Risk of Incident Anxiety After Dermatologic Diagnoses in Young Adults: A Propensity Matched Cohort Study Using Electronic Health Records (Preprint)

BACKGROUND Dermatologic conditions such as acne, psoriasis, and dermatitis commonly affect young adults and may contribute to psychological distress. While prior studies have suggested an association between skin disease and anxiety, longitudinal population-level evidence in young adults remains limited. OBJECTIVE To examine the association between common dermatologic conditions and the incidence of anxiety among young adults using a large electronic health record–based cohort. METHODS We conducted a retrospective cohort study using the TriNetX Research Network, including young adults aged 18–22 years with and without a qualifying dermatologic diagnosis between 2019 and 2020. The index date was defined as the first dermatologic diagnosis for exposed individuals and a qualifying ambulatory visit for controls. Individuals with a prior diagnosis of anxiety were excluded. Propensity score matching was used to balance demographic characteristics and ambulatory visit history between cohorts. Incident anxiety diagnoses were assessed at 1, 3, and 5 years following the index date. Cumulative incidence, absolute risk differences, risk ratios, and time-to-event analyses were evaluated. RESULTS After matching, 169,720 individuals were included in each cohort. Across all follow-up intervals, young adults with dermatologic conditions experienced a consistently higher cumulative incidence of anxiety compared with matched controls. At 1 year, anxiety occurred in 3.90% of individuals with dermatologic conditions compared with 3.41% of controls. At 3 years, cumulative incidence increased to 11.75% versus 10.43%, and by 5 years to 16.85% versus 15.48%. Absolute risk differences ranged from approximately 0.5 percentage points at 1 year to 1.4 percentage points at 5 years. Time to event analyses demonstrated a modest but statistically significant increased hazard of anxiety among individuals with dermatologic conditions, with hazard ratios ranging from approximately 1.12 to 1.14 across follow-up periods. CONCLUSIONS In this large, propensity score–matched cohort of young adults, common dermatologic conditions were associated with a small but persistent increase in the incidence of anxiety over time. Although absolute differences were modest, the consistency of findings across multiple analytic approaches highlights the importance of considering psychological well-being as part of comprehensive care for young adults with dermatologic disease.