title: Depression, anxiety, and functional impairment in children with trichotillomania.
abstract: BACKGROUND
  Trichotillomania (TTM) remains understudied in children. Adult research suggests that TTM is accompanied by significant depression, anxiety, and functional impairment. The purpose of this study is to examine the occurrence of depression and anxiety in a relatively large sample of youth with TTM and the extent to which these symptoms mediate the relationship between TTM severity and associated impairment.
  
  
  METHODS
  The study utilized data from the Child and Adolescent Trichotillomania Impact Project (CA-TIP), an internet-based sample of 133 youth aged 10-17 (inclusive) with TTM.
  
  
  RESULTS
  Over 45% of children with TTM endorsed depressive symptoms and 40% endorsed anxiety symptoms in excess of one standard deviation (SD) above published community norms. More remarkably, 25% of our sample reported depressive and 20% reported anxiety symptoms in excess of 2 SD above these norms. Older participants reported more symptoms of depression and anxiety than younger ones; age of onset (children with later onset), but not duration of illness, was predictive of higher reports of both depressive and anxiety symptoms. Neither depressive nor anxiety symptoms were related to pulling site. Depressive symptoms partially mediated the relationship between TTM severity and functional impairment.
  
  
  CONCLUSIONS
  Based on an internet sample recruited from the homepage of the Trichotillomania Learning Center, data from this study suggests that symptoms of depression and anxiety may be pervasive among youth with TTM and likely impact functional impairment. Longitudinal studies using directly assessed samples are needed to replicate and extend these findings.
authors.affiliation: UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024-1759, USA. alewin@mednet.ucla.edu
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Flessner
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Woods
authors.forename: Martin E
authors.initials: ME
authors.lastname: Franklin
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Keuthen
authors.forename: Phoebe
authors.initials: P
authors.lastname: Moore
authors.forename: Muniya
authors.initials: M
authors.lastname: Khanna
authors.forename: John S
authors.initials: JS
authors.lastname: March
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: D000124:Achievement; D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003674:Defense Mechanisms; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D033062:Friends / Q000523:psychology; D006306:Health Surveys; D006801:Humans; D007389:Internal-External Control; D020407:Internet; D008297:Male; D010555:Personality Inventory; D012649:Self Concept; D012917:Social Adjustment; D014256:Trichotillomania / Q000453:epidemiology* / Q000523:psychology