# HS and Mental Health: Depression, Anxiety and How to Get Support

Canonical URL: https://www.acneinversa.life/en/blog/hs-depression-anxiety-mental-health-support/
Markdown URL: https://www.acneinversa.life/en/blog/hs-depression-anxiety-mental-health-support.md
Plain text URL: https://www.acneinversa.life/en/blog/hs-depression-anxiety-mental-health-support.txt
Language: en
Category: Mental Health
Published: 2026-09-19
Last updated: 2026-09-19
Last editorially reviewed: 2026-09-19
Next scheduled review: 2027-09-19
Evidence strength: Moderate evidence — Backed by consistent observational studies or smaller trials.
Author: Dr. rer. nat. Dennis Alexander Kwiatkowski (Biochemist, Scientific Writer and Pharma Expert)
Scientific editor: Dr. rer. nat. Dennis Alexander Kwiatkowski
Reviewer qualifications: Biochemist, Scientific Writer and Pharma Expert
Review scope: Scientific literature, clinical guidelines, sources, and editorial clarity
Clinical reviewer: No independent clinical review
Tags: Acne Inversa, Hidradenitis Suppurativa, HS, Mental Health, depression, anxiety, mental health, suicide prevention, psychiatric comorbidities, screening

> Depression and anxiety are about twice as common in people with HS. What 83 studies show, what guidelines advise, and how to get support today.

Medical disclaimer: This website is for general educational information only and does not replace medical advice, diagnosis, or treatment. Please speak with qualified medical professionals about symptoms or treatment decisions.

## 60-second summary

- Depression is about twice as common in HS: a 2025 meta-analysis of 83 studies found 20.9% versus 8.4% in comparison groups.
- Anxiety follows a similar pattern: 19.3% in HS versus 8.1% in comparison groups across the same analysis.
- Completed suicide was recorded in 0.7% of people with HS versus 0.4% in comparison groups — both figures are low.
- Guidelines now treat mental health as part of HS care and recommend screening for depression, anxiety and suicide risk.
- HS-specific trials of psychological treatments are missing — a research gap, not evidence that therapy does not help.

**What this means:** If HS is affecting your mood, sleep or confidence, that is a recognised part of the condition, not a personal failing — and it is worth raising with a clinician.

**What we are less certain about:** Whether HS causes depression, whether depression makes HS harder to manage, or whether treating HS lowers depression risk is not settled — these studies show association, not cause and effect.

**What you can do next:** Read the warning signs and the support list below, then use the appointment scripts to raise your mood with your care team.

## Article

Depression and anxiety are more common in people with hidradenitis suppurativa (HS, also called acne inversa) than in people without it. In a 2025 analysis of 83 studies, about 21% of people with HS had depression, compared with about 8% in comparison groups. That is a pattern across many people, not a verdict on you — in these studies, most people with HS did not have depression. But if low mood, constant worry or hopelessness has lasted most days for two weeks or longer, it deserves the same attention as a painful lesion, and there are concrete ways to get help.

## Need support right now

**If you are in danger, or you might act on thoughts of harming yourself:** call your local emergency number now (**112** in the EU, **999** in the UK, **911** in the US) or go to the nearest emergency department. If you can, tell someone near you.

**If you are struggling but not in immediate danger,** a free helpline will listen at any hour:

| Country | Number |
|---|---|
| Germany | TelefonSeelsorge — [0800 111 0 111](tel:08001110111), [0800 111 0 222](tel:08001110222) or [116 123](tel:116123) |
| Austria | [142](tel:142) |
| Switzerland | [143](tel:143) |
| UK and Ireland | Samaritans — [116 123](tel:116123) |
| US | [988](tel:988), call or text |
| Anywhere else | [findahelpline.com](https://findahelpline.com/) lists verified helplines in more than 175 countries |

The full list, opening hours and how each service works are set out in [Where to get help](#where-to-get-help) below.

