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Relationship between elimination disorders and internalizing-externalizing problems in children: A systematic review and meta-analysis

Published online by Cambridge University Press:  19 July 2023

C. Aymerich ,
B. Pedruzo ,
M. Pacho ,
M. Laborda ,
J. Herrero ,
M. Bordenave ,
G. Salazar de Pablo ,
E. Sesma ,
A. Fernandez-Rivas  and
A. Catalan
...Show all authors
C. Aymerich*
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain
B. Pedruzo
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain
M. Pacho
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain
M. Laborda
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain
J. Herrero
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain
M. Bordenave
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain
G. Salazar de Pablo
Affiliation:
2Institute of Psychiatry, Psychology and Neuroscience, King’s College London 3Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom
E. Sesma
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain 4Neuroscience, University of the Basque Country (UPV/EHU) 5Psychiatry, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao 6Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid
A. Fernandez-Rivas
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain 5Psychiatry, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao 6Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid 7Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Spain
A. Catalan
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain 5Psychiatry, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao 6Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid 7Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Spain 8Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
M. Á. González-Torres
Affiliation:
1Psychiatry, Basurto University Hospital, Bilbao, Spain 5Psychiatry, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao 6Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid 7Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Spain
*
*Corresponding author.

Abstract

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Introduction

Elimination disorders (ED) include enuresis, defined as wetting from 5 years, and encopresis, defined as soiling from 4 years onwards after organic causes are excluded. They are highly prevalent in childhood and often associated with clinically relevant comorbid psychological disorders. However, no systematic review or meta-analysis examines their co-occurrence with internalizing and externalizing problems in children.

Objectives

The aim of this study is to determine if, and to what extent, children with ED show higher internalizing and externalizing problems than their healthy peers.

Methods

A multistep literature search was performed from database inception until May 1st, 2022. PRISMA/MOOSE-compliant systematic review (PROSPERO: CRD42022303555) were used to identify studies reporting on internalizing and/or externalizing symptoms in children with an ED and a healthy control (HC) group. First, a systematic review was provided. Second, where data allowed for it, a quantitative meta-analysis using random effects model was conducted to analyze the differences between the ED and the HC groups for internalizing and externalizing symptoms. Effect size was standardized mean difference. Meta-regression analyses were conducted to examine the effect of sex, age, and study quality. Funnel plots were used to detect a publication bias. Where found, the trim and fill method was used to correct it.

Results

36 articles were included, 32 of them reporting on enuresis (n=3244; mean age=9.4; SD=3.4; 43.84% female) and 7 of them on encopresis (n=214; mean age=8.6; SD=2.3; 36.24% female) [Image 1]. The ED group presented significantly lower self-concept (ES:0.42; 95%CI: [0.08;9.76]; p=0.017) and higher symptom scores for thought problems (ES:-0.26; 95%CI: [-0.43;-0.09]; p=0.003), externalizing symptoms (ES:-0.20; 95%CI: [-0.37;-0.03]; p=0.020), attention problems (ES:-0.37; 95%CI: [-0.51;-0.22]; p=0.0001), aggressive behaviour (ES:-0.33; 95%CI: [-0.62;-0.04]; p=0.025) and social problems (ES: 0.39; 95%CI: [-0.58;-0.21]; p=0.0001) [Image 2]. Significant publication biases were found across several of the studied domains [Image 3]. No significant effect of sex, age or quality of the study score was found.

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Image 2:

Image 3:

Conclusions

Children with an elimination disorder may have significant internalizing and externalizing problems, as well as impaired self-concept. It is recommendable to screen for them in children with ED and provide interventions as appropriate.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 66 , Special Issue S1: Abstracts of the 31st European Congress of Psychiatry , March 2023 , pp. S328 - S330
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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