{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T02:12:11Z","timestamp":1790993531131,"version":"4.1.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nVitiligo is an acquired depigmenting skin disease which is often accompanied by mental distress. There are numerous studies dedicated to local and global prevalence of depression in patients with vitiligo but anxiety has not been recognized as a major mental problem within named population. We aimed to evaluate the prevalence of anxiety among patients with vitiligo from different countries and to compare it with patients suffering from eczema, psoriasis, and acne.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nIn November 2019, we conducted a systematic search for observational studies that examined the prevalence of anxiety in vitiligo patients. Fifteen studies comprising 1176 patients with vitiligo were included to our systematic review.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThe general prevalence of anxiety among vitiligo patients was equal to 35.8%. Statistically significant difference in anxiety rates was found among female and male patients (47.32% vs 42.4%) (P<\/jats:italic> = 0.03), but the clinical relevance of this issue remains arguable. In addition, the pooled odds ratio among vitiligo and non-vitiligo patients did not indicate a statistical significance among patients coming from different continents.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nThe pooled prevalence of anxiety among vitiligo patients worldwide was comparable to other severe skin disorders. This finding accentuates the necessity of anxiety awareness in management of patients with skin diseases.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0241445","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T20:27:11Z","timestamp":1605040031000},"page":"e0241445","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":92,"title":["Vitiligo and anxiety: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"15","author":[{"given":"Assiya","family":"Kussainova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4448-6455","authenticated-orcid":true,"given":"Laura","family":"Kassym","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almira","family":"Akhmetova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalya","family":"Glushkova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulugbek","family":"Sabirov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saltanat","family":"Adilgozhina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raikhan","family":"Tuleutayeva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliya","family":"Semenova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,10]]},"reference":[{"key":"pone.0241445.ref001","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jenvrad.2018.09.016","article-title":"Associations 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patients with other pigmentary disorders.","volume":"15","author":"JR Porter","year":"1986","journal-title":"J Am Acad Dermatol"},{"issue":"5","key":"pone.0241445.ref008","doi-asserted-by":"crossref","first-page":"679","DOI":"10.4103\/0378-6323.116737","article-title":"The psychosocial impact of vitiligo in Indian patients Indian","volume":"79","author":"M Ramam","year":"2013","journal-title":"J Dermatol Venereol Leprol"},{"issue":"3","key":"pone.0241445.ref009","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1111\/bjd.15199","article-title":"Vitiligo and depression: a systematic review and meta-analysis of observational studies","volume":"177","author":"YC Lai","year":"2017","journal-title":"Br J Dermatol"},{"issue":"8","key":"pone.0241445.ref010","first-page":"1343","article-title":"The prevalence and odds of depression in patients with vitiligo: a meta-analysis.","volume":"32","author":"G Wang","year":"2018","journal-title":"JEADV"},{"issue":"7","key":"pone.0241445.ref011","first-page":"637","article-title":"Impact of Vitiligo on Quality of Life.","volume":"108","author":"MA Morales-S\u00e1nchez","year":"2017","journal-title":"Actas Dermosifiliogr."},{"issue":"4","key":"pone.0241445.ref012","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1111\/bjd.16049","article-title":"The prevalence of psychological comorbidity in people with vitiligo: a systematic review and meta-analysis","volume":"178","author":"O Osinubi","year":"2017","journal-title":"Br J Dermatol"},{"issue":"5","key":"pone.0241445.ref013","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1111\/j.1365-2133.2008.08881.x","article-title":"Guideline for the diagnosis and management of vitiligo","volume":"159","author":"DJ Gawkrodger","year":"2008","journal-title":"Br J 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Available at: https:\/\/unstats.un.org\/unsd\/methodology\/m49\/."},{"issue":"6","key":"pone.0241445.ref017","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale.","volume":"67","author":"AS Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand."