Anxiety and depression in adolescents with a visible difference: A systematic review and meta-analysis
Open accessAbstract
Living with a visible difference can entail challenging social situations, associated with psychosocial symptoms. However, it is not clear whether adolescents with a visible difference experience more anxiety and depression than unaffected peers. We aim to determine whether adolescents with a visible difference experience more symptoms of anxiety and depression than unaffected peers. A literature search was conducted in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, PsycINFO Ovid, and Google Scholar. Meta-analyses were done using random-effects models to calculate a standardised mean difference. Analyses for subgroups were used to study causes of visible difference. Eleven studies were identified (n = 1075, weighted mean age = 15.80). Compared to unaffected peers, adolescents with a visible difference experience more symptoms of anxiety (SMD = 0.253, 95 % CI [0.024, 0.482], p = .030), but not depression (SMD = 0.236, 95 % CI [-0.126, 0.599], p = .202). Adolescents with a skin condition did not experience more symptoms of anxiety (SMD = 0.149, 95 % CI [-0.070, 0.369], p = .182) or depression (SMD = 0.090, 95 % CI [-0.082, 0.262], p = .305) when compared to unaffected peers. Overall, more symptoms of anxiety are found in adolescents with a visible difference compared to peers. No differences in anxiety or depression were found for skin differences. Screening for anxiety is recommended.
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Individuals with a visible difference in appearance experience high levels of social anxiety.
“Individuals living with a visible difference in appearance experience high levels of social anxiety, yet self-help interventions for this heterogeneous population are not available.”
From An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. (2023) · cites this paper as van Dalen et al., 2020
The Discussion reports higher levels of social anxiety in adults with a visible difference, but says more research is needed for a definite conclusion. The paper’s analysis concerns general anxiety in adolescents, not social anxiety across all individuals with a visible difference, so the unqualified claim is broader than the evidence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe difference in anxiety symptoms between adolescents with a visible difference and unaffected individuals may vary by condition.
“a recent meta-analysis found that compared to unaffected individuals, adolescents with a visible difference have more symptoms of anxiety, but not depression, and this may vary by condition (van Dalen et al., 2020).”
From An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. (2023) · cites this paper as van Dalen et al., 2020
Adolescents with a visible difference do not have more symptoms of depression compared to unaffected individuals.
“a recent meta-analysis found that compared to unaffected individuals, adolescents with a visible difference have more symptoms of anxiety, but not depression, and this may vary by condition (van Dalen et al., 2020).”
From An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. (2023) · cites this paper as van Dalen et al., 2020
Adolescents with a visible difference have more symptoms of anxiety compared to unaffected individuals.
“a recent meta-analysis found that compared to unaffected individuals, adolescents with a visible difference have more symptoms of anxiety, but not depression, and this may vary by condition (van Dalen et al., 2020).”
From An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. (2023) · cites this paper as van Dalen et al., 2020
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- Authors
- van Dalen, M., Dierckx, B., Pasmans, S. G. M. A., Aendekerk, E. W. C., Mathijssen, I. M. J., Koudstaal, M. J., Timman, R., Williamson, H., Hillegers, M. H. J., Utens, E. M. W. J., & Okkerse, J. M. E.
- Affiliations
- Erasmus MC - Sophia Children’s Hospital (NL)
- Erasmus MC (NL)
- University of the West of England (GB)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Okkerse, J.M.E.
- ORCID
- Venue
- Body Image
- Publisher
- Elsevier BV
- Published
- 2020-06
- Volume
- 33
- Pages
- 38-46
- ISSN
- 1740-1445 (ISSN-L)
- OpenAlex
- W3007525703
- Cited by
- 44
- References
- 49
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 9 · 2021: 9 · 2020: 2
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Body Image (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion, cc-by-nc-nd)
- UWE Research Repository (UWE Bristol) (submittedVersion, cc-by-nc-nd)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Funders
- Innovatiefonds Zorgverzekeraars (B 17-133)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- visible difference, adolescents, anxiety, depression, psychosocial symptoms, skin diseases, social stigma, anxiety screening
- MeSH terms
- Physical Appearance, Body, Adolescent, Psychology, Adolescent, Anxiety, Body Image, Child, Depression, Female, Humans, Male, Young Adult, Self Report
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