Lifetime prevalence, comorbidities, and Sociodemographic predictors of post-traumatic stress disorder (PTSD): the National Epidemiology of Iranian Children and adolescents Psychiatric disorders (IRCAP).

OBJECTIVE: The aims of this study were to (a) evaluate the lifetime prevalence of post-traumatic stress disorder (PTSD) according to sociodemographic characteristics, (b) determine sociodemographic factors associated with PTSD, (c) estimate the lifetime prevalence rates of comorbidities by age and gender, and (d) assess the proportion of traumatic events in the non-PTSD sample and the PTSD sample, according to gender. METHODS: The data used for the present study were obtained from the IRCAP study which was a cross-sectional, community-based study on 29,250 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Trained psychologists conducted diagnostic interviews with parents, children, and adolescents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: In this study, the prevalence of PTSD across the sample population was 0.6% (95% CI, 0.5-0.7%). Higher rates of PTSD were observed among girls (0.7%, CI 0.5-0.8%), adolescents aged 15-18 years (0.8%, CI 0.6-1.0%), and participants who had unemployed (1.5%, CI 0.8-2.8%), or farmer fathers (1.1%, CI 0.5-2.5%). Of the participants with PTSD, 65.1% met the criteria for at least one other psychiatric disorder. PTSD had a high rate of comorbidity with oppositional defiant disorder (22.9%, CI 17.5-29.4%), generalized anxiety disorder (20.8%, CI 15.7-27.1%), separation anxiety disorder (20.3%, CI 15.2-26.6%), and major depressive disorder (19.8%, CI 14.8-26.0%). We found 9.5% of non-PTSD sample experienced at least one traumatic event. Witness to domestic violence was the most common traumatic event experienced by 32.8% of PTSD sample. CONCLUSION: Our results in the prevalence, comorbidities, and sociodemographic factors associated with PTSD supported findings of previous studies that used a structured diagnostic interview. It is recommended to use purposive sampling and to investigate comorbidities of PTSD and type of traumatic events in a large clinical population.

Evaluation of lifestyle and dietary inflammatory score and their relationship with the odds of depression, stress, and anxiety in adults living in Yazd, Iran; based on YaHS and TAMYZ cohort study.

BACKGROUND: Mental disorders such as depression, anxiety and stress are becoming more common worldwide. The aim of this study was to examine the relationship between dietary inflammations scores (DIS) and lifestyle inflammation scores (LIS) and the risk of depression, stress, and anxiety in a large sample of Iranian adults. METHODS: This study was based on 5579 adults (20-70 years) who participated in the Yazd Health Study (YaHS). The DIS score was calculated from the intake of 19 food groups and the LIS score was derived from four components. Multivariable logistic regression models were used to estimate the odds ratio (ORs) and 95 % confidence interval (CI) of depression, stress, and anxiety across quartiles of DIS and LIS. RESULTS: 2749 of the participants (46 % male) had anxiety, depression and stress. According to the adjusted model, there was a positive association between LIS and the risk of anxiety (OR: 1.23, 95 % CI: 1.01-1.49) and depression (OR: 1.39, 95 % CI: 1.14-1.69, P for trend: 0.03). However, there was no significant association between LIS and the risk of stress. There was also no significant association between DIS and the risk of anxiety, depression and stress. CONCLUSIONS: This study demonstrated that higher LIS scores were associated with depression and anxiety. It is suggested that following a LIS that includes smoking status, physical activity, alcohol consumption, and body mass index as indicators of the inflammatory promoting lifestyle, may increase the risk of depression and anxiety.

A Cardiovascular Risk Assessment Model According to Behavioral, Psychosocial and Traditional Factors in Patients With ST-Segment Elevation Myocardial Infarction (CRAS-MI): Review of Literature and Methodology of a Multi-Center Cohort Study.

This study aims to provide a comprehensive risk-assessment model including lifestyle, psychological parameters, and traditional risk factors to determine the risk of major adverse cardiovascular events (MACE) in patients with the first acute ST-segment elevation myocardial infarction episode. Patients were recruited from new hospital admissions of acute ST-segment elevation myocardial infarction and will be followed up to 3 years. Clinical and paraclinical characteristics, lifestyle, psychological, and MACE information are collected and will be used in the risk-assessment model. Totally, 1707 patients were recruited (male: 81.4%, mean age: 56.60 ± 10.34). Primary percutaneous coronary intervention was the most prevalent type of coronary revascularization (81.9%). In case of baseline psychological characteristics, mean depression score was 5.40 ± 4.88, and mean distress score was 7.64 ± 5.08. A comprehensive approach, focusing on medical, lifestyle, and psychological factors, will lead to better identification of cardiovascular disease patients at risk of developing MACE through comprehensive risk-assessment models.

