Psychiatric disorders in children with enuresis at 6 and 11 years old in a birth cohort<sup>,</sup>

Mota, Denise M.; Matijasevich, Alicia; Santos, Iná S.; Petresco, Sandra; Mota, Laís Marques

doi:10.1016/j.jped.2018.11.010

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • J. Pediatr. (Rio J.) 96 (3) • May-Jun 2020 • https://doi.org/10.1016/j.jped.2018.11.010 copy

Psychiatric disorders in children with enuresis at 6 and 11 years old in a birth cohort^☆ ☆ Please cite this article as: Mota DM, Matijasevich A, Santos IS, Petresco S, Mota LM. Psychiatric disorders in children with enuresis at 6 and 11 years old in a birth cohort. J Pediatr (Rio J). 2019. https://doi.org/10.1016/j.jped.2018.11.010 ^,^☆☆ ☆☆ Study conducted at Universidade Federal de Pelotas (UFPel), Faculdade de Medicina, Pelotas, RS, Brasil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Enuresis may have a negative impact on the self-image in childhood and adolescence. The objective of this study was to evaluate the association between enuresis and psychiatric disorders at 6 and 11 years of age.

Method:

3,356 children of a birth cohort were evaluated. A standard questionnaire on urinary habits and mental health (Development and Well-Being Assessment [DAWBA]), was used. The prevalence of psychiatric disorders pursuant to the existence of enuresis and its subtypes (monosymptomatic and non-monosymptomatic), stratified by sex, was described. A logistic regression was used for adjusted analysis.

Results:

The prevalence of enuresis at age 6 years was of 10.2% (9% non-monosymptomatic) and, at 11 years old, of 5.4% (4.5% non-monosymptomatic). At age 6 years, boys with non-monosymptomatic enuresis showed more hyperactivity disorders than those without enuresis (6.2% vs. 2.7%, p = 0.017). At 11 years old, after adjustment, among the boys with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder, hyperactivity disorders, and oppositional disorders was, respectively, 3.2, 3.4, and 2.6 times higher than in boys without enuresis; and, among the girls with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder and oppositional disorders was, respectively, 4 and 5.5 times higher than among girls without enuresis.

Conclusion:

There is a strong association between non-monosymptomatic enuresis and psychiatric disorders at 6 and 11 years old.

KEYWORDS
Enuresis; Children; Cohort; Psychiatric disorders

	Overall sample	Enuresis at 6 years of age (10.2%)		Enuresis at 11 years of age (5.4%)
Variable	Total	Monosymptomatic	Non-monosymptomatic	Monosymptomatic	Non-monosymptomatic
	n (%)	1.2% (n = 38)	9.0% (n = 292)	1.0% (n = 31)	4.5% (n = 144)
Sex		p = 0.112	p = 0.281	p = 0.009	p = 0.053
Male	1634 (51.5)	1.4	9.3	1.5	5.0
Female	1539 (48.5)	0.8	8.2	0.6	3.6
Prematurity		p = 0.400	p = 0.086	p = 0.044	p = 0.031
Yes	448 (14.1)	0.7	10.9	2.0	6.3
No	2721 (85.9)	1.2	8.4	0.9	4.0
Birth weight		p = 0.689	p = 0.006	p = 0.803	p = 0.507
<2500 grams	256 (8.1)	0.9	13.6	0.9	5.1
≥2500 grams	2916 (91.9)	1.1	8.3	1.1	4.2
Maternal age (years)		p = 0.085	p = 0.008	p = 0.195	p = 0.045
Adolescent (until 19)	599 (18.7)	1.9	11.7	1.5	5.3
20-29	1550 (48.3)	1.1	9.2	1.3	4.8
30-39	947 (29.5)	0.5	6.7	0.5	3.2
≥40	111 (3.5)	1.9	6.7	1.0	1.0
Maternal education (years)		p = 0.223	p = 0.001	p = 0.139	p = 0.014
0-4	467 (14.7)	1.9	10.4	1.7	6.4
5-8	1319 (41.5)	1.0	10.8	1.3	5.0
9-11	1087 (34.2)	1.3	6.5	0.7	3.1
≥12	305 (9.6)	0.3	6.3	0.3	3.0
Reference quintiles for socioeconomic status (IEN)		p = 0.046	p = 0.049	p = 0.048	p = 0.001
1 (poorest) (at 4 years of age)	696 (21.8)	2.1	11.0	2.1	5.8
2	668 (20.9)	0.9	9.5	0.8	6.1
3	743 (23.3)	1.3	9.3	1.0	4.1
4	535 (16.7)	0.4	6.5	0.4	2.9
5 (wealthiest)	554 (17.3)	0.7	7.3	0.7	2.0
Maternal skin color		p = 0.732	p = 0.001	p = 0.155	p = 0.390
White	1917 (62.2)	1.1	7.3	1.1	3.8
Parda	650 (21.1)	1.4	10.2	0.5	4.3
Black	517 (16.8)	1.0	12.2	1.7	5.2
Number of children in the house (at 4 years of age)		p = 0.685	p = 0.001	p = 0.100	p = 0.001
None	1233 (38.4)	1.0	7.6	0.5	3.7
One	340 (10.6)	1.2	12.0	2.0	5.6
Two	1356 (42.3)	1.1	8.1	1.3	3.6
Three or more	280 (8.7)	1.9	14.4	1.2	8.6

