title: Obsessive-compulsive symptoms are associated with psychiatric comorbidities, behavioral and clinical problems: a population-based study of Brazilian school children.
abstract: Pediatric-onset obsessive-compulsive disorder (OCD) is underdiagnosed, and many affected children are untreated. The present study seeks to evaluate the presence and the clinical impact of OCD and obsessive-compulsive symptoms (OCS) in a large sample of school-age children. In Phase I, we performed an initial screening using the Family History Screen (FHS). In Phase II, we identified an "at-risk" sample, as well as a randomly selected group of children. A total of 2,512 children (6-12 years old) were assessed using the FHS, the Development and Well-Being Assessment (DAWBA), the Strengths and Difficulties Questionnaire (SDQ), and the Child Behavior Checklist (CBCL). Data analyses included descriptive and multivariate analytical techniques. 2,512 children (mean age: 8.86 ± 1.84 years; 55.0% male) were categorized into one of the three diagnostic groups: OCD (n = 77), OCS (n = 488), and unaffected controls (n = 1,947). There were no significant socio-demographic differences (age, gender, socioeconomic status) across groups. The OCS group resembled the OCD on overall impairment, including school problems and delinquent behaviors. However, the OCD group did have significantly higher rates of several comorbid psychiatric disorders, including separation anxiety, generalized anxiety, and major depressive disorder, than OCS or unaffected controls. Moreover, the OCD group also scored higher than the SDQ, as well as on each of CBCL items rated by the parent. Our findings suggest that there is a psychopathological continuum between OCS and OCD in school-aged children. The presence of OCS is associated with functional impairment, which needs further investigation in longitudinal studies.
authors.affiliation: Department and Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 01060-970, Brazil. pedrodealvarenga@gmail.com.|National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo, SP, 01060-970, Brazil. pedrodealvarenga@gmail.com.
authors.forename: Pedro G
authors.initials: PG
authors.lastname: Alvarenga
authors.affiliation: National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo, SP, 01060-970, Brazil. mariaceica.rosario@gmail.com.|Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Pedro de Toledo, 590, São Paulo, SP, 04038-020, Brazil. mariaceica.rosario@gmail.com.
authors.forename: Maria C
authors.initials: MC
authors.lastname: do Rosario
authors.affiliation: Department and Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 01060-970, Brazil.|National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo, SP, 01060-970, Brazil.
authors.forename: Raony C
authors.initials: RC
authors.lastname: Cesar
authors.affiliation: National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo, SP, 01060-970, Brazil. gmanfro@gmail.com.|Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil. gmanfro@gmail.com.
authors.forename: Gisele G
authors.initials: GG
authors.lastname: Manfro
authors.affiliation: Department and Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 01060-970, Brazil.|National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo, SP, 01060-970, Brazil.
authors.forename: Tais S
authors.initials: TS
authors.lastname: Moriyama
authors.affiliation: Child Study Center, Yale School of Medicine, 230, South Frontage Rd, New Haven, CT, 06519, USA. michael.bloch@yale.edu.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Bloch
authors.affiliation: Department and Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 01060-970, Brazil.|National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo, SP, 01060-970, Brazil.
authors.forename: Roseli G
authors.initials: RG
authors.lastname: Shavitt
authors.affiliation: Department and Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 01060-970, Brazil.|National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo, SP, 01060-970, Brazil.
authors.forename: Marcelo Q
authors.initials: MQ
authors.lastname: Hoexter
authors.affiliation: Child Study Center, Yale School of Medicine, 230, South Frontage Rd, New Haven, CT, 06519, USA.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Coughlin
authors.affiliation: Department and Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 01060-970, Brazil.|Child Study Center, Yale School of Medicine, 230, South Frontage Rd, New Haven, CT, 06519, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Leckman
authors.affiliation: Department and Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 01060-970, Brazil.|National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo, SP, 01060-970, Brazil.
authors.forename: Euripedes C
authors.initials: EC
authors.lastname: Miguel
mesh_terms: D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015999:Multivariate Analysis; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012574:Schools; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Child and adolescent psychiatry; Comorbidities; Epidemiology; Obsessive–compulsive disorder; School-aged children