The Rb/E2F axis is a key regulator of the molecular signatures instructing the quiescent and activated adult neural stem cell state.

Long-term maintenance of the adult neurogenic niche depends on proper regulation of entry and exit from quiescence. Neural stem cell (NSC) transition from quiescence to activation is a complex process requiring precise cell-cycle control coordinated with transcriptional and morphological changes. How NSC fate transitions in coordination with the cell-cycle machinery remains poorly understood. Here we show that the Rb/E2F axis functions by linking the cell-cycle machinery to pivotal regulators of NSC fate. Deletion of Rb family proteins results in activation of NSCs, inducing a transcriptomic transition toward activation. Deletion of their target activator E2Fs1/3 results in intractable quiescence and cessation of neurogenesis. We show that the Rb/E2F axis mediates these fate transitions through regulation of factors essential for NSC function, including REST and ASCL1. Thus, the Rb/E2F axis is an important regulator of NSC fate, coordinating cell-cycle control with NSC activation and quiescence fate transitions.

The Relationship of Parental Personality Disorders with Offspring Eating Disorders at Childhood and Adolescence Age.

This study aimed to investigate parents' PDs that could be associated with children and adolescents' EDs. We studied association of parental PDs with offspring EDs in age group 6-18 years in a nationally representative sample of Iranians with 27,111 children and adolescents and their parents. We used a multistage random cluster sampling method. We used Millon Clinical Multiaxial Inventory-Third Edition and Persian present and lifetime version of Kiddie Schedule for Affective Disorders and Schizophrenia to measure parental PDs and children and adolescents' EDs, respectively. We used descriptive statistics and binary logistic regression analysis methods to analyze the data. Maternal but not paternal PDs were significantly associated with EDs in offspring. Maternal antisocial, borderline, schizoid, histrionic, and compulsive PDs were significantly associated with EDs in offspring by 32.06, 4.66, 4.32, 3.15, and 1.71 odd ratios, respectively. Of EDs in offspring, anorexia nervosa and binge ED were significantly associated with maternal PDs.

Social Capital of Parents of Children and Adolescents and Its Relation to Psychiatric Disorders; A Population-Based Study.

Social capital is a complex concept that is considered an effective factor in the development of societies. Considering the importance of burdens of psychiatric disorders in Iran, we studied the relationship between various dimensions of social capital of parents of children and adolescents and psychiatric disorders among them. In this cross-sectional study, 18,940 parents of children and adolescents aged 6 to 18 years old were randomly selected from all provinces of Iran and were evaluated by the Millon clinical multiaxial inventory-III (MCMI-III) and a modified version of Nahapiet and Ghoshal questionnaire. MCMI-III was designed as a self-report tool for investigating psychiatric clinical disorders and personality traits in the general population. Modified Nahapiet and ghoshal questionnaire has 20 items and measures four components of social capital included trust, values, communication, and collaboration. Validity and reliability of both questionnaires have been approved in Iran. In the regression model, the relationship between social capital components and clinical and sever clinical syndromes, in the form of regression weight and standard weight for trust was - 0.558 and - 0.062 with p value less than 0.0001, and for values was - 0.466 and - 0.057, respectively, with p value less than 0.0001. There was a reverse correlation between social capital components of parents of children and adolescents and psychiatric disorders in Iran. In regression statistical models, the two components of values and trust were negative predictors of psychiatric disorders. Considering the high prevalence of psychiatric disorders in Iran, it seems that the strengthening of cognitive and structural aspects of social capital of parents of children and adolescents is one of the effective factors in reducing the prevalence of these disorders among them.

Lifetime Prevalence, Predictors and Comorbidities of Tic Disorders: A Population-Based Survey of Children and Adolescents in Iran.

