More anxious or more shy? Examining the social anxiety levels of adolescents with primary enuresis nocturna: a controlled study.
INTRODUCTION
Enuresis nocturna (EN) is very common worldwide, and psychiatric disorders are 1.3-4.5 times higher in children with EN. When the authors focus on symptoms of individuals with EN, they figured out that the individuals were impaired in social and emotional skills because of the dramatic consequences of EN. The authors presume that, despite a lack of psychiatric comorbidity, primary enuresis nocturna (PEN) itself and its consequences may increase adolescents' social anxiety (SA), leading to adulthood mental diseases.


OBJECTIVE
In this study, the authors aimed to investigate the presence of SA of adolescents with monosymptomatic PEN without any psychiatric comorbidity by comparing them with their healthy peers.


METHODS
The study was composed of 56 children who applied to pediatric nephrology outpatient clinic and were diagnosed with monosymptomatic PEN and 42 healthy controls. The psychiatric diagnoses were made by a child psychiatrist, with the help of a semistructured interview (Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, K-SADS-PL), and patients were required to fill out the Screen for Child Anxiety and Related Disorders, Social Anxiety Scale for Adolescents (SAS-A), and Children's Depression Inventory (CDI) scales with the help of a clinical psychologist. The physical examination made by a pediatric nephrologist and dysfunctional voiding and incontinence scoring system questionnaire were used to evaluate the voiding dysfunction in children.


RESULTS
There was no significant difference in the total depression and anxiety scores between the groups (p > 0.05). There was a significant difference between the two groups in the subscale of SA (t = 2.67 p = 0.009) (Table). Social Anxiety Scale for Adolescents (p < 0.001) and subscales of SAS-A (Fear of Negative Evaluation [p < 0.001], General Social Avoidance and Distress [p = 0.003], Social Avoidance and Distress in New Situations [p < 0.001]) scores were significantly higher in the patient group.


DISCUSSION
The authors want to emphasize the comorbid SA of adolescents diagnosed with PEN. This anxiety may disturb adolescents' health in two ways: first, with the help of direct consequences of the SA and second, being late for seeking help for the EN and possible delay in EN treatments. The main limitation of this study is the assessments of the prior mental status of subjects were made by K-SADS-PL, thus remaining a recall bias. A follow-up study may be more objective.


CONCLUSION
So all adolescents diagnosed with PEN should require a detailed mental examination to prevent further negative consequences and provide more comprehensive treatment. Also, the study needed to be repeated in larger samples, and prospective studies should be designed to enhance authors' understanding.