Distance, Insurance Viewed as Barriers to Mental Health Care for Atopic Dermatitis

Almost 50% of caregivers report their children with atopic dermatitis having had 6 or more days of mental health struggle in the prior month, new findings suggest, with barriers to mental health service access being described as inaccessibility, transportation and distance issues, and insurance-related issues.1

The investigators who identified these data, led by Courtney A. Chau from the Icahn School of Medicine at Mount Sinai, highlighted the observation of atopic dermatitis-associated comorbidities and mental health-related conditions being common among pediatric patients.

Prior research cited by Chau and colleagues demonstrated a 2-fold higher likelihood among children with severe atopic dermatitis of depression as well as internalizing symptoms compared to those without the inflammatory skin condition.2

“Factors influencing access to [mental health] services among pediatric [atopic dermatitis] patients are not yet described,” Chau and colleagues wrote. “This cross-sectional survey study describes caregiver-perceived [mental health] burden and barriers to accessing [mental health] care for pediatric [atopic dermatitis] patients.”1

Analyzing Mental Health Services Barriers for Atopic Dermatitis

The National Eczema Association (NEA) distributed an online survey aimed at gathering information on adults with atopic dermatitis and caregivers of children in the 8 - 17 year age range who also have the skin disease. The investigative team assessed this data between October - November 2023, recruiting survey participants through the NEA website, social media platforms, email outreach, and the EczemaWise app.

Survey respondents gave electronic informed consent prior to taking part. The team focused on evaluating caregivers’ perspectives regarding their child's mental health as well as any experiences in seeking mental health care services. Services included cognitive behavioral therapy, general counseling, support groups, alternative therapy options, and medications.

The investigators conducted their data analyses through the use of R, making any necessary group comparisons via Fisher’s exact tests, t-tests, and Chi-squared tests. By the survey’s conclusion, 1,496 individuals had completed the questions and 66.2% of these individuals were shown to have met the study’s criteria for inclusion.

Among those who qualified for the study, 16.4% of these 991 individuals were described as caregivers of pediatric patients with atopic dermatitis. There were 163 children and 66.9% of these patients were noted by the research team as being between the ages of 8 - 12.

The investigative team noted that 60.1% reported mild-to-moderate disease and 62.0% had been given primary care for their condition by a specialist. Notably, 47.9% were shown to have reported at least 6 days of poor mental health symptoms over the previous month. The team further highlighted that 33.1% had been aged 13 - 17, with 56.4% being male and 64.4% classified as White.

Substantially greater numbers of poor mental health days were reported by adolescents in the 13–17 age range versus the younger age range (P = .036). Those with moderate-to-severe atopic dermatitis were also found to have a far greater number of poor mental health days versus participants with clear or mild disease (P < .001).

A wide array of barriers to accessing mental health services were cited by caregivers who responded to surveys, with the investigators finding the most frequently noted challenges were issues with finding an available mental health provider (27.0%).

Other issues had been transportation and distance-related issues reported by 23.3% and insurance limitations reported by 19.0%. Such findings were noted by the research team as indicative of the substantial mental health burden many children with atopic dermatitis face. They added that the findings point to major obstacles faced by such patients in obtaining appropriate care.

“This cross-sectional survey study of caregivers of pediatric [atopic dermatitis] patients offers insights into factors influencing motivation to seek and ability to access [mental health] services,” they wrote. “[Mental health] burden should be addressed by [atopic dermatitis] providers in a youth-friendly manner, regardless of [atopic dermatitis] severity. Engagement of [mental health] providers is essential to overcome access barriers, potentially through telehealth.”1

References

1. Chau CA, Loiselle AR, Johnson JK, Begolka WS. Caregiver-Reported Motivation and Access to Mental Health Services for Pediatric Atopic Dermatitis Patients: A Cross-Sectional Study. Pediatr Dermatol. 2025 Feb 9. doi: 10.1111/pde.15880. Epub ahead of print. PMID: 39924295.

2. C. Kern, J. Wan, K. Z. LeWinn, et al., “Association of Atopic Dermatitis and Mental Health Outcomes Across Childhood: A Longitudinal Cohort Study,” JAMA Dermatology 157, no. 10 (2021): 1200–1208, https://doi.org/10.1001/jamadermatol.2021.2657.