In this population-based survey, we have evaluated the lifetime prevalence of tic disorders and related sociodemographic factors and comorbidities of them. The data obtained from face-to-face interviews with 29,885 children and adolescents aged 6-18 years. We used the multistage cluster sampling method and a cross-sectional design. Tic disorders and other psychiatric disorders were assessed using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). The lifetime prevalence of tic disorders was 1.5% (95% CI (1.3-1.7%)). The highest prevalence was in the age range of 15-18 years old with 1.9% (95% CI (1.6-2.3%)).57.7% (95% CI 51.8-63.3%) of patients with tic disorders had comorbidity with other psychiatric disorders. Increasing the prevalence of tic disorder with increasing age among Iranian children and adolescents, emphasizes the need to pay more attention to use of pharmacological and non-pharmacological treatments and increase education to families in this regard.

Parents' Personality Disorders as Predictor of Substance Use Disorder in Children and Adolescents.

BACKGROUND: This study investigated how the parents' personality disorders may be related to substance use disorder in children and adolescents. METHODS: The study was a cross-sectional study in which 28,540 children and adolescents (aged 6 to 18 years) and their parents participated between 2015 and 2016. The diagnosis of substance use was made using the Kiddie Schedule for Affective Disorders and Schizophrenia--Present and Lifetime Version (K-SADS-PL) interview and the personality disorders were assessed using Millon Clinical Multiaxial Inventory - Third Edition (MCMI-III). The parents were also surveyed for their personality assessed with MCMI. RESULTS: The results showed that the paranoid personality disorder in father (odds ratio [OR] = 8.34, 95% CI, P = 0.042) and borderline personality disorder in mother (OR = 4.6, 95% CI, P = 0.049) increase the chance of substance use in children. CONCLUSION: The findings suggest that in designing preventive programs for substance use, the personality characteristics of the parents need to be taken into account.

Prevalence, comorbidity, and predictors of obsessive-compulsive disorder in Iranian children and adolescents.

BACKGROUND AND OBJECTIVES: Obsessive-compulsive disorder (OCD) is a disease that causes personal distress or social dysfunction, especially in childhood. The present study aimed to provide the prevalence, comorbidity, and predictors of OCD among children and adolescents. METHODS: This was a cross-sectional national project conducted on 29,858 children and adolescents using the multi-stage cluster random sampling in Iran. There were both genders in each cluster and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research included a demographic questionnaire and K-SADS-PL. To analyze the data, logistic regression and cross-tab tests were used. RESULTS: According to the results, the prevalence of OCD in children and adolescents was 3.1 in boys and 3.8 in girls. Also, gender, age, place of residence, and history of psychiatric hospitalization of parents could predict OCD. OCD had comorbidity with behavioral disorders (OR = 0.60, 95%CI: 0.39-0.92), elimination disorders (OR = 0.50, 95%CI: 0.30-0.83), mood disorders (OR = 2.92, 95%CI: 1.43-5.94), and smoking and alcohol disorders (OR = 4.33, 95%CI: 1.28-14.63). CONCLUSION: In the development of the obsessive-compulsive disorder, other disorders and symptoms also environmental factors can play a role and are important. Based on our findings, given the prevalence rate of OCD was higher in the age groups of 10-14 and 15-18 years, are one of the most important stages of development for the prevention and treatment of mental disorders, especially OCD, clinical specialists can design appropriate clinical trials or modify existing interventions based on the results of such research.

Prevalence of elimination disorders and comorbid psychiatric disorders in Iranian children and adolescents.

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4% covering both enuresis (p= 5.4, 95% CI = 5.1-5.7) and encopresis (p= 0.13, 95% CI = 0.09-0.2). The total prevalence of comorbid disorders was 38%, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p= 11, 95% CI = 9.5-12.7) and Separation Anxiety (p= 10.6, 95% CI = 9.1-12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders.

Relationship between Anxiety Disorders and Anthropometric Indices, Risk Factors, and Symptoms of Cardiovascular Disorder in Children and Adolescents.

