{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:25:11Z","timestamp":1790717111157,"version":"4.1.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Chronic spontaneous urticaria (CSU) is related to psychiatric comorbidities. It is not clear whether the relationship is affected by modifiable factors.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Objectives:<\/jats:bold>\n                    To investigate whether the effect of CSU on anxiety and depression in adolescents is mediated by the symptoms of itching and sleep disturbance.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Questionnaire survey was conducted among newly enrolled college students. Dermatologists diagnose skin diseases, including CSU, during health examination. Anxiety and depression were measured by the Generalized Anxiety Disorder Scale and Patient Health Questionnaire, respectively. Sleep quality was measured by the Pittsburgh Sleep Quality Index. The symptoms of itching were measured by the numeric rating scale. According to the hypothesis, the mediating effect model was put forward and the structural equation model is used to build the mediation effect model. The mediation effect model was proposed according to the hypothesis and established using a structural equation model.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    A total of 2,358 students with no history of systemic disease and no pruritus disease (except CSU) were included in the analysis. A total of 393 CSU patients were included, and 1,965 healthy controls were selected based on age and sex matching. CSU was significantly associated with both anxiety and depression when the symptoms of itching and sleep quality were not modeled. A mediation model was proposed as CSU \u2192 itching \u2192 sleep disturbance \u2192 anxiety or depression. Itching and sleep quality mediated 65.4 and 77.6% of CSU's effects on anxiety and depression, respectively, and CSU had no significant direct effect on anxiety or depression in the mediation models.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    The associations of CSU with anxiety and depression were mediated by the symptoms of itching and sleep disturbance. Effectively reducing the symptoms of itching thereby could increase natural sleep, which can further treat the emotional disorders among patients with CSU.\n                  <\/jats:p>","DOI":"10.3389\/fpsyt.2021.655802","type":"journal-article","created":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T01:47:35Z","timestamp":1630979255000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Association of Chronic Spontaneous Urticaria With Anxiety and Depression in Adolescents: A Mediation Analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Yuzhou","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danrong","family":"Jing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianglin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minxue","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1111\/all.13397","article-title":"The EAACI\/GA(2)LEN\/EDF\/WAO guideline for the definition, classification, diagnosis and management of urticaria","volume":"73","author":"Zuberbier","year":"2018","journal-title":"Allergy."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1016\/j.jaci.2014.02.036","article-title":"The diagnosis and management of acute and chronic urticaria: 2014 update","volume":"133","author":"Bernstein","year":"2014","journal-title":"J Allergy Clin Immunol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1111\/all.12884","article-title":"The definition, diagnostic testing, and management of chronic inducible urticarias - the EAACI\/GA(2) LEN\/EDF\/UNEV consensus recommendations 2016 update and revision","volume":"71","author":"Magerl","year":"2016","journal-title":"Allergy."},{"key":"B4","first-page":"1","article-title":"The maddening itch: an approach to chronic urticaria","volume":"24","author":"Viegas","year":"2014","journal-title":"J Investig Allergol Clin Immunol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1111\/ddg.12194","article-title":"Revisions to the international guidelines on the diagnosis and therapy of chronic urticaria","volume":"11","author":"Maurer","year":"2013","journal-title":"J German Soc Dermatol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1056\/NEJMcp011186","article-title":"Clinical practice. Chronic urticaria and angioedema","volume":"346","author":"Kaplan","year":"2002","journal-title":"N Engl J Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1001\/jamadermatol.2016.5538","article-title":"Global skin disease morbidity and mortality: an update from the global burden of disease study 2013","volume":"153","author":"Karimkhani","year":"2017","journal-title":"JAMA Dermatol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/0923-1811(94)90007-8","article-title":"Anxiety, depression, psychosomatic symptoms and autonomic nervous function in patients with chronic urticaria","volume":"8","author":"Hashiro","year":"1994","journal-title":"J Dermatol Sci."},{"key":"B9","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1111\/j.1398-9995.2005.00964.x","article-title":"EAACI\/GA2LEN\/EDF guideline: definition, classification and diagnosis of urticaria","volume":"61","author":"Zuberbier","year":"2006","journal-title":"Allergy."