ArticleFrontiers in psychiatry2026
Tic severity and quality of life in children with tic disorders: the chain mediating effects of stigma and anxiety.
Article in Frontiers in psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To explore the association between tic severity and quality of life (QoL) in children with tic disorder (TD) and the hypothesized chain mediating roles of stigma and anxiety in this association. Methods: A total of 198 children with TD (January 2023-October 2025) were enrolled. Data were collected using the Yale Global Tic Severity Scale (YGTSS), Stigma Scale for Mental Illness in Children (SSMI-C), Screen for Child Anxiety Related Emotional Disorders (SCARED), Pediatric QoL Inventory 4.0 (PedsQL 4.0), and a general questionnaire. Correlation and chain mediation analyses were performed using SPSS 26.0, and mediation effects were verified using the bootstrap method (5,000 re-samples). Results: Among the 198 children with TD, the mean total scores were as follows: YGTSS, 41.19 ± 13.34; SSMI-C, 41.12 ± 9.98; SCARED, 26.29 ± 6.07; and PedsQL 4.0, 62.29 ± 14.10. PedsQL 4.0 scores differed significantly according to gender, monthly family income, and disease course (all P<0.05). Pearson correlation analysis showed that YGTSS, SSMI-C, and SCARED scores were negatively correlated with PedsQL 4.0 scores (r = -0.791, -0.743, and -0.689, respectively; all P<0.05), whereas YGTSS scores were positively correlated with SSMI-C and SCARED scores (r = 0.831 and 0.659, respectively; both P<0.05). SSMI-C scores were positively correlated with SCARED scores (r = 0.609, P<0.05). The direct effect of YGTSS on PedsQL 4.0 was significant, accounting for 53.89% of the total effect. Three significant indirect pathways were identified: (1) YGTSS→SSMI-C→PedsQL 4.0 (effect = -0.195, 23.35%); (2) YGTSS→SCARED→PedsQL 4.0 (effect = -0.142, 17.01%); and (3) YGTSS→SSMI-C→SCARED→PedsQL 4.0 (effect = -0.048, 5.75%). Conclusion: Tic severity is directly associated with the QoL in children with TD and is also indirectly associated with the QoL through the individual mediating effects of stigma and anxiety, as well as the hypothesized chain mediating pathway of stigma and anxiety. These cross-sectional findings are consistent with a hypothesized sequential pathway and suggest that interventions targeting stigma and anxiety-including cognitive-behavioral therapy, peer-support programs, school-based psychoeducation, and family interventions-should be evaluated as potential strategies to improve QoL in children with TD.
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