Abstract: Background Neurocardiogenic syncope (NMS) is commonly caused by vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS). Clinical observations by our research team have suggested that some pediatric NMS patients exhibit varying degrees of anxiety and depressive tendencies. Objective To investigate the correlation between NMS and anxiety-depression in pediatric patients. Design A case-control study. Methods Refering to the 2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents, this study included children aged >9 years who were diagnosed with VVS or POTS at multidisciplinary syncope consultation clinic of Children's Hospital of Fudan University between July 2019 and October 2022 and agreed to participate in the study as the NMS group. A control group was selected from healthy children aged >9 years undergoing routine physical examinations at the hospital during the same period. Children diagnosed with respiratory, cardiovascular, gastrointestinal, infectious, or transmissible disorders were excluded from both groups. The participants' anxiety and depressive states were assessed using the Somatic Symptom Scale (SSS), the Generalized Anxiety Disorder Scale (GAD-7), and the 9-item Patient Health Questionnaire (PHQ-9). The correlation between NMS and anxiety-depression was analyzed. Main outcome measures The correlation coefficient between NMS and anxiety-depression Results A total of 70 cases were included in the NMS group and 30 cases in the control group. The NMS group consisted of 45 children with VVS and 25 with POTS, including 34 boys and 36 girls. The control group included 11 boys and 19 girls. The BMI of the NMS group was significantly lower than that of the control group (P<0.05), while there were no significant differences in sex distribution, age, height, or weight between the two groups. Similarly, within the NMS group, there were no significant differences in sex distribution, age, height, weight, or BMI between the VVS and POTS subgroups. The total scores for SSS, GAD-7, and PHQ-9 were significantly higher in the NMS group than in the control group, with a lower proportion of normal scores (P<0.05). In the NMS group, 45 cases (64.3%) had abnormal SSS scores, with mild, moderate, and severe somatic symptoms occurring more frequently than in the control group. Abnormal GAD-7 scores were observed in 36 cases (51.4%), with higher proportions of mild and moderate anxiety compared to the control group. Similarly, 41 cases (59.6%) exhibited abnormal PHQ-9 scores, with depressive tendencies as well as mild, moderate, and severe depression being more common in the NMS group (P<0.05). No significant differences were found between the VVS and POTS subgroups regarding total scores and severity levels on the three assessment scales. Correlation analysis revealed associations between SSS and GAD-7 (r= 0.792, P<0.01) and between SSS and PHQ-9 (r=0.859, P<0.01), as well as between GAD-7 and PHQ-9 (r=0.794, P<0.01). Multiple regression analysis showed that SSS, GAD-7, and PHQ-9 scores were not significantly associated with sex, age, or BMI but were significantly associated with NMS diagnosis (β= -9.846, -2.915, and -3.154, respectively, all P<0.05). Conclusion The SSS, GAD-7, and PHQ-9 scales are valuable tools for assessing the psychological state of children with NMS. This study found a s correlation between NMS and anxiety-depression, with more than half of NMS patients exhibiting anxiety or depressive tendencies of varying severity. Somatic symptoms were the predominant clinical manifestation of psychological distress in these patients.

Key words: Neurocardiogenic syncope, Children, Anxiety, Depression