},{"key":"B10","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1111\/j.1365-2133.2005.06976.x","article-title":"Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity","volume":"154","author":"Staubach","year":"2006","journal-title":"Br J Dermatol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1111\/all.12068","article-title":"Psychosocial factors and chronic spontaneous urticaria: a systematic review","volume":"68","author":"Ben-Shoshan","year":"2013","journal-title":"Allergy."},{"key":"B12","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3389\/fmed.2020.00039","article-title":"A meta-analysis of observational studies on the association of chronic urticaria with symptoms of depression and anxiety","volume":"7","author":"Huang","year":"2020","journal-title":"Front Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1007\/s00105-010-1931-x","article-title":"Pruritus and urticaria","volume":"61","author":"Raap","year":"2010","journal-title":"Hautarzt."},{"key":"B14","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1046\/j.1365-2133.2002.04758.x","article-title":"Clinical characteristics of pruritus in chronic idiopathic urticaria","volume":"147","author":"Yosipovitch","year":"2002","journal-title":"Br J Dermatol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.jaad.2007.10.010","article-title":"Disease severity, scratching, and sleep quality in patients with atopic dermatitis","volume":"58","author":"Bender","year":"2008","journal-title":"J Am Acad Dermatol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"508","DOI":"10.2340\/00015555-1221","article-title":"Itch severity and quality of life in patients with pruritus: preliminary validity of a Danish adaptation of the itch severity scale","volume":"92","author":"Zachariae","year":"2012","journal-title":"Acta Derm Venereol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"395","DOI":"10.2340\/00015555-0864","article-title":"Somatic and psychiatric comorbidity in patients with chronic pruritus","volume":"90","author":"Ferm","year":"2010","journal-title":"Acta Derm Venereol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"543","DOI":"10.2340\/00015555-1251","article-title":"Itch and pain in adolescents are associated with suicidal ideation: a population-based cross-sectional study","volume":"92","author":"Halvorsen","year":"2012","journal-title":"Acta Derm Venereol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"532","DOI":"10.2340\/00015555-1572","article-title":"Incidence and determinants of chronic pruritus: a population-based cohort study","volume":"93","author":"Matterne","year":"2013","journal-title":"Acta Derm Venereol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1111\/j.1365-2230.2006.02211.x","article-title":"Psychosomatic cofactors and psychiatric comorbidity in patients with chronic itch","volume":"31","author":"Schneider","year":"2006","journal-title":"Clin Exp Dermatol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1007\/s40257-016-0215-3","article-title":"Itch in the general internal medicine setting: a cross-sectional study of prevalence and quality-of-life effects","volume":"17","author":"Silverberg","year":"2016","journal-title":"Am J Clin Dermatol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jad.2011.01.011","article-title":"Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies","volume":"135","author":"Baglioni","year":"2011","journal-title":"J Affect Disord."},{"key":"B23","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.jpeds.2018.08.034","article-title":"Daily intake of soft drinks and moderate-to-severe acne vulgaris in chinese adolescents","volume":"204","author":"Huang","year":"2019","journal-title":"J Pediatr."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1111\/all.12313","article-title":"Methods report on the development of the 2013 revision and update of the EAACI\/GA2 LEN\/EDF\/WAO guideline for the definition, classification, diagnosis, and management of urticaria","volume":"69","author":"Zuberbier","year":"2014","journal-title":"Allergy."},{"key":"B25","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/S0190-9622(81)70081-1","article-title":"Dermatopsychosomatics: classification, physiology, and therapeutic approaches","volume":"5","author":"Medansky","year":"1981","journal-title":"J Am Acad Dermatol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1001\/archderm.128.3.381","article-title":"Psychodermatology. Practical guidelines on pharmacotherapy","volume":"128","author":"Koo","year":"1992","journal-title":"Arch Dermatol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1001\/archderm.119.6.501","article-title":"Psychosomatic concepts in dermatology. A dermatologist-psychoanalyst's viewpoint","volume":"119","author":"Koblenzer","year":"1983","journal-title":"Arch Dermatol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/0738-081X(84)90050-6","article-title":"Psychosomatic dermatology","volume":"2","author":"Panconesi","year":"1984","journal-title":"Clin Dermatol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1016\/S0733-8635(05)70222-9","article-title":"The use of psychotropic drugs in dermatology","volume":"18","author":"Gupta","year":"2000","journal-title":"Dermatol Clin."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1111\/jdv.12024","article-title":"Clinical practice guideline for an integrated approach to comorbidity in patients with psoriasis","volume":"27","author":"Dauden","year":"2013","journal-title":"J Euro Acad Dermatol Venereol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/all.13231","article-title":"Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with psychiatric hospitalization or suicide","volume":"73","author":"Thyssen","year":"2018","journal-title":"Allergy."