects, and examine the association between the clinical severity of vitiligo (assessed using the Vitiligo Area Scoring Index, VASI) and depressive symptoms (measured using the PHQ-9, a validated screening instrument based on DSM criteria). Materials and Methods: A total of 700 participants were included, comprising 340 individuals with vitiligo and 360 controls with other skin conditions. Participants completed a web-based questionnaire that collected sociodemographic data and included the PHQ-9 assessment. The severity of vitiligo was determined using the VASI. Statistical analysis involved using the computer program IBM Statistical Program for Social Sciences (SPSS) (version 26.0). Results: The average PHQ-9 score was significantly higher for patients with vitiligo (8.28 ± 7.36) compared to controls (6.30 ± 4.70, p = 0.028). While the overall rates of mild to severe depression were comparable (41.5% in vitiligo patients versus 40.3% in controls, p = 0.748), vitiligo patients exhibited higher occurrences of moderately severe depression (11.8%) and severe depression (10.9%) compared to controls (5.8% and 0.8%, respectively; p < 0.001). A weak, yet significant, positive correlation was found between VASI and PHQ-9 scores (ρ = 0.184, p < 0.001). The vulgaris and segmental types of vitiligo exhibited the highest median depression scores (PHQ-9: 11 and 9, respectively; p < 0.001). Logistic regression analysis indicated that those with genital vitiligo had greater odds of experiencing depression (OR = 12.10, p = 0.039), while those with universalis vitiligo faced even higher odds (OR ≈ 26,837.84, p = 0.001). Interestingly, higher VASI scores were linked to lower odds of depression (OR = 0.927, p = 0.029). Additionally, the risk of depression significantly increased with higher income levels and among individuals aged 50 years and older. Conclusions: Although the overall prevalence of depression was not significantly different between vitiligo patients and controls, the degree of depressive symptoms was notably more severe in those with vitiligo. Specific clinical subtypes, particularly genital and universalis vitiligo, were found to be more closely associated with an increased risk of depression. These results highlight the importance of regular mental health screenings and customized psychosocial support in dermatological care, especially for high-risk groups.

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