Enuresis at 6 years of age
Psychiatrist disorders	Boys				Girls				p ^a a p-Value of the difference between the psychiatric disorders of the overall sample among sex.
	Overall	Yes (n = 186)	No (n = 1,448)	p	Overall	Yes (n = 142)	No (n = 1,397)	p
		% (95% CI)	% (95% CI)			% (95% CI)	% (95% CI)
Any disorder	14.6 (12.8-16.3)	16.0 (10.3-21.6)	14.4 (12.5-16.3)	0.596	10.8 (9.2-12.4)	15.9 (9.6-22.2)	10.3 (8.6-11.9)	0.048	0.002
Emotional disorders	9.4 (7.9-10.8)	8.6 (4.2-12.9)	9.6(7.9-11)	0.720	8.6 (7.2-10.1)	11.4 (5.9-16.9)	8.4 (6.9-9.8)	0.239	0.476
Anxiety disorders	7.7 (6.3-9.0)	5.9 (1.9-8.8)	7.9(6.5-9.3)	0.344	8.0 (6.6-9.3)	10.6 (5.9-16.6)	7.9(6.2-9.0)	0.264	0.760
Depression	1.2 (0.7-1.8)	2.5 (0.05-4.9)	1.1 (0.5-1.6)	0.391	0.6 (0.2-1.0)	0.76 (-0.7-2.3)	0.6 (0.2-1)	0.568	0.078
Hyperactivity disorders	3.0 (2.2-3.8)	5.9 (1.9-8.8)	2.7 (1.9-3.6)	0.016	0.9 (0.4-1.4)	2.1 (-0.6-3.6)	1.0 (0.4-1.4)	0.228	< 0.001
Oppositional disorders	3.4 (2.5-4.3)	4.8(1.5-8.1)	3.3 (2.3-4.2)	0.286	1.1 (0.6-1.7)	0.7(0)	1.3 (0.7-1.8)	0.548	< 0.001
Monosymptomatic enuresis
		Yes (n = 22)	No (n = 1,516)	p		Yes (n = 12)	No (n = 1,450)	p
		% (95% CI)	% (95% CI)			% (95% CI)	% (95% CI)
Any disorder		4.6 (-4.9 to 14)	14.7 (12.9-16.5)	0.180		16.7 (-8.141.4)	10.8 (9.2-12.4)	0.512
Emotional disorders		4.6 (-4.9 to 14)	9.4 (8-10.9)	0.435		16.7 (-8.141.4)	8.6 (7.1-10)	0.318
Anxiety disorders		4.6 (-4.9 to 14)	7.7 (6.4-9)	0.581		16.7 (-8.141.4)	7.9 (6.5-9.3)	0.262
Depression		0	1.3 (0.7-1.8)	0.597		0	0.6 (0.2-1)	0.784
Hyperactivity disorders		0	3.0 (0.5-1.4)	0.406		0	0.9 (0.5-1.4)	0.735
Oppositional disorders		0	3.5 (2.6-4.4)	0.372		0	1.1 (0.6-1.7)	0.709
Non-monosymptomatic enuresis
		Yes (n = 141)	No (n = 1,397)			Yes (n = 122)	No (n = 1,375)	p
		% (95% CI)	% (95% CI)			% (95% CI)	% (95% CI)
Any disorder		17.7 (11.3-24.1)	14.2 (12.4-16.1)	0.263		15.8 (9.2-22.5)	10.4 (8.7-12)	0.064
Emotional disorders		9.2 (4.4-14.1)	9.4 (7.8-10.9)	0.951		10.8 (5.2-16.5)	8.4 (6.9-9.9)	0.367
Anxiety disorders		5.5 (1.8-9.3)	7.9 (6.5-9.3)	0.310		10.7 (5.1-16.2)	7.7 (6.3-9.1)	0.249
Depression		2.8 (0.1-5.6)	1.1 (0.5-1.6)	0.071		0.8(-0.8 to 2.5)	0.6 (0.2-1)	0.750
Hyperactivity disorders		6.2 (2.2-10.2)	2.7 (1.8-3.5)	0.017		1.6 (-0.6 to 3.9)	0.9 (0.4-1.4)	0.399
Oppositional disorders		5.5 (1.8-9.3)	3.2 (2.3-4.2)	0.151		0	1.2 (0.7-1.8)	0.217