},{"key":"B32","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1080\/08870440802530780","article-title":"Stress, psychiatric co-morbidity and coping in patients with chronic idiopathic urticaria","volume":"25","author":"Chung","year":"2010","journal-title":"Psychol Health."},{"key":"B33","doi-asserted-by":"publisher","first-page":"469","DOI":"10.2340\/00015555-3164","article-title":"European S2k guideline on chronic pruritus","volume":"99","author":"Weisshaar","year":"2019","journal-title":"Acta Derm Venereol."},{"key":"B34","first-page":"214","article-title":"Epidemiology of urticaria in Spain","volume":"14","author":"Gaig","year":"2004","journal-title":"J Investig Allergol Clin Immunol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/j.jid.2019.05.034","article-title":"Itch and mental health in dermatological patients across Europe: a cross-sectional study in 13 countries","volume":"140","author":"Dalgard","year":"2020","journal-title":"J Investig Dermatol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1016\/j.clindermatol.2018.08.015","article-title":"Psychosomatic and psychiatric disorders and psychologic factors in pruritus","volume":"36","author":"Stumpf","year":"2018","journal-title":"Clin Dermatol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1806","DOI":"10.1038\/jid.2008.3","article-title":"The brain processing of scratching","volume":"128","author":"Yosipovitch","year":"2008","journal-title":"J Investig Dermatol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2201","DOI":"10.1097\/j.pain.0000000000001319","article-title":"Chronic itch impairs mood and HPA axis function in mice: modulation by CRFR1 antagonist","volume":"159","author":"Zhao","year":"2018","journal-title":"Pain."},{"key":"B39","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1111\/j.1365-2133.1997.tb14895.x","article-title":"The impact of chronic urticaria on the quality of life","volume":"136","author":"O'Donnell","year":"1997","journal-title":"Br J Dermatol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.iac.2013.09.011","article-title":"Urticaria: impact on quality of life and economic cost","volume":"34","author":"O'Donnell","year":"2014","journal-title":"Immunol Allergy Clin North Am."},{"key":"B41","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1111\/j.1398-9995.2008.01920.x","article-title":"The German version of the Chronic Urticaria Quality-of-Life Questionnaire: factor analysis, validation, and initial clinical findings","volume":"64","author":"Mlynek","year":"2009","journal-title":"Allergy."},{"key":"B42","first-page":"445","article-title":"Does sleep disturbance predict depression in elderly people? A study in inner London","volume":"43","author":"Livingston","year":"1993","journal-title":"Br J General Prac."},{"key":"B43","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1176\/ajp.157.1.81","article-title":"Sleep complaints and depression in an aging cohort: a prospective perspective","volume":"157","author":"Roberts","year":"2000","journal-title":"Am J Psychiatry."},{"key":"B44","doi-asserted-by":"publisher","first-page":"473","DOI":"10.31887\/DCNS.2008.10.4\/plfranzen","article-title":"Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications","volume":"10","author":"Franzen","year":"2008","journal-title":"Dial Clin Neurosci."},{"key":"B45","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1207\/S15402010BSM0103_3","article-title":"Role of nocturnal cognitive arousal in the complaint of insomnia among older adults","volume":"1","author":"Alapin","year":"2003","journal-title":"Behavioral sleep medicine."},{"key":"B46","first-page":"864","article-title":"Sleep complaints among older general practice patients: association with depression","volume":"55","author":"Almeida","year":"2005","journal-title":"Br J General Pract."},{"key":"B47","doi-asserted-by":"publisher","first-page":"101311","DOI":"10.1016\/j.smrv.2020.101311","article-title":"The relationship between sleep duration and mood in adolescents: a systematic review and meta-analysis","volume":"52","author":"Short","year":"2020","journal-title":"Sleep Med Rev."},{"key":"B48","doi-asserted-by":"publisher","first-page":"101282","DOI":"10.1016\/j.smrv.2020.101282","article-title":"Sleep in the anxiety-related disorders: a meta-analysis of subjective and objective research","volume":"51","author":"Cox","year":"2020","journal-title":"Sleep Med Rev."},{"key":"B49","doi-asserted-by":"publisher","first-page":"161","DOI":"10.3109\/13651501.2014.907919","article-title":"Assessment of the effects of antihistamine drugs on mood, sleep quality, sleepiness, and dream anxiety","volume":"18","author":"Ozdemir","year":"2014","journal-title":"Int J Psychiatry Clin Pract."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.655802\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T01:47:40Z","timestamp":1630979260000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.655802\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,7]]},"references-count":49,"alternative-id":["10.3389\/fpsyt.2021.655802"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2021.655802","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,7]]},"article-number":"655802"}}