> **How this article talks about suicide.** This article follows the World Health Organization's guidance for communicating about suicide. It does not describe methods, avoids sensational language, and places help options first.

## Key takeaways

- Depression and anxiety are common in HS, not inevitable. Pooled estimates put depression at around one in five people with HS, more than double the rate in comparison groups, and most people in these studies did not have depression.
- Different methods give different numbers. Screening questionnaires flag more people than clinical diagnoses do, so a single percentage should be read as a range, not a prediction.
- Feeling low is not "just" a reaction you have to put up with. If symptoms last most of the day, nearly every day, for at least two weeks, seek care.
- Support exists in every route: your dermatologist or GP, a psychotherapist, and free helplines.

## How common are depression and anxiety in HS?

### Depression

Four meta-analyses, each combining many individual studies, point in the same direction with different exact numbers.

| Analysis | Studies | Depression in HS | Comparison | Odds ratio (95% CI) |
|---|---|---|---|---|
| Folkmann et al., 2025 | 76 in the quantitative analysis | 20.9% | 8.4% | 2.06 (1.75–2.41) |
| Jalenques et al., 2020 | 28 | 21% (17–25) | pooled prevalence, no comparator | 1.99 (1.63–2.43) in case-control studies |
| Patel et al., 2020 | 27 in the meta-analysis | 26.5% | 6.6% | 2.54 (2.15–3.01) |
| Machado et al., 2019 | 10 | 16.9% (9.9–27.2) | pooled prevalence, no comparator | 1.84 (1.57–2.15) |

The direction is consistent across all four; the size varies, and most included studies observe people at a single point in time rather than following them over years.

### Anxiety

Anxiety shows a similar pattern. Folkmann and colleagues found 19.3% versus 8.1% (odds ratio 1.91), Patel and colleagues found 18.1% versus 7.1% (odds ratio 2.00), and Jalenques and colleagues reported a pooled prevalence of 12% (odds ratio 1.97 in case-control studies). The earliest of the four analyses reported a lower figure of 4.9%, but had too few comparison studies to estimate a reliable odds ratio.

### Why the numbers vary so much

Two things explain most of the spread.

**How depression is measured.** In the 2019 meta-analysis, studies that used clinical diagnostic criteria found depression in 11.9% of people with HS, while studies that used screening questionnaires found 26.8%. A single-centre Polish study of 114 people with HS used two standard questionnaires and found symptoms suggesting depression in 41.2% and anxiety in 40.4%. A questionnaire result is a prompt for a conversation, not a diagnosis.

**How the study is built.** A Danish national registry study of 7,732 people with HS found no significant association with depression in its cross-sectional analysis (odds ratio 1.13, 95% CI 0.87–1.47), yet found higher antidepressant use (hazard ratio 1.30). One meta-analysis found higher rates of depression and anxiety in HS but no difference in average questionnaire scores. None of this cancels the overall pattern, but it is a reason to distrust any single headline figure, including the ones on this page.

### Who is affected more?

In the 2025 analysis, depression was more common with more advanced disease: 19.5% at Hurley stage I, 20.9% at stage II and 35.3% at stage III. The confidence intervals are wide and overlap, so treat this as a trend rather than a threshold. Psychiatric conditions overall were more common in women with HS (28.0%) than in men (21.1%), and depression was more common in adults (19.1%) than in children and adolescents (9.5%).

## Suicide and self-harm: what the research shows

This is a difficult subject and the numbers are easy to misread, so here is the short, careful version.

Across studies pooled in the 2025 meta-analysis, completed suicide was recorded in 0.7% of people with HS versus 0.4% in comparison groups (odds ratio 1.56, 95% CI 1.14–2.14). Both figures are small. The difference is statistically robust, and it matters for how care should be organised. A Danish registry study separately found 11 suicides among 7,732 people with HS, giving an adjusted hazard ratio of 2.42 — but with a wide confidence interval (1.07–5.45) because there were so few events. A meta-analysis of 38 studies concluded that HS was associated with suicidality as well as with depression and anxiety.