Psychiatrist disorders	Enuresis at 11 years of age								p ^a a p-Value of the difference between psychiatric disorders of the overall sample among sex.
	Boys				Girls
	Overall	Yes (n = 99)	No (n = 1467)	p		Yes (n = 61)	No (n = 1434)	p
		(95% CI)	(95% CI)			(95% CI)	(95% CI)
Any disorder	12.4 (10.8-14)	27.3 (18.3-36.2)	11.4 (9.6-13)	< 0.001	8.1 (6.7-9.5)	23.0 (12.1-33.8)	7.5 (6.1-8.8)	<0.001	<0.001
Emotional disorders	4.9 (3.8-6.0)	8.1(2.6-13.5)	4.7 (3.6-5.8)	0.133	4.6 (3.6-5.7)	3.3 (-1.3 to 7.9)	4.7 (3.6-5.8)	0.611	0.696
Anxiety disorders	2.6 (1.8-3.4)	4.0 (0.09-7.9)	2.5 (1.7-3.3)	0.370	3.3 (0.5-4.2)	1.6 (-1.6 to 4.9)	3.4 (2.4-4.3)	0.464	0.280
Depression	0.8 (0.3-1.2)	2.0 (-0.8 to 4.8)	0.7 (0.3-1.1)	0.139	0.5 (0.1-0.8)	0	0.5 (0.1-0.8)	0.584	0.294
Hyperactivity disorders	4.2 (3.2-5.2)	11.0 (4.8-17.2)	3.8 (2.8-4.7)	< 0.001	1.3 (0.7-1.8)	0	1.4 (0.7-1.9)	0.366	<0.001
Oppositional disorders	4.3 (3.3-5.3)	11.0 (4.8-17.2)	3.8 (2.8-4.8)	0.001	1.7 (1.0-2.3)	6.7 (0.2-13)	1.5 (0.8-2.1)	0.002	<0.001
Monosymptomatic enuresis at 11 years of age
		Yes (n = 23)	No (n = 1467)	p		Yes (n = 8)	No (n = 1434)	p
		(95% CI)	(95% CI)			(95% CI)	(95% CI)
Any disorder		17.4 (0.6-34.2)	11.4 (9.6-13.0)	0.370		12.5 (-17.1-42.1)	7.5 (6.1-8.8)	0.589
Emotional disorders		4.4(-4.7-13.4)	4.7 (3.6-5.8)	0.936		0	4.7 (3.6-5.8)	0.531
Anxiety disorders		4.4 (-4.7-13.4)	2.5(1.7-3.3)	0.581		0	3.3(2.4-4.3)	0.599
Depression		0	0.7(0.3-11)	0.691		0	0.5 (0.1-0.8)	0.843
Hyperactivity disorders		4.4 (-4.7-13.3)	3.8 (2.8-4.7)	0.880		0	1.3 (0.7-1.9)	0.743
Oppositional disorders		8.7(-3.8-21.1)	3.8 (2.8-4.8)	0.230		0	1.5 (0.8-2.1)	0.730
Non-monosymptomatic enuresis at 11 years of age
		Yes (n = 76)	No (n = 1468)	p		Yes (n = 53)	No (n = 1434)	p
		(95% CI)	(95% CI)			(95% CI)	(95% CI)
Any disorder		30.3 (19.7-40.8)	11.4 (9.8-13)	<0.001		24.5 (12.6-36.5)	7.5 (6.1-8.8)	<0.001
Emotional disorders		9.2 (2.6-15.9)	4.7 (3.6-5.8)	0.077		3.8 (-1.5 to 9.1)	4.7 (3.6-5.8)	0.760
Anxiety disorders		3.9 (-0.5 to 8.3)	2.5 (1.7-3.3)	0.459		1.9 (-1.9 to 5.7)	3.3 (2.4-4.3)	0.560
Depression		2.6 (-1.1 to 6.3)	0.7 (0.3-1.1)	0.059		0	0.5 (0.1-0.8)	0.610
Hyperactivity disorders		13.0 (5.3-20.7)	3.8 (2.8-4.7)	<0.001		0	1.3 (0.7-1.9)	0.399
Oppositional disorders		11.7 (4.3-19)	3.83.8 (2.8-4.8)	0.001		7.6 (0.2-14.9)	1.5 (0.8-2.1)	0.001

