Thirty-nine AA patients and 41 healthy controls were included in the study. While the age of AA patients was between 8 and 18 (median (IQR), 12 (10–14); mean, 12.38 years) and the number of girls was 27 (53.9%), the age of HC was between 8 and 17 (median (IQR), 12 (9-14.5); mean, 12.17 years) and the number of girls was 21 (65.9%). There was no statistically significant difference between the control and patient groups in terms of age, gender, mother's age, father's age, and father's employment status (all p > 0.05). In the patient group, the proportion of both parents with primary school education or less was significantly higher than in the control group. In comparison, the proportion of both parents with university education or above was significantly lower than the control group (p < 0.001 and p < 0.001, respectively). The proportion of working mothers in AA group was significantly lower compared to the control group (p < 0.001) (Table 1).
Table 1
Sociodemographic characteristics of patients and healthy controls and their parents.
|
Healthy controls
|
Patients
|
p
|
|
n = 41
|
n = 39
|
|
Age (median(IQR))
|
12(9-14.5)
|
12(10–14)
|
0.749*
|
Gender
|
|
|
|
Female (n (%))
|
27 (65.9)
|
21 (53.8)
|
0.273**
|
Age (mother) (median(IQR))
|
40(35–44)
|
40(35.5–44)
|
0.619***
|
Age (father) (median(IQR))
|
44(39.5–49)
|
44(40.5–47.5)
|
0.922***
|
Educational Level (mother)
|
|
|
|
Primary school (n (%))
|
4 (9.8)a
|
21 (53.8)b
|
< 0.001**
|
High school (n (%))
|
16 (39)a
|
10 (25.6)a
|
|
University (n (%))
|
21 (51.2)a
|
8 (20.5)b
|
|
Employment Status (mother)
|
|
|
|
Employed (n (%))
|
28 (68.3)
|
10 (25.6)
|
< 0.001**
|
Educational Level (father)
|
|
|
|
Primary school (n (%))
|
1 (2.4)a
|
11 (28.9)b
|
< 0.001**
|
High school (n (%))
|
19 (46.3)a
|
20 (52.6)a
|
|
University (n (%))
|
21 (51.2)a
|
7 (18.4)b
|
|
Employment Status (father)
|
|
|
|
Employed (n (%))
|
39 (95.1)
|
35 (92.1)
|
0.667****
|
Disease-related features
|
|
|
|
Age of onset (mean ± SD)
|
8.37 ±3.26
|
|
|
Disease duration (mean ± SD)
|
3.78 ± 2.54
|
|
|
Number of attacks with active hair loss (n(%))
|
|
|
|
1 (n (%))
|
14 (35.90)
|
|
|
2 (n (%))
|
10 (25.64)
|
|
|
3 and more (n (%))
|
15 (38.46)
|
|
|
SALT score (mean ± SD)
|
66.46 ± 35.39
|
|
|
IQR: Interquartile Range, *Mann-Whitney U test, **Chi-squared test, ***Independent Sample t-test, ****Fisher’s Exact test
|
While the value of the PSS scale acceptance/involvement was significantly higher in the children of the control group than in the children with AA, the other subscales did not differ statistically significantly between AA and HC (p < 0.001, p = 0.375 and p = 0.270, respectively). When controlling for the variables of mother's education, father's education, and mother's employment status, it was found that lower scores on the acceptance/involvement and strictness/supervision were significantly associated with alopecia areata (OR = 0.81 and OR = 0.83, respectively). The total anxiety t scores and total anxiety and depression t scores (RCADS) of the children with AA were statistically significantly higher than in HC. The BAI and BDI scale scores of both mothers and fathers of children diagnosed with alopecia areata were statistically significantly higher than those of HC. When controlling the variables of mother's education, father's education, and mother's employment status, it was found that higher anxiety and depression t score (RCADS), higher BAI and BDI score of parents were significantly associated with alopecia areata (Table 2).
Table 2
Comparison of the patient and control groups with regard to PSS, RCADS, parents’ BDI, and BAI scores.
|
Healthy Controls
|
Patients
|
p*
|
Adjusted a
|
|
n = 41
|
n = 39
|
|
O.R. (%95 C.I.)
|
p
|
|
Median(IQR)
|
Median(IQR)
|
|
|
|
PSS
|
|
|
|
|
|
Acceptance/involvement
|
25(22.5–28)
|
20.5(17–23)
|
< 0.001
|
0.81(0.71–0.92)
|
0,001
|
Psychological autonomy
|
18(16–21)
|
18(15–21)
|
0.375**
|
0.95(0.83–1.09)
|
0.497
|
Strictness/supervision
|
25(23–26)
|
23.5(20.75-26)
|
0.27
|
0.83(0.71–0.96)
|
0.015
|
Total Anxiety t (RCADS)
|
40(34–55)
|
61(50.75–68.25)
|
< 0.001
|
1.11(1.04–1.17)
|
0.001
|
Total Anxiety Depression t (RCADS)
|
39(33.5–57)
|
62.5(49-70.25)
|
< 0.001
|
1.10(1.05–1.17)
|
< 0.001
|
BAI (mother)
|
7(2.5–13)
|
14(6–24)
|
0.011
|
1.05(1.00-1.10)
|
0.045
|
BDI (mother)
|
6(4–11)
|
19(10–29)
|
< 0.001
|
1.20(1.09–1.34)
|
< 0.001
|
BAI (father)
|
3(0-10.5)
|
7(2–17)
|
0.031
|
1.06 (1.00-1.12)
|
0.040
|
BDI (father)
|
3(0-7.5)
|
13(6-21.25)
|
< 0.001
|
1.33(1.13–1.57)
|
0.001
|
IQR: Interquartile Range, *Mann-Whitney U test, **Independent Sample t-test
PSS: Parenting Style Scale, RCADS: Revised Children's Anxiety and Depression Scale, BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory.
