Clinical Severity and Age as Correlates of Quality of Life, Anxiety, and Depression in Adults with Alopecia Areata: A Cross-Sectional Study

Abstract Background: Alopecia areata (AA) is a chronic organ-specific autoimmune disease with a pronounced adverse effect on patients' emotional wellbeing and quality of life (QoL). Although the psychosocial consequences of the disease have been examined in numerous studies, age-related differences in how the clinical severity of alopecia areata affects QoL, anxiety and depressive symptoms, and the subjective experience of illness remain insufficiently studied. Objective. To examine the influence of alopecia areata severity and patient age on QoL, anxiety and depressive symptoms, and clinical and psychological parameters, and to investigate the interrelationships among these variables. Materials and Methods. A cross-sectional comparative study was conducted in 60 patients with alopecia areata. According to disease severity, patients were allocated to a SALT <50% group ( n =40) and a SALT ≥50% group ( n =20), each further divided into age subgroups of 18–29 years and ≥30 years. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and QoL using the Skindex-29 dermatological questionnaire. Statistical analysis included the Student t-test, the Mann–Whitney U test, the Spearman rank correlation coefficient, comparison of independent correlation coefficients using Fisher r-to-z transformation ( r → z ), and effect size estimation (r). Differences were considered statistically significant at p <0.05. Results. Regardless of age, severe alopecia areata (SALT ≥50%) was associated with more pronounced depressive symptoms, greater emotional disturbance, and lower QoL than SALT <50%. The most marked psychoemotional disturbances occurred in patients aged 18–29 years with severe disease, who showed higher levels of anxiety and depression, more pronounced emotional and functional impairment, and lower QoLscores than patients older than 30 years. In moderate disease, age-related differences were less evident and involved mainly individual emotional measures. Correlation analysis revealed a close association between QoL and anxiety-depressive symptoms and all Skindex-29 domains, irrespective of age. Among patients aged 18-29 years, increasing clinical severity was accompanied by a statistically significant shift in the structure of factors related to QoL: at SALT <50%, QoL was linked primarily to the subjective severity of disease symptoms, whereas at SALT ≥50% the contribution of functional limitations increased. No comparable shift in the structure of these associations was observed in patients older than 30 years. However, direct comparison of the correlation structure between the age groups showed no statistically significant differences ( p >0.05). Conclusion. The clinical severity of alopecia areata is associated with poorer QoL and greater psychoemotional disturbance. The most pronounced QoLimpairment, anxiety and depressive symptoms, and psychosocial burden were found in young patients with severe disease (SALT ≥50%). These findings suggest that in severe alopecia areata the objective clinical severity of the disease is accompanied by a more intense subjective experience of its consequences in young patients, manifested as higher levels of anxiety and depression, more pronounced emotional and functional impairment, and a greater reduction in QoL. At the same time, the observed age-related features in the structure of associations between clinical and psychological parameters and QoL did not reach statistical significance on direct comparison of the age groups and require further confirmation in studies with larger samples. These data support the need to assess not only clinical disease severity but also QoL, emotional state, and the subjective experience of illness when planning personalized management of patients with alopecia areata.