},{"issue":"2","key":"pone.0241445.ref018","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1002\/wps.20050","article-title":"The DSM-5: Classification and criteria changes.","volume":"12","author":"DA Regier","year":"2013","journal-title":"World Psychiatry."},{"issue":"01","key":"pone.0241445.ref019","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1017\/S0033291700021644","article-title":"A scaled version of the General Health Questionnaire.","volume":"9","author":"DP Goldberg","year":"1979","journal-title":"Psychol Med"},{"issue":"2","key":"pone.0241445.ref020","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1348\/014466505X29657","article-title":"The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample.","volume":"44","author":"JD Henry","year":"2005","journal-title":"Br J Clin Psychol"},{"issue":"6","key":"pone.0241445.ref021","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1080\/080394899427692","article-title":"Development and psychometric properties of the Emotional State Questionnaire, a self-report questionnaire for depression and anxiety.","volume":"53","author":"A Aluoja","year":"1999","journal-title":"Nord J Psychiatry."},{"issue":"6","key":"pone.0241445.ref022","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1001\/archpsyc.1961.01710120031004","article-title":"An Inventory for Measuring Depression.","volume":"4","author":"AT Beck","year":"1961","journal-title":"Arch Gen Psychiatry."},{"issue":"3","key":"pone.0241445.ref023","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1080\/08870449608400270","article-title":"The illness perception questionnaire: A new method for assessing the cognitive representation of illness.","volume":"11","author":"J Weinman","year":"1996","journal-title":"Psychol Health."},{"key":"pone.0241445.ref024","doi-asserted-by":"crossref","first-page":"367","DOI":"10.4172\/2378-5756.1000367","article-title":"Prevalence and Factors Associated with Anxiety among Patients with Common Skin Disease on follow up at Alert Referral Hospital, Addis Ababa, Ethiopia.","volume":"19","author":"G Abebe","year":"2016","journal-title":"J Psychiatry"},{"issue":"2","key":"pone.0241445.ref025","doi-asserted-by":"crossref","first-page":"e217","DOI":"10.18295\/squmj.2016.16.02.013","article-title":"Depression, Anxiety and Stress among Saudi Arabian Dermatology Patients: Cross-sectional study.","volume":"16","author":"AE Ahmed","year":"2016","journal-title":"Sultan Qaboos Univ Med J."},{"issue":"7","key":"pone.0241445.ref026","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1111\/jdv.12216","article-title":"Quantification and comparison of psychiatric distress in African patients with albinism and vitiligo: a 5-year prospective study.","volume":"28","author":"FO Ajose","year":"2014","journal-title":"J Eur Acad Dermatol Venereol."},{"key":"pone.0241445.ref027","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1111\/j.1365-4632.2010.04514.x","article-title":"Al Ghamdi. 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dermatologic diseases.","volume":"243","author":"N Tsintsadze","year":"2015","journal-title":"Georgian Med News."},{"issue":"1","key":"pone.0241445.ref038","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1001\/jamadermatol.2014.1875","article-title":"Afamelanotide and Narrowband UV-B Phototherapy for the Treatment of Vitiligo","volume":"151","author":"HW Lim","year":"2015","journal-title":"JAMA Dermatol"},{"issue":"05","key":"pone.0241445.ref039","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1017\/S003329171200147X","article-title":"Global prevalence of anxiety disorders: a systematic review and meta-regression.","volume":"43","author":"AJ Baxter","year":"2012","journal-title":"Psychol Med"},{"issue":"2","key":"pone.0241445.ref040","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/S1550-8579(06)80201-9","article-title":"Quality of life with vitiligo: Comparison of male and female muslim patients in Iran.","volume":"3","author":"L Borimnejad","journal-title":"Gend Med."},{"issue":"3","key":"pone.0241445.ref041","first-page":"233","article-title":"Vitiligo and quality of life: a case-control study.","volume":"134","author":"H Belhadjali","year":"2007","journal-title":"Ann Dermatol Venereol"},{"issue":"1","key":"pone.0241445.ref042","doi-asserted-by":"crossref","first-page":"\u043511","DOI":"10.1186\/1751-0759-5-11","article-title":"Psychosocial judgements and perceptions of adolescents with acne vulgaris: A blinded, controlled comparison of adult and peer evaluations.","volume":"5","author":"E Ritvo","year":"2011","journal-title":"Biopsychosoc Med"},{"issue":"1","key":"pone.0241445.ref043","doi-asserted-by":"crossref","first-page":"e0210581","DOI":"10.1371\/journal.pone.0210581","article-title":"Quality of life of adult vitiligo patients using camouflage: A survey in a Chinese vitiligo community.","volume":"14","author":"D Chen","year":"2019","journal-title":"PLoS 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