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

Premonitory urges (PUs) are common in tic disorders (TDs), but their relationships with tic severity and quality of life (QoL) in pediatric patients remain unclear. This study examined the associations among PU severity, tic severity, and QoL in drug-naïve children and adolescents with TDs, and tested whether tic severity statistically mediated the association between PU severity and QoL. Drug-naïve children and adolescents aged 6–17 years with TDs were recruited from Beijing Children’s Hospital. Tic severity, PU severity, and QoL were assessed using the Yale Global Tic Severity Scale, Premonitory Urge for Tics Scale, and Gilles de la Tourette Syndrome–Quality of Life Scale. Group comparisons, logistic regression, partial correlation, and bootstrap-based mediation analyses were performed. A total of 1,232 drug-naïve participants with TDs were included, of whom 1,060 had PUs, giving a prevalence of 86.0% (95% CI, 84.0%–87.9%). Compared with the NPU group, the PU group was older and had higher YGTSS motor-tic, tic-related impairment, and total scores; these differences remained statistically significant after false-discovery-rate correction. No statistically significant between-group differences were found in sex, ADHD status, YGTSS vocal-tic score, or GTS-QOL total and domain scores after correction. Multiple logistic regression showed that age was associated with PU presence, whereas sex and ADHD status were not. In the PU group, mediation analyses showed statistically significant indirect effects of motor tic severity, vocal tic severity, and tic-related impairment in the association between PU severity and overall QoL and its cognitive, obsessive–compulsive, physical, and psychological domains. The direct association between PU severity and QoL remained statistically significant across models. PU presence was more common at older ages and was associated with greater tic severity. In participants with PUs, tic-severity measures showed statistically significant indirect effects in the association between PU severity and QoL, while the direct association remained significant. Given the cross-sectional design, these findings should not be interpreted as establishing a causal pathway or as supporting a treatment priority between premonitory urges and tic symptoms.