{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:56:49Z","timestamp":1787767009213,"version":"build-2784847793"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T00:00:00Z","timestamp":1660521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Introduction: Nocturnal enuresis is a common problem affecting 20% of 5-year-old children; its prevalence decreases with age. Nocturnal bedwetting in children younger than 5 is generally accepted by parents and society, but the expectation of parents is that children will achieve a higher degree of responsibility and increased control with age. Some studies have identified maternal distress as a factor associated with childhood urinary incontinence; specifically, maternal stress, maternal depression, and maternal anxiety. The aim of this study was to compare the degree of anxiety (trait and state) among mothers of children with nocturnal enuresis and mothers of healthy children. Methods: This was a prospective, cross-sectional, comparative study including two groups: a control group of 25 mothers of healthy children from open population, and an enuresis group of 25 mothers of children with nocturnal enuresis of the pediatric urology clinic of a third-level Mexican Hospital. STAI-T and STAI-S tests were performed and assessed blindly. Quantitative variables were compared using the Mann\u2013Whitney U test, and qualitative determinations using a chi-square test or Fischer\u2019s exact test. Results: The STAI-S and STAI-T tests results identified 14 (56%) mothers of enuretic children with moderate-to-severe trait anxiety versus 4 (16%) mothers from the control group and moderate-to-severe state anxiety in 23 (92%) of the mothers of enuretic children compared to 7 (28%) control-group mothers. The anxiety scores were significantly higher for the enuresis group for both tests: STAI-T: 53.00 \u00b1 8.39 versus 41.52 \u00b1 9.61 (p &lt; 0.001) and STAI-S: 56.48 \u00b1 6.83 versus 43.84 \u00b1 10.57 (p &lt; 0.001). Conclusion: Mothers of children with nocturnal enuresis present state anxiety ranging from moderate to severe. In clinical practice, our results indicate that the transitory emotion experienced by mothers of enuretic children cannot be neglected in an enuresis treatment program, state anxiety needs to be evaluated, and psychological interventions need to be implemented.<\/jats:p>","DOI":"10.3390\/children9081232","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T20:58:08Z","timestamp":1660597088000},"page":"1232","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Maternal Anxiety Associated with Nocturnal Childhood Enuresis"],"prefix":"10.3390","volume":"9","author":[{"given":"Javier","family":"Quiroz-Guerrero","sequence":"first","affiliation":[{"name":"Department of Pediatric Urology, Hospital Regional de Alta Especialidad del Baj\u00edo, Leon 37660, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Ortega-Pardo","sequence":"additional","affiliation":[{"name":"Department of Pediatric, Hospital Regional de Alta Especialidad del Baj\u00edo, Leon 37660, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Edgardo","family":"Maldonado-Valadez","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Regional de Alta Especialidad del Baj\u00edo, Leon 37660, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ra\u00fal","family":"Garc\u00eda-D\u00edaz de Le\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Psychology, Hospital Regional de Alta Especialidad del Baj\u00edo, Leon 37660, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Mercado-Villareal","sequence":"additional","affiliation":[{"name":"Department of Psychology, Hospital Regional de Alta Especialidad del Baj\u00edo, Leon 37660, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4287-9626","authenticated-orcid":false,"given":"Edel Rafael","family":"Rodea-Montero","sequence":"additional","affiliation":[{"name":"Department of Research, Hospital Regional de Alta Especialidad del Baj\u00edo, Leon 37660, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,15]]},"reference":[{"key":"ref_1","unstructured":"WHO (1992). ICD-10: Alphabetical Index, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1159\/000052245","article-title":"Nocturnal enuresis: Basic facts and new horizons","volume":"33","year":"1998","journal-title":"Eur. Urol."},{"key":"ref_3","first-page":"414","article-title":"Bed-wetting in US children: Epidemiology and related behavior problems","volume":"98","author":"Byrd","year":"1996","journal-title":"Pediatrics"},{"key":"ref_4","first-page":"150","article-title":"Nocturnal Enuresis Frequency in Children and Anxiety-Depression Risks of Parents","volume":"7","author":"Demirci","year":"2017","journal-title":"J. Clin. Exp. Investig."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s00787-018-1193-1","article-title":"A prospective cohort study of biopsychosocial factors associated with childhood urinary incontinence","volume":"28","author":"Joinson","year":"2019","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/00000446-200608000-00024","article-title":"Helping Children with Nocturnal Enuresis: The wait-and-see approach may not be in anyone\u2019s best interest","volume":"106","author":"Berry","year":"2006","journal-title":"AJN Am. J. Nurs."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/0005-7967(86)90190-7","article-title":"Maternal attributions and tolerance for nocturnal enuresis","volume":"24","author":"Butler","year":"1986","journal-title":"Behav. Res. Ther."},{"key":"ref_8","first-page":"39","article-title":"Children\u2019s notions about enuresis and the implications for treatment","volume":"163","author":"Butler","year":"1994","journal-title":"Scand. J. Urol. Nephrol. Suppl."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/S0302-2838(02)00127-6","article-title":"Vande Self-image and performance in children with nocturnal enuresis","volume":"41","author":"Theunis","year":"2002","journal-title":"Eur. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1080\/00365590310001665","article-title":"The impact of monosymptomatic nocturnal enuresis on attachment parameters","volume":"38","author":"Schober","year":"2004","journal-title":"Scand. J. Urol. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1046\/j.1464-4096.2001.01774.x","article-title":"Overcoming parental intolerance in childhood nocturnal enuresis: A survey of professional opinion","volume":"89","author":"Butler","year":"2002","journal-title":"BJU Int."},{"key":"ref_12","first-page":"433","article-title":"da Assessment of domestic violence against children and adolescents with enuresis","volume":"85","author":"Sapi","year":"2009","journal-title":"J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1016\/j.juro.2010.11.051","article-title":"Psychological and psychiatric issues in urinary and fecal incontinence","volume":"185","author":"Baeyens","year":"2011","journal-title":"J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1046\/j.1464-410x.1998.00015.x","article-title":"An Italian epidemiological multicentre study of nocturnal enuresis","volume":"81","author":"Chiozza","year":"1998","journal-title