a Mother's education, father's education, and mother's employment status were included in the logistic regression model.
|
In the AA group, the number of authoritative and indulgent (PSS) families was statistically significantly higher than in the control group, and the number of neglectful families was statistically significantly higher than in the HC group (Table 3).
Table 3
Comparison of the patient and control groups with regard to parental attitudes.
|
Healthy controls
|
Patients
|
p*
|
|
n = 41
|
n = 39
|
|
|
n (%)
|
n (%)
|
|
Parental attitudes (PSS)
|
|
|
|
Authoritative
|
18(43.9)a
|
6(15.8)b
|
< 0.001
|
Authoritarian
|
6(14.6)a
|
12(31.6)a
|
|
Indulgent
|
13(31.7)a
|
5(13.2)b
|
|
Neglectful
|
4(9.8)a
|
15(39.5)b
|
|
*Chi-squared test,
|
Each superscript letter denotes significantly different groups at p = 0.05 level.
PSS: Parenting Style Scale
|
There was no statistically significant association between AA patients’ SALT score and their parents' anxiety and depression scores, age of onset, and duration of illness. Furthermore, When the patients were divided into 4 groups according to their parents' attitudes (authoritative, authoritarian, indulgent, neglectful), there was no statistically significant difference in SALT scores between the groups.
When the anxiety and depression scores of the patients and their parents were evaluated according to the number of exacerbation periods with active hair loss, the BDI score of mothers of children with 3 or more exacerbation periods was significantly higher than that of children with 2 attacks. For the other scores, there were no statistically significant differences depending on the number of exacerbation periods (Table 4).
Table 4
Relationship between the number of exacerbation periods with active hair loss and the RCADS, parent’s BDI and BAI scores of the parents.
|
Number of exacerbation periods with active hair loss
|
|
|
1
|
2
|
3 and above
|
p*
|
|
n = 14
|
n = 10
|
n = 15
|
|
|
Median(IQR)
|
Median(IQR)
|
Median(IQR)
|
|
Total anxiety t score (RCADS)
|
64(45.75-73)
|
60(56.5–65.5)
|
59(48-69.25)
|
0.943
|
Total anxiety-depression t score (RCADS)
|
66.5(46.5-73.25)
|
61(58.25–68.5)
|
62(49-72.25)
|
0.967
|
BAI (mother)
|
16(5-20.75)
|
8(0–26)
|
15(10–25)
|
0.324
|
BDI (mother)
|
18(10.75–27.5)a,b
|
8.5(3.75–21.25)b
|
28(13–35)a
|
0.022
|
BAI (father)
|
7(2.5–15.5)
|
6(1.5–28)
|
6.5(2.5-22.25)
|
0.907
|
BDI (father)
|
14.5(7.25–19.5)
|
19(8.75–25.25)
|
10.5(3.75–14.25)
|
0.379
|
*Kruskall-Wallis test
RCADS: Revised Children's Anxiety and Depression Scale, BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory.
Groups that do not contain the same letter indicate different groups at p < 0.05 level.
|
Maternal BDI scores of children diagnosed with AA who had high levels of depression were significantly higher than those of children with normal levels of depression (p = 0.006), (Table 5).
Table 5
Comparison of normal and high anxiety-depression groups (RCADS) in terms of PSS, SALT score, parents’ BDI, and BAI scores.
|
RCADS - Total anxiety and depression
|
|
|
Normal
|
High (70 and above)
|
p*
|
|
n = 26
|
n = 11
|
|
|
Median (IQR)
|
Median (IQR)
|
|
Salt Score
|
64 (25–100)
|
100 (70–100)
|
0.142
|
PSS
|
|
|
|
Acceptance/ involvement
|
20.5(16.75-23,25)
|
21(18–23)
|
0.566
|
Psychological autonomy
|
18(15–21)
|
17(14–19)
|
0.3
|
Strictness/ supervision
|
23(20.5–26)
|
26(20–26)
|
0.523
|
BAI (mother)
|
10(5–23)
|
20(15–33)
|
0.006
|
BDI (mother)
|
16(7–27)
|
23(13–31)
|
0.132
|
BAI (father)
|
4.5(2–15,5)
|
13(4-31.25)
|
0.145
|
BDI (father)
|
11(5.5–17)
|
18(6–30)
|
0.06
|
*Mann-Whitney U test
RCADS: Revised Children's Anxiety and Depression Scale, PSS: Parenting Style Scale, BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory.
|