D2.261 - Mental health and quality of life in patients with chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) is known to significantly impair quality of life (QoL) and may be associated with psychological distress. This study aimed to determine the frequency of anxiety, depression and stress symptoms in patients with CSU and evaluate their relationship with disease control and QoL. 

A cross-sectional study was conducted between January-June 2025 including 102 adult CSU patients evaluated in a specialized consultation. Consecutive sampling was used and all participants provided informed consent. Disease control, psychological symptoms, QoL and somatic symptom burden were assessed using Urticaria Control Test (UCT), Depression Anxiety Stress Scale (DASS-21), Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), Dermatology Life Quality Index (DLQI), and Patient Health Questionnaire (PHQ-15). Psychological and psychiatric follow-up data were recorded. Comparisons were performed between well-controlled and poorly controlled patients. Statistical significance was defined as a p-value<0.05.

Out of the 102 participants, 27.5% of patients reported anxiety, 5.9% depression and 21.6% reported both. Previous or current use of psychotropic medication was observed in 46.1% of patients, mainly sertraline, trazodone and venlafaxine. According to DASS-21, 17% of patients presented moderate anxiety symptoms and 16% severe anxiety symptoms; moderate depressive symptoms were present in 13.7% and severe depressive symptoms in 8.8%; moderate stress symptoms were identified in 12% and severe stress symptoms in 11%. Psychological follow-up was reported in 17.6% and psychiatric follow-up in 30.4% of patients. Those followed in Psychiatry showed significantly worse scores on DASS-21(16.97 vs 11.58; p=0.034), CU-Q2oL (51.0 vs 43.1; p=0.037) and PHQ-15 (10.97 vs 7.59; p=0.018). Positive correlations were observed between DASS-21 and CU-Q2oL (ρ=0.704; p<0.001), including the sleep/mental state/eating subdimension, and between DASS-21 and DLQI (ρ=0.515; p<0.001). A moderate negative correlation was found between UCT and DASS-21 (ρ=–0.519; p<0.001), indicating that better disease control was associated with fewer psychological symptoms.

Psychological symptoms are frequent in CSU and are associated with poorer QoL and greater somatic burden. The low proportion of patients receiving psychological care highlights an important gap in management, underscoring the need for systematic screening and early multidisciplinary intervention.