Dermatologic Conditions and Incident Anxiety in Young Adults: Propensity Score–Matched Retrospective Cohort Study

Abstract 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 This study aimed 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 to 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 propensity score matching, 169,720 individuals were included in each cohort. Young adults with dermatologic conditions consistently exhibited a higher incidence of anxiety across all time points. At 1 year, anxiety occurred in 3.9% (5838/149,464) of individuals in the dermatologic condition group compared with 3.4% (3237/95,020) of controls. By 3 years, incidence increased to 11.8% (17,559/149,464) of individuals vs 10.4% (9906/95,020) of controls, and by 5 years to 16.8% (25,184/149,464) of individuals vs 15.5% (14,712/95,020) of controls. Absolute risk differences widened over time, from 0.50 to 1.40 percentage points. Time-to-event analyses demonstrated a modest but consistent increase in hazard, with hazard ratios ranging from 1.12 to 1.14 (all P <.001). 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 conditions.