title: Psychosocial stress predicts future symptom severities in children and adolescents with Tourette syndrome and/or obsessive-compulsive disorder.
abstract: BACKGROUND
  The goals of this prospective longitudinal study were to monitor levels of psychosocial stress in children and adolescents with Tourette syndrome (TS) and/or obsessive-compulsive disorder (OCD) compared to healthy control subjects and to examine the relationship between measures of psychosocial stress and fluctuations in tic, obsessive-compulsive (OC), and depressive symptom severity.
  
  
  METHODS
  Consecutive ratings of tic, OC and depressive symptom severity were obtained for 45 cases and 41 matched healthy control subjects over a two-year period. Measures of psychosocial stress included youth self-report, parental report, and clinician ratings of long-term contextual threat. Structural equation modeling for unbalanced repeated measures was used to assess the temporal sequence of psychosocial stress with the severity of tic, OC and depressive symptoms.
  
  
  RESULTS
  Subjects with TS and OCD experienced significantly more psychosocial stress than did the controls. Estimates of psychosocial stress were predictive of future depressive symptoms. Current levels of psychosocial stress were also a significant predictor of future OC symptom severity, but not vice versa. Current OC symptom severity was a predictor of future depressive symptom severity, but not vice versa. Current levels of psychosocial stress and depression were independent predictors of future tic severity, even after controlling for the effect of advancing chronological age.
  
  
  CONCLUSIONS
  The impact of antecedent psychosocial adversity is greater on future depressive symptoms than for tic and/or OC symptoms. Worsening OC symptoms are also a predictor of future depressive symptoms. Advancing chronological age is robustly associated with reductions in tic severity.
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-7900, USA.
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
authors.forename: Liliya
authors.initials: L
authors.lastname: Katsovich
authors.forename: Musie
authors.initials: M
authors.lastname: Ghebremichael
authors.forename: Diane B
authors.initials: DB
authors.lastname: Findley
authors.forename: Heidi
authors.initials: H
authors.lastname: Grantz
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Lombroso
authors.forename: Robert A
authors.initials: RA
authors.lastname: King
authors.forename: Heping
authors.initials: H
authors.lastname: Zhang
authors.forename: James F
authors.initials: JF
authors.lastname: Leckman
mesh_terms: D000293:Adolescent; D002648:Child; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011446:Prospective Studies; D011584:Psychology; D012720:Severity of Illness Index; D012919:Social Behavior; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D013997:Time Factors; D005879:Tourette Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*