A 2026 research letter in *JAMA Dermatology*, based on nationwide registry data, looked specifically at self-harm and suicide in HS. Only the abstract-level information was available when this article was written, so its figures are not quoted here; this page will be updated once the full results have been reviewed.

What this does not mean: most people with HS do not die by suicide, and thoughts of suicide are a sign that someone needs support, not a fixed feature of the disease. If you have them, use the [support list above](#need-support-right-now) now, not later.

## Why might HS and depression go together?

*This is an active area of research.* The studies show that the two occur together more often than chance would predict. They do not show that HS *causes* depression, and they cannot rule out that other shared factors play a role. Burdens that people with HS commonly describe include:

- **Pain, drainage, odour and unpredictability** as daily burdens — see [describing HS pain](/en/hs-pain/) and [HS odour and drainage](/en/blog/hs-odor-drainage/).
- **Poor sleep and exhaustion**, which can wear down mood on their own — see [HS, sleep and fatigue](/en/blog/hs-sleep-fatigue-exhaustion/).
- **A long road to diagnosis.** Getting a correct diagnosis often [takes years](/en/blog/why-hidradenitis-suppurativa-is-often-diagnosed-late/), which can leave people feeling unheard.
- **Shame and stigma.** A 2025 systematic review of 27 studies across five chronic skin diseases, including HS, found that social stigma, coping styles such as lack of acceptance, and lack of social support were the main predictors of self-stigma. Almost all of the included studies looked at one point in time, so they cannot show cause and effect. More in [Shame, Body Image and HS](/en/blog/shame-body-image-acne-inversa/).

There is also a practical loop worth knowing about. Low energy, poor concentration and disrupted sleep are themselves symptoms of depression. It is reasonable to expect that they make appointments, wound care and treatment routines harder to keep up. That is an inference rather than a direct study result, but it is one more reason to treat mood as part of HS care rather than as a separate matter.

## Signs worth acting on

*This is not a diagnostic checklist. Only a clinician can diagnose depression or an anxiety disorder.*

The World Health Organization describes depression as a persistent low mood or loss of interest that lasts most of the day, nearly every day, for at least two weeks, often together with poor concentration, feelings of excessive guilt or low self-worth, hopelessness about the future, thoughts about dying or suicide, disrupted sleep, changes in appetite or weight, and feeling very tired or low in energy. Its advice is simple: seek care if you have symptoms of depression.

Anxiety can show up differently in HS: constant worry that is hard to switch off, dread before or during flares, or avoiding sport, intimacy, work or social situations because of the skin. If worry is shaping your days, that is worth telling a clinician, whatever label it eventually gets.

Feeling low, angry or frightened after a diagnosis of a chronic disease is an understandable reaction. It still deserves attention, and you do not have to decide alone whether it is "bad enough".

## What helps: what guidelines and research say

**Clinicians are expected to look.** The US and Canadian HS Foundations reviewed the evidence on 30 associated conditions and recommend screening for depression, generalized anxiety disorder and suicide risk in people with HS, while noting that the dermatologist's own role in screening varies by condition. The European S2k treatment guideline says the care team should address all of a patient's symptoms and difficulties, including "mental health support and well-being," and should point people to credible HS patient groups at the first consultation. The [health checks beyond the skin](/en/blog/hs-comorbidity-screening-guide/) guide explains what to expect.

**Psychological treatments are the first-line treatment for depression in general.** The WHO states that psychological treatments are the first treatments for depression, and can be combined with antidepressant medicines in moderate and severe depression. Choices about medicine belong with a doctor; this article does not cover them.

**In HS specifically, the evidence is thin.** The European guideline states that indirect evidence indicates psychological intervention is beneficial to people with different skin diseases, "but specific studies are needed to confirm this in HS." A missing HS trial is not the same as a treatment that does not work.

