A drawing of a girl frowning with blemishes on her face.
Adolescence is a tough time, and blemishes make it all the tougher. (For Spectrum Health Beat)

It’s intuitive that acne causes depression, but a massive new study out of England shows just how devastating acne can weigh on people’s psyches.

Researchers, following nearly 2 million men and women in England over a 15-year period, found a 63 percent increase in clinical depression in the first year people had acne compared to those without acne.

Most people were younger than 19 at the start of the study, but they ranged in age from 7 to 50.

“This is not surprising,” said Adele Cadieux, PsyD, a pediatric psychologist with Spectrum Health Helen Devos Children’s Hospital. “Unfortunately acne begins when kids are much more focused on their physical appearance” than other qualities.

Acne is mostly unavoidable: About 85 percent of people will experience a breakout at some point, making it the most common skin condition in the U.S., according to the American Academy of Dermatology. Women are more likely to get acne, and more likely to suffer depression because of it.

There are ways, however, to reduce children and teens’ risk of suffering depression after an outbreak.

Recognize the signs

Acne is a skin condition in which hair follicles become plugged with oil and dead skin cells. This can cause whiteheads, blackheads or pimples on the face, forehead, back, chest and shoulders.

Many people think of acne as a relatively benign condition, but the study shows otherwise, researchers said.

“For these patients with acne, it is more than a skin blemish—it can impose significant mental health concerns and should be taken seriously,” Dr. Isabelle Vallerand, the lead researcher, noted in a statement.

Parents concerned about their children should look for possible signs of depression.

“If (kids) mention they might not want to go social or extracurricular activities, or their child’s behavior or grades start changing, or they seem more withdrawn,” those could be signs the child is struggling with something, Dr. Cadieux said.

“Whether the child identifies whether any of this is related to acne or not, it’s important to take that next step of trying to evaluate what’s contributing to these changes.”

The best way to find out answers: Ask questions, Dr. Cadieux said.

If kids seem reluctant to talk to their parents, take them to a pediatrician or encourage a special teacher, coach or religious figure to talk with them, she said. Sometimes children are more likely to open up to non-family members than they would a parent.

‘You’re on a stage and being judged’

An effective way to gird children and teenagers against depression is to focus on qualities other than physical appearance.

“One of the things that is really important for kids is to focus on aspects of their life that are going well,” Dr. Cadieux said. “Families can be very important in providing some of that feedback, whether it’s their personal qualities, their skills, really anything other than focusing on physical appearance.”

Fostering those other skills and qualities—getting them into music classes, sports leagues, coding or theater camps, depending on their interests—can also help them form an identity around those qualities rather than their physical appearance, doctors said.

If those efforts don’t work, counseling is an option.

The increase in risk of depression is the worst in the first year of acne, and lasts for five years, the study showed. Although still high, the increased risk of depression decreases each year after the first year of diagnosis.

After five years, the increased risk disappears, even if the acne persists. This also isn’t surprising, Dr. Cadieux said.

“As you get older, your maturity level changes,” she said. “In adolescence, you’re so focused on physical appearance, as if you’re on stage and being judged.

“But as you transition into adulthood, you begin to recognize your skills, abilities and successes—you can build your self-esteem on these and not focus as much on physical appearance. These can help reduce the risk of depression.”