Abstract: Objective To explore the clinical significance of orthostatic intolerance(OI)symptom scores and 24 h urinary catecholamines in the assessment of anxiety and depressive disorders in children with vasovagal syncope(VVS). Methods This was a retrospective analysis. The medical records of 53 children with VVS admitted to the Department of Pediatrics, Qilu Hospital of Shandong University from June 2018 to December 2021 were collected. They were divided into anxious group(29 cases), non-anxious group(24 cases), depressed group(13 cases), and non-depressed group(40 cases)according to the scores of psychological scale. All children were assessed using the OI symptom score, screen for child anxiety related emotional disorders(SCARED), and child depression inventory(CDI)scales. The childrens 24 h urinary catecholamine levels were analyzed by liquid chromatography-tandem mass spectrometry. Normative controls were derived from nationally published studies of school-aged children normal model group assessed with the same scales. t-test, Mann-Whitney U-test, and χ² test were used to compare the data between groups. The Pearson or Spearman correlation method was used for correlation analysis, and the predictive value of the OI symptom scores was analyzed using the ROC curve. Results (1)The mean SCARED score of 53 children with VVS was 26.7±15.5, higher than that of the normal model group(t=5.73, P<0.001); the detection rate of anxiety disorder was 54.7%, which was also higher than that of the normal model group(χ²=21.12, P<0.001). The mean CDI score of 53 children was 14.3±8.8, higher than that of the normal model group(t=2.21, P=0.032); the detection rate of depressive disorder was 24.5%, higher than that of the normal model group(χ²=3.95, P=0.047). (2)The non-anxious group had lower OI symptom scores than the anxious group(Z=5.25, P<0.001); 53 children had a positive correlation between SCARED scores and OI symptom scores(r_s=0.76, P<0.001); there was no correlation with 24 h urinary nonepinephrine levels(r=-0.16, P=0.254), and no correlation with 24 h urinary adrenaline or dopamine levels(r_s=-0.16, -0.21; P=0.245, 0.136). (3)There was no significant difference in OI symptom scores between non-depressive and depressive children(Z=1.68, P=0.093); there was a positive correlation between CDI scores and OI symptom scores in 53 children(r_s=0.41, P=0.002), and there was no correlation with 24 h urinary nonepinephrine levels(r=-0.07, P=0.616)and no correlation with 24 h urinary adrenaline and dopamine levels(r_s=-0.09, -0.10; P=0.502, 0.475). (4)When the OI symptom score in children with VVS was 8.5, its sensitivity for predicting the presence of anxiety disorders in children with VVS was 75.9% and its specificity was 95.8%, while those for depressive disorders were 69.2% and 65.0%, respectively. Conclusion SCARED and CDI scores of children with VVS are positively correlated with OI symptom scores, but not with 24 h urinary catecholamine levels; OI symptom scores have predictive value for emotional disorders in children with VVS.

Key words: Emotional disorder, Syncope, Orthostatic intolerance, Catecholamines, Children