**HS treatment and mental health care go together.** The guideline frames mental health support as part of holistic HS care, not a substitute for treating the skin disease. Whether treating HS itself reduces the risk of depression is not something the sources reviewed for this article can confirm.

**Peer support can help some people.** Many people describe meeting others with HS as reducing isolation, though reliable outcome data on this specifically was not found. Peer support is available, but formats differ: German-language and international HS communities include self-help forums, patient organisations and virtual support groups. If you want to explore them, our [peer-support directory](/en/peer-support/) explains who runs each option, how participation works and what to check before sharing personal information. Check who funds any group, and be wary of any group that promises cures.

## How to bring it up at your next HS appointment

Many people find this the hardest step. These are examples of words you can use — adapt them, or read them out.

**To your dermatologist or GP:**

- "HS is affecting my mood and sleep as well as my skin. Can we include that in the plan?"
- "I have been feeling low or anxious most days for [number] weeks. Who should I talk to about that?"
- "Do you ask patients with HS about mood as part of their care, or should I see someone else for that?"

**To a psychotherapist (Germany, first consultation):**

- "I have a chronic skin condition, hidradenitis suppurativa, and I am finding it hard to cope with the pain, the shame and the unpredictability."

**To make it easier:**

- Write down your notes beforehand. The [appointment summary tool](/en/symptom-tracker/local-summary/) works in your browser without an account and can include your saved appointment questions. Add sleep, mood and what you have stopped doing to your list.
- Bring a trusted person if you can, or ask for a longer appointment.
- You are not obliged to tell anyone. Sharing simply gives your care team the chance to help. The [shame and stigma conversation planner](/en/hs-shame-stigma/) can help you plan what to say and to whom.

Not sure what else to ask? See [15 questions to ask your dermatologist](/en/blog/15-questions-to-ask-your-dermatologist/) and [shared decision-making in HS](/en/blog/hs-shared-decision-making/).

## Where to get help

Details were checked on September 19, 2026 against each service's own website. Services change; if a number does not connect, use [findahelpline.com](https://findahelpline.com/) or your local directory.

### If you might act on thoughts of harming yourself

| Where | Emergency |
|---|---|
| European Union | **112**, free, any EU country, 24/7 — ask for an ambulance or the police |
| United Kingdom | **999** if life is at risk; **NHS 111** for urgent mental health advice |
| United States | **911** in life-threatening situations; **988** Suicide & Crisis Lifeline — call, text or chat, 24/7 |

### Free listening lines (no diagnosis needed, not only for emergencies)

| Country | Service | Contact | Notes |
|---|---|---|---|
| Germany | TelefonSeelsorge | 0800 111 0 111 · 0800 111 0 222 · 116 123 | Free, day and night; also by chat and email via [telefonseelsorge.de](https://www.telefonseelsorge.de/) |
| Austria | Telefonseelsorge | 142 | Free, 24/7; chat daily 16:00–23:00; email answered within 48 hours |
| Switzerland | Die Dargebotene Hand | 143 | 24/7, anonymous; chat and email; English-language phone line 0800 143 000, 6–11 pm |
| UK and Ireland | Samaritans | 116 123 | Free from any phone, 24/7; the UK email service is being phased out during 2026 |
| United States | 988 Lifeline | 988 | Call, text or chat, free, 24/7 |
| Other countries | Find A Helpline | [findahelpline.com](https://findahelpline.com/) | Directory of verified helplines in more than 175 countries, run by ThroughLine |

