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Health-Related Quality of Life, Depression, and Self-esteem in Patients With Androgenetic AlopeciaA Systematic Review and Meta-analysis

Educational Objective
To examine the association of androgenetic alopecia with health-related quality of life and psychiatric disorders.
1 Credit CME
Key Points

Question  Is androgenetic alopecia associated with patients’ health-related quality of life?

Findings  In this systematic review and meta-analysis of 41 studies with 7995 patients, the pooled Dermatology Life Quality Index score for androgenetic alopecia was higher than for other common dermatoses. The pooled Hair-Specific Skindex-29 score showed moderate impairment in the emotion dimension of this assessment tool, whereas the pooled Center for Epidemiologic Studies Depression Scale score did not show an association with depression.

Meaning  Results of this study show an association between androgenetic alopecia and moderate impairment of not only health-related quality of life but also emotions, suggesting that patients with this disease may need psychological and psychosocial support.


Importance  Androgenetic alopecia (AGA) is associated with trichodynia, anxiety, low self-esteem, and depression, which have implications for quality of life. However, no systematic evaluation has been performed on the association of AGA with health-related quality of life (HRQOL).

Objective  To systematically examine the association of AGA with HRQOL and psychiatric disorders.

Data Sources  Cochrane Library, PubMed, Embase, and WanFang databases were searched from inception through January 24, 2021.

Study Selection  Case series, case-control studies, cross-sectional studies, cohort studies, and randomized clinical trials that examined either HRQOL or psychiatric disorders in patients with AGA were included. Studies published in languages other than English and Mandarin were excluded.

Data Extraction and Synthesis  The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used. The risk of bias in included studies was assessed with the Risk of Bias in Non-randomized Studies of Intervention (ROBINS-I) tool. A random-effects model meta-analysis was performed to calculate the pooled effect on HRQOL. A subgroup analysis according to sex and geographic regions was also conducted.

Main Outcomes and Measures  The outcome was HRQOL of patients with AGA.

Results  A total of 41 studies involving 7995 patients was included. The pooled Dermatology Life Quality Index score was 8.16 (95% CI, 5.62-10.71). The pooled Hair-Specific Skindex-29 score indicated moderate impairment of emotions, with the meta-analysis showing a score of 29.22 (95% CI, 24.17-34.28) in the emotion dimension. The pooled Center for Epidemiologic Studies Depression Scale score did not indicate depression, with the meta-analysis showing a score of 14.98 (95% CI, 14.28-15.68). Factors that had a direct association with HRQOL included married or coupled status and receipt of medical treatments, whereas factors that had an inverse association with HRQOL included higher self-rated hair loss severity, lower visual analog scale score, and higher educational level.

Conclusions and Relevance  This systematic review and meta-analysis found a significant association of AGA with moderate impairment of HRQOL and emotions, but no association was found with depressive symptoms. The findings suggest that patients with AGA may need psychological and psychosocial support.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: May 9, 2021.

Published Online: July 7, 2021. doi:10.1001/jamadermatol.2021.2196

Corresponding Author: Ching-Chi Chi, MD, MMS, DPhil, Department of Dermatology, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Guishan Dist, Taoyuan 33305, Taiwan (

Author Contributions: Prof Chi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chi.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Huang.

Critical revision of the manuscript for important intellectual content: Fu, Chi.

Statistical analysis: Chi.

Administrative, technical, or material support: Chi.

Supervision: Chi.

Conflict of Interest Disclosures: None reported.

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