title: Anxiety and depression levels in prepubertal obese children: a case-control study.
abstract: BACKGROUND
  Childhood obesity has become a worldwide epidemic in Western and in developing countries and has been accompanied by many serious and severe comorbidities, such as diabetes, hypertension, sleep apnea syndrome, depression, dyslipidemia, impaired glucose homeostasis, steatohepatitis, and intracranial hypertension, as well as medical concerns unique to youth, such as accelerated pubertal and skeletal development and orthopedic disorders. To date, no specific studies about the psychological assessment in pediatric obesity are present. Therefore, the aim of this study was to evaluate the putative relationship between psychological troubles and obesity in a sample of school-aged children.
  
  
  METHODS
  The study population consists of 148 obese subjects (body mass index [BMI] >95th percentile) (69 males, mean age 8.9±1.23 years) consecutively referred from clinical pediatricians to the Child and Adolescent Neuropsychiatry department at the Second University of Naples. In all subjects, weight, height, and BMI z-score were evaluated. In order to assess the anxiety levels and the presence of depressive symptoms, the Children Depression Inventory (CDI) and the Italian Self-Administered Psychiatric Scales for Children and Adolescents (SAFA) were administered. The control group consisted of 273 healthy children (129 males and 144 females) (mean age 9.1±1.8 years), enrolled in schools within the Campania region of Italy.
  
  
  RESULTS
  No significant differences between the two study groups were found for age (8.9±1.23 years in the obese sample and 9.1±1.8 years in the control group) (P=0.228) or sex (ratio male/female: 69/79 in the obese group versus 129/144 in the control group) (P=0.983). Obviously, significant difference was found for the BMI z-score (2.46±0.31 in the obese group vs 0.73±0.51 in the control group) (P<0.001). The obese subjects showed significant higher level of depressive symptoms (CDI total score) (16.82±7.73 vs 8.2±2.9) (P<0.001) and anxiety (SAFA - Anxiety [SAFA-A]) scale score (58.71±11.84 vs 27.75±11.5) (P<0.001) compared with the control group. Moreover, the Pearson's correlation analysis showed a significantly positive relationship between the BMI z-score and both the CDI (r=0.677; P<0.001) and SAFA-A scores (r=0.591; P<0.001).
  
  
  CONCLUSIONS
  Our findings highlighted the importance of assessing the presence of internalizing problems, such as anxiety and depression, in the common management of childhood obesity.
authors.affiliation: Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Esposito
authors.affiliation: Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Gallai
authors.affiliation: Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Roccella
authors.affiliation: Department of Psychiatry, "Magna Graecia" University of Catanzaro, Catanzaro, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Marotta
authors.affiliation: Department of Psychiatry, "Magna Graecia" University of Catanzaro, Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lavano
authors.affiliation: Department of Psychiatry, "Magna Graecia" University of Catanzaro, Catanzaro, Italy.
authors.forename: Serena Marianna
authors.initials: SM
authors.lastname: Lavano
authors.affiliation: Unit of Child and Adolescent Neuropsychiatry, AUSL Umbria 2, Terni, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mazzotta
authors.affiliation: Centro per la Diagnosi e Cura dei Disturbi dell'apprendimento e del Comportamento Associazione per la ricerca scientifica Fusis, Alvignano, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Bove
authors.affiliation: Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Sorrentino
authors.affiliation: Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Precenzano
authors.affiliation: Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carotenuto
keywords: CDI; SAFA; childhood obesity; internalizing problems