### If you are in Germany and want professional support

- **Psychotherapy through statutory health insurance.** You do not need a referral. The first step is a psychotherapeutic consultation (Sprechstunde). The appointment service **116117** (phone, or eterminservice.de) must arrange an appointment within one week, to take place within four weeks, or within two weeks for acute treatment. This applies to people covered by statutory health insurance; privately insured people should ask their insurer. [116117 and HS](/en/blog/116117-hidradenitis-suppurativa-when-to-call/) explains what the number is for and what it is not.
- **Info-Telefon Depression** (Stiftung Deutsche Depressionshilfe): 0800 33 44 533, free, Mon/Tue/Thu 13:00–17:00 and Wed/Fri 08:30–12:30. It provides information about depression, treatment and local help. It is not a crisis line and does not replace a consultation with a doctor or psychotherapist; in an acute crisis, contact your doctor, a psychiatric clinic or 112.
- **Your HS care team.** Use the [My HS Care Team](/en/hs-care-team/) planner and [specialist finder](/en/hs-specialists/) to prepare the conversation.

### Peer support

- Compare current groups and communities in the [peer-support directory](/en/peer-support/).
- Read real experiences in [patient stories](/en/patient-stories/), or [ask a question anonymously](/en/ask-the-hs-community/). Nothing appears before editorial review.

## If someone you care about has HS

You cannot fix this for them, and you do not need to. Listen without judging, take their pain and shame seriously, and encourage them to speak to a doctor. You can offer to look up the numbers above together, or to sit with them while they call. If you think they are in immediate danger, call the emergency number. [For Partners](/en/blog/supporting-partner-with-acne-inversa/) has more on everyday support.

## What researchers still need to answer

- Do psychological therapies — for example cognitive behavioural therapy or acceptance-based approaches — improve mood and quality of life specifically in people with HS? The guideline says HS-specific studies are needed.
- Does effective treatment of the skin disease reduce the risk of depression, anxiety or self-harm, and by how much?
- Which questionnaires work best for people with HS, and when should screening happen?
- How do cause and effect run: does HS lead to depression, does depression influence HS, or do shared factors drive both? Most studies so far observe people at a single point in time.
- What do the newest nationwide registry data on self-harm and suicide in HS show once their full results are published and reviewed?

## The bottom line

Depression and anxiety are about twice as common in people with HS as in people without, and depression appears more common in more advanced disease — but most people with HS were not depressed in these studies, and the risk is not a sentence. Mood belongs in HS care. If you have been low, anxious or hopeless for two weeks or more, tell a clinician. If you are in danger or thinking about ending your life, use the emergency number or a helpline today. You do not have to wait for the next appointment.

## Not sure which associated health topics apply to you?

Mood is one of several areas worth checking in HS, alongside heart health, metabolic health and joints.

## FAQ

### Is depression common in people with hidradenitis suppurativa?

Yes, more so than in people without HS. A 2025 meta-analysis of 83 studies found depression in 20.9% of people with HS versus 8.4% in comparison groups. Individual studies range widely, from about 12% when clinical diagnostic criteria are used to about 27% or higher with screening questionnaires.

### Does HS cause depression?

Nobody knows for certain. The studies show an association, not cause and effect. Pain, drainage, poor sleep, delayed diagnosis and stigma are all plausible contributors, but most studies look at people at one point in time and cannot separate them from other factors.

### Is feeling low with HS just a normal reaction?

Sadness, anger and worry after a diagnosis of a chronic disease are understandable. Whether it is "normal" matters less than whether it is getting in your way. If low mood or loss of interest lasts most of the day, nearly every day, for two weeks or more, seek care.

### Should my dermatologist ask about my mood?

Guidelines say mental health belongs in HS care. The US and Canadian HS Foundations recommend screening for depression, anxiety and suicide risk, and the European S2k guideline asks care teams to address mental health support and well-being. In practice this varies, so it is reasonable to raise it yourself.

### Can therapy help if my HS is not under control?

Psychological treatments are the first-line treatment for depression in general. For HS specifically, the European guideline notes that indirect evidence from other skin diseases suggests psychological intervention is beneficial, but HS-specific studies are still needed. Working on mood and working on the skin are not either/or.

