The Prevalence and Comorbidity of Tic Disorders and Obsessive-Compulsive Disorder in Chinese School Students Aged 6–16: A National Survey

Abstract

Background: Obsessive-compulsive disorder (OCD) and tic disorders (TDs) are closely related and considered to etiologically overlap. Both disorders are characterized by repetitive behaviors. TD and OCD often co-occur. The high comorbidity between OCD and TD individuals suggests that we also need to pay more attention to the homogeneity and heterogeneity between TS and OCD. To date, there has been no systematic nationwide epidemiological survey of the mental health (including tic disorders and obsessive-compulsive disorder) of children and adolescents in China. Methods: A two-stage epidemiological study of psychiatric point prevalence was conducted. We used the multistage cluster stratified random sampling strategy to assess five provinces of China. The Child Behavior Checklist was used to identify behavioral problems among the enrolled students in the first stage. The results from the Mini-International Neuropsychiatric Interview for Children and Adolescents and evaluations from two psychiatrists based on the Diagnostic and Statistical Manual-IV were used to make a diagnosis. Point weighted prevalence for TD and OCD was estimated. We adjusted prevalence estimates with the product of sampling weights and poststratification weights. Standard error values and 95% confidential intervals were generated with Taylor series linearization. Rao–Scott adjusted chi-square (χ2) tests were employed to compare the prevalence estimates of different age and sex groups. Results: In the first stage, 73,992 participants aged 6–16 years old were selected. The prevalence rates of OCD and TDs were 1.37% (95% CI: 1.28–1.45) and 2.46% (95% CI: 2.35–2.57), respectively. The prevalence of OCD was found to be higher in girls (p < 0.001) and higher in boys with transient tic disorder (TTD) (p < 0.001) and Tourette’s syndrome (TS) (p < 0.001). The most common comorbidity of TS was OCD (40.73%), and for OCD, it was TS (11.36%). Conclusions: Our study is the first nationwide survey on the prevalence of TD (2.46%) and OCD (1.37%) in school students aged 6–16 years old in China. The high comorbidity between OCD and TD individuals suggested overlap based on the prevalence dimensions, which might be influenced by age and sex. This result suggested that we also need to pay more attention to the homogeneity and heterogeneity between TS and OCD.

Time is ticking for TikTok tics: A retrospective follow‐up study in the post‐COVID‐19 isolation era

“…Further differentiating FTLB sufferers from those with tics is that fewer than ¼ of our patients had comorbid OCD, in contrast to tic disorders in which the comorbidity with OCD is estimated at 40–50% (Hirschtritt et al., 2015 ; Termine et al., 2006 ; Yan et al., 2022 ). This discrepancy is consistent with the largest controlled study to date which found that overall a lack of tic‐related OCD behaviors and lack of family history were the strongest predictors of functional tics versus neurodevelopmental tics (Cavanna et al., 2023b ).…”

“…In our cohort, the percentage of patients with FTLBs and ASD is similar to those with classic tics (9% vs. 7%), though given our small cohort size, this remains to be validated in a larger sample. Data from : Termine C et al., (Termine et al., 2006 ) Yan J et al., (Yan et al., 2022 ) Hirschtritt ME et al., (Hirschtritt et al., 2015 ) Ogundele MO et al., (Ogundele & Ayyash, 2018 ) and Gulisano M, Barone R, Mosa MR, et al. Incidence of Autism Spectrum Disorder in Youths Affected by Gilles de la Tourette Syndrome Based on Data from a Large Single Italian Clinical Cohort.…”

“…Data from: Termine C et al,(Termine et al, 2006) Yan J et al,(Yan et al, 2022) Hirschtritt ME et al, (Hirschtritt et al, 2015 Ogundele MO et al,(Ogundele & Ayyash, 2018) and Gulisano M, Barone R, Mosa MR, et al Incidence of Autism Spectrum Disorder in Youths Affected by Gilles de la Tourette Syndrome Based on Data from a Large Single Italian Clinical Cohort. Brain Sci.…”

Treatment of Tourette syndrome by acupuncture combined with Chinese medicine based on syndrome differentiation: A review

“…[2] TS is estimated to be diagnosed in 0.3% to 0.9% of school-aged children [3] and 0.002% to 0.08% of adults, [4] but there are few adult epidemiological studies worldwide. According to the latest national survey, [5] the latest estimate of TS prevalence in China is 2.46%. TS occurs mostly in men, with a ratio of 4:1, and the symptoms tend to be more severe in men than in women.…”

Human mutations in high-confidence Tourette disorder genes affect sensorimotor behavior, reward learning, and striatal dopamine in mice

“…Tics are frequently precipitated by unpleasant sensations and urges, with the tic providing relief (1,2). Chronic tic disorders (CTD), a broad category that includes TD, are estimated to affect ~1/50 school aged children in the United States and China (3)(4)(5).…”