Symptoms	Boys
Symptoms	Any disorder	Hyperactivity disorders	Oppositional disorders
Enuresis at 11 years of age (yes)
Gross	2.92 (1.82-4.67)	3.18 (1.61-6.28)	3.12 (1.58-6.16)
Adjusted	2.75 (1.71-4.43)^a a Adjusted for socioeconomic status.	2.72 (1.37-5.45)^b b Adjusted for number of children in the house, socioeconomic status.	2.42 (1.20-4.85)^c c Adjusted for number of children in the house, socioeconomic status, and maternal age.
Non-monosymptomatic enuresis (yes)
Gross	3.38 (2.02-5.66)	3.83 (1.85-7.85)	3.34 (1.59-7.03)
Adjusted	3.17 (1.89-5.33)^a a Adjusted for socioeconomic status.	3.39 (1.64-7.01)^b b Adjusted for number of children in the house, socioeconomic status.	2.63 (1.23-5.62)^c c Adjusted for number of children in the house, socioeconomic status, and maternal age.
	Girls
	Any disorder	Hyperactivity disorders	Oppositional disorders
Enuresis at 11 years of age (yes)
Gross	3.69 (1.97-6.93)		4.73 (1.57-14.2)
Adjusted	3.62 (1.89-5.95)^d d Adjusted for maternal skin color. The other psychiatric disorders did not show statistical significance, as well as monosymptomatic enuresis.		4.73 (1.57-14.2)
Non-monosymptomatic enuresis (yes)
Gross	4.03 (2.09-7.77)		5.50 (1.82-16.6)
Adjusted	3.95 (2.0-7.81)^d d Adjusted for maternal skin color. The other psychiatric disorders did not show statistical significance, as well as monosymptomatic enuresis.		5.50 (1.82-16.6)

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:denisemmota@gmail.com (D.M. Mota).