Relationships among premonitory urge, tics, and quality of life in drug-naive children with tic disorders: a mediation analysis of a Chinese sample

Background: This study explores the relationship among premonitory urges (PU), tic severity, and quality of life in individuals with tic disorders (TD). Methods: : Clinical data from 1204 drug-naive TD patients aged 6-16 were collected, including the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge to Tic Scale (PUTS), and Tourette-Quality of Life Scale (GTS-QOL). Patients were categorized into PU (PUTS > 12) and non-PU (NPU, PUTS ≤ 12) groups. Logistic regression assessed age and gender's influence on PU presence. Correlation and mediation analyses were performed. Results: : Among 911 PU and 293 NPU patients, significant differences (p < 0.05) existed in age, YGTSS, GTS-QOL scores, excluding cognitive and physical factors. Sex differences were insignificant ( p = 0.228). Age was a significant predictor for PU (OR = 1.127, p = 0.001). Tic-related impairment did not mediate ( p > 0.05) the PU-quality of life relationship. Vocal tics mediated ( p < 0.05) overall quality of life, while motor tics mediated ( p < 0.05) the PU-quality of life link. Conclusions: : PU incidence in TD increases with age, predicting higher tic severity and reduced quality of life. Motor and vocal tics, but not tic-related impairment, mediate the PU-quality of life effect. Targeting PU, motor tics, or vocal tics in therapies may enhance TD patients' quality of life.