Objective: Anxiety is an unpleasant feeling characterized by symptoms of tachycardia, sweating, and stress. The exact relationship between anxiety and cardiovascular disorder is not well distinguished. The aim of the present study was to evaluate the relationship between anxiety disorders and anthropometric indices and risk factors, including fasting blood sugar (FBS), hyperlipidemia, and hypertension, according to the results, FBS low-density lipoprotein (LDL) and symptoms of cardiovascular disorder in children and adolescents aged 6 to 18 years. Method : In this community-based study, multistage cluster sampling method was used. We randomly selected 1174 children and adolescents who referred to Afshar hospital in Yazd, then, 167 blocks were randomly collected by each cluster head. Each cluster consisted of 6 cases, including three cases of each gender in different age groups (6-9, 10- 14, and 15-18 years). The clinical psychologists instructed the participants to complete the Persian version of Kiddie-Schedule for Affective Disorders and Schizophrenia - Present and Lifetime version (K-SADS-PL). In addition, cardiovascular risk factors were determined for participants and demographic data were obtained from the participants. Results: A total of 1035 children and adolescents participated in this study. The results showed that 228 of the participants (22.2%) suffered from anxiety disorder. There was an indirect significant correlation between anxiety disorder and the symptoms of heart palpitation, shortness of breath, and chest pain. There was no statistically significant relationship between the different types of anxiety disorders and FBS, hyperlipidemia, and hypertension. According to the results, FBS and LDL are a predictor for anxiety disorders. Conclusion: There was a statistically significant association between anxiety in children and adolescents and some risk factors of cardiovascular disorder. Also, this study introduces some cardiovascular predictors of anxiety. However, further studies are needed in this regard.

Prevalence of ADHD and Its Comorbidities in a Population-Based Sample.

Objective: We aimed to investigate the prevalence of ADHD and its comorbidities and some associated demographic factors in a large sample population-based study. Method: As part of a population-based survey among 30,532 children and adolescents between 6 and 18 years, we used K-SADS-PL to screen and detect ADHD and its comorbidities. Results: The prevalence of ADHD was 4%, with more prevalence among boys (5.2% vs. 2.7%), younger participants, urban residents, and offspring of mothers who had a history of psychiatric hospitalization. Anxiety disorders (37.9%) and behavioral disorders (31%) are the most prevalent group of comorbidities, and oppositional defiant disorder (ODD) is the most prevalent comorbid disorder (26.1%). Mood disorders and anxiety disorders are more common among girls, but conduct disorder has a higher rate among boys. Conclusion: ADHD is a common neurodevelopmental disorder which is accompanied by several comorbid conditions. The high rate of comorbidities makes it complicated and difficult to manage.

Age-, sex-, and height-based blood pressure reference charts, Yazd children 6-18 years, Iran.

BACKGROUND: Pediatric hypertension is the main cause of morbidity and mortality in pediatric populations. PURPOSE: To examine pediatric hypertension in a clinical setting, we used the percentile rank approach and defined hypertension as that above the 95th percentile. METHODS: The present study was linked to the a national analytical cross-sectional community-based Iranian Children and Adolescents' Psychiatric Disorders (IRCAP) survey. The survey was nationwide and funded by the National Institute of Medical Research Development. The IRCAP survey included 31,000 children and adolescents aged 6-18 years in all 31 Iran provinces. The current study included 1,035 children and adolescents and linked the data of the risk factors of cardiovascular disease only in Yazd province via random cluster sampling. RESULTS: Of the total participants, 456 (44.1%) were male and 579 (55.9%) were female. The mean age was 11.2±3.8 years (11.7±3.7 years for males, 11.0±3.6 years for females), while mean height was 146±20.0 cm overall, 147.2±22.0 cm for males, and 144.6±17.0 cm for females (P=0.009). The blood pressure distributions and percentiles were evaluated. CONCLUSION: Here we determined age- and height-specific 50th, 90th, 95th, and 99th percentiles of systolic and diastolic blood pressures in Yazd boys and girls using 10-cm height intervals.

Prevalence, comorbidity and predictors of anxiety disorders among children and adolescents.

Childhood anxiety may lead to serious health consequences in later life. The present study provides the prevalence, comorbidity, and predictors of anxiety disorders among children and adolescents. This was a cross-sectional national project that was implemented on 28,698 children and adolescents in Iran. Participants entered the study by multistage cluster sampling with an equal number of each gender and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research were the demographic questionnaire and K-SADS-PL. To analyze the data logistic regression and chi-square tests were used in SPSS (ver. 16). The prevalence of anxiety disorder in children and adolescents was 13.2 in boys and 15.1 in girls. Furthermore, gender, age, place of residence and history of psychiatric hospitalization of parents could predict anxiety disorders. Anxiety disorders had comorbidity with behavioral disorders, neurodevelopmental disorders, mood disorders, psychotic disorders, substance abuse disorders, and elimination disorders. According to our findings in this study, anxiety disorders affect the performance, health and life of children and adolescents, identifying the childhood anxiety, as well as finding diseases that are associated with anxiety disorders, can help in the prevention of the disorder.