### Do I have to tell my dermatologist how I feel?

No. But telling them lets them help or refer you. In Germany you can also go directly to a psychotherapy consultation through statutory health insurance without a referral.

### Are there HS support groups?

Yes. German-language and international options exist, including self-help forums, patient organisations and virtual groups; our peer-support directory compares them. Check who funds any group, and remember that one person's experience may not apply to you.

### What should I do if I am having thoughts of suicide?

Use the support list on this page now. If you might act on the thoughts, call your emergency number (112 in the EU, 999 in the UK, 911 in the US) or go to an emergency department. If you are not in immediate danger, call a free helpline such as TelefonSeelsorge in Germany, Samaritans in the UK and Ireland, or 988 in the US. Telling someone close to you can also help.

## References

1. Folkmann CL, Pinborg EH, Iversen M, Rønnstad ATM, Holgersen N, Nielsen ML, et al. The association between hidradenitis suppurativa and psychiatric disease: a systematic review and meta-analysis. - British Journal of Dermatology, 2025 - https://doi.org/10.1093/bjd/ljaf151
2. Machado MO, Stergiopoulos V, Maes M, Kurdyak PA, Lin PY, Wang LJ, et al. Depression and anxiety in adults with hidradenitis suppurativa: a systematic review and meta-analysis. - JAMA Dermatology, 2019 - https://doi.org/10.1001/jamadermatol.2019.0759
3. Patel KR, Lee HH, Rastogi S, Vakharia PP, Hua T, Chhiba K, et al. Association between hidradenitis suppurativa, depression, anxiety, and suicidality: a systematic review and meta-analysis. - Journal of the American Academy of Dermatology, 2020 - https://doi.org/10.1016/j.jaad.2019.11.068
4. Jalenques I, Ciortianu L, Pereira B, D'Incan M, Lauron S, Rondepierre F. The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: systematic review and meta-analysis. - Journal of the American Academy of Dermatology, 2020 - https://doi.org/10.1016/j.jaad.2020.03.041
5. Rymaszewska JE, Krajewski PK, Szczęch J, Szepietowski JC. Depression and anxiety in hidradenitis suppurativa patients: a cross-sectional study among Polish patients. - Postępy Dermatologii i Alergologii, 2023 - https://doi.org/10.5114/ada.2022.119080
6. Thorlacius L, Cohen AD, Gislason GH, Jemec GBE, Egeberg A. Increased suicide risk in patients with hidradenitis suppurativa. - Journal of Investigative Dermatology, 2018 - https://doi.org/10.1016/j.jid.2017.09.008
7. Holgersen N, Rosenø NAL, Nielsen VW, Hjorthøj C, Nordentoft M, Garg A, et al. Hidradenitis suppurativa and risk of self-harm and suicide. - JAMA Dermatology, 2026 - https://doi.org/10.1001/jamadermatol.2026.0037
8. Stuhlmann CFZ, Traxler J, Paucke V, da Silva Burger N, Sommer R. Predictors and mechanisms of self-stigma in five chronic skin diseases: a systematic review. - Journal of the European Academy of Dermatology and Venereology, 2025 - https://doi.org/10.1111/jdv.20314
9. Depression: fact sheet. - World Health Organization, updated September 2026 - https://www.who.int/news-room/fact-sheets/detail/depression
10. Garg A, Malviya N, Strunk A, Wright S, Alavi A, Alhusayen R, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. - Journal of the American Academy of Dermatology, 2022 - https://doi.org/10.1016/j.jaad.2021.01.059
11. Zouboulis CC, Bechara FG, Benhadou F, Bettoli V, Bukvić Mokos Z, Del Marmol V, et al. European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: treatment. - Journal of the European Academy of Dermatology and Venereology, 2025 - https://doi.org/10.1111/jdv.20472
12. Preventing suicide: a resource for media professionals, update 2023. - World Health Organization - https://www.who.int/publications/i/item/9789240076846