Generalized anxiety disorder: Prevalence, predictors, and comorbidity in children and adolescents.

Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders among children and adolescents. OBJECTIVES: The purpose of this study is to determine the prevalence, sociodemographic variables, and comorbidity of GAD among children and adolescents to suggest the main predictors, using an analytical cross-sectional study. METHOD: Data were collected via a multistage random-cluster sampling method from 29,709 children and adolescents aged 6-18 years old in Iran. We used the Persian present and lifetime version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). Then, we analyzed the data via descriptive analysis and multivariate logistic regression analysis methods. RESULTS: The lifetime prevalence rate for GAD was 2.6 % (95 % Cl, 2.4%-2.8%). Overall, logistic regression analyses revealed five variables with significant unique contributions to the prediction of GAD. Significant predictors were: age, sex, mother history of psychiatric hospitalization, mother education, and residence. Participants with these risk factors were between 0.23-2.91 times more likely to present with GAD. Besides, the highest and lowest comorbidity rates of psychiatric disorder with GAD was 57.6 % and 0.3 % related to anxiety and eating disorders, respectively. Age or sex also affects the comorbidity of GAD and some mental disorders including behavioral, neurodevelopmental, elimination, and mood disorders. CONCLUSION: This study, which was conducted in Iran, is located at the low end of the range of international estimates for GAD. Awareness of the predictors and comorbidity of GAD could be used in the prevention of GAD in children and adolescents.

Prevalence, Comorbidity and Predictor of Separation Anxiety Disorder in Children and Adolescents.

Separation Anxiety Disorder(SAD) is one of the earliest anxiety disorders. The effect of this disorder on the performance of children and adolescents reveals the need for awareness of the prevalence and comorbidity of this disorder in each region. This study is a cross-sectional analytical study implemented in all provinces of Iran. The instrument used in this study is the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version(K-SADA-PL) questionnaire. The total number of participants was 29,699. The overall prevalence of SAD was 5.3%. The comorbidity rate of 65.3% was found between SAD and other psychiatric disorders. Specific phobia and oppositional defiant disorder had the highest comorbidity with this disorder in the studied population. The more prevalence of separation anxiety disorder in the age range of 6-9 years old highlights the need for early detection of this disorder and targeting screening programs in childhood and adolescence.

Prevalence of Abdominal Obesity and Metabolic Syndrome in Children and Adolescents: A Community Based Cross-Sectional Study.

BACKGROUND: Although the prevalence of abdominal obesity and metabolic syndrome has been widely studied in the adult population, little is known about it in children and adolescents especially in developing countries. This study aimed to determine the prevalence of abdominal obesity and metabolic syndrome among children and adolescents in Yazd Greater Area, Iran; over the period of 2016-2017. METHODS: This study was part of a larger national study with a cross-sectional design. Using multistage cluster random sampling method, 1035 children, and adolescents of both sexes aged 6-18 yr were randomly selected from rural and urban districts in Yazd Greater Area, Iran. Components of metabolic syndrome, and anthropometry measured in the standard situation. RESULTS: The prevalence of abdominal obesity in children 6-10 yr old was 13.2% in boys versus 24.7% in girls. The overall prevalence of metabolic syndrome according to International Diabetes Federation (IDF) criteria in adolescents aged 10-18 yr old was 7.6% (9.4% in boys). The most prevalent metabolic syndrome components were low HDL-cholesterol (56.2%) and abdominal obesity (27.8%). CONCLUSION: Comparatively, the prevalence of metabolic syndrome in Yazd is high. Low HDL-cholesterol levels and abdominal obesity were the most common component, and family history of heart disease, BMI, and male gender were the main determinants of metabolic syndrome in adolescents.

The Most Important Predictors of Metabolic Syndrome Persistence after 10-year Follow-Up: YHHP Study.

BACKGROUND: Metabolic syndrome (MetS) is one of the world's largest health epidemics, and its management is a major challenge worldwide. The aim of this 10-year follow-up study was to assess the most important predictors of MetS persistence among an Iranian adult population. METHODS: In this cohort study, 887 out of 2000 participants with MetS aged 20-74 years in the central part of Iran were followed-up for about 10 years from 2005-2006 to 2015-2016. MetS was defined based on the criteria of NCEP-ATP III adopted for the Iranian population. Cox proportional hazards regression was conducted to evaluate the predictors of MetS persistence in crude- and multivariate-adjusted models. RESULTS: Our analyses showed that 648 out of 887 participants (73%) completed the follow-up and 565 (87.2%) of them had persistence of MetS after 10-year follow-up. There was a significant association between age, weight, body mass index, triglyceride, and waist circumference in participants who had MetS compared to those without MetS after 10-year follow-up (P < 0.05). There was a direct association between increases in the mean changes of systolic/diastolic blood pressure, waist circumference, and low HDL-C and risk of MetS persistence after adjusting the model for sex and age in the total population (P trend < 0.05). The trends were the same for women except in diastolic blood pressure. After adjustment for potential confounders, the risk of MetS persistence in men was significantly higher than women (HR = 1.98, 95% CI: 1.38-2.85, Ptrend = 0.001). CONCLUSIONS: Most of the risk factors of MetS were positively associated with persistence of MetS. Therefore, modification of lifestyle is recommended to reduce MetS.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP)

Objective: This was the first national epidemiological study on oppositional defiant disorder (ODD) in Iran, which provided new information about the prevalence, comorbidities, and sociodemographic predictors of ODD. Methods: Data from a face-to-face household survey of 30,532 children and adolescents aged 6-18 years were collected from across all 31 provinces of Iran using a multistage cluster sampling design. The Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) was used in this study. Results: The lifetime prevalence of ODD was found to be 3.9%. ODD was significantly more common in boys than girls and appeared in late adolescence more frequently than in childhood. A lower prevalence of ODD was found among participants who lived in rural areas. ODD is highly likely to co-occur with attention deficit hyperactivity disorder, separation anxiety disorder, generalized anxiety disorder, and depressive disorders. Conclusions: The findings of this national population-based study confirm and extend previous findings on the prevalence, comorbidities, and sociodemographic predictors of ODD.

Social anxiety disorder among children and adolescents: A nationwide survey of prevalence, socio-demographic characteristics, risk factors and co-morbidities.

BACKGROUND: Social anxiety disorder is a frequent psychiatric disorder. We aimed to estimate the life-time prevalence, socio-demographic characteristics, risk factors and co-morbidities of this condition among children and adolescents. METHODS: This was a cross sectional national survey conducted in Iranian individuals aged 6 to 18 years. Face-to-face household interviews were performed by trained clinical psychologists. The Farsi version of the kiddie schedule for affective disorders and schizophrenia for school-age children/present and lifetime version (K-SADS-PL) was administered to estimate the SAD prevalence. Parental personality traits and their psychopathologies were also obtained using Millon clinical multiaxial inventory, third edition (MCMI-III) to find the possible risk factors. RESULTS: From 29,878 participants, 585 individuals were diagnosed with SAD and weighted lifetime prevalence of 1.8% was observed. The odds of this condition was significantly higher among older adolescents (odds ratio (OR):1.47; 95% confidence interval(CI): 1.11-1.95) and individuals with paternal history of psychiatric hospitalization (OR: 2.96; 95%CI: 1.29-6.79). Higher means of persistent depression disorder (OR: 1.009; 95%CI: 1.000-1.018) and melancholic personality trait (OR: 1.007; 95%CI: 1.001-1.014) in mothers as well as schizophrenia spectrum (OR: 1.014; 95%CI: 1.001-1.027) and anxiety (OR: 1.010; 95%CI: 1.010-1.021) in fathers were statistically associated with higher odds of SAD in their children. Other anxiety disorders and behavioral disorders were the most prevalent co-morbidities. LIMITATIONS: The cross-sectional analysis does not enable analyses of possible causal associations. Lacking control group and follow-up periods were other major limitations that should be resolved in future studies. CONCLUSION: Clinicians and researchers need to continue studying this condition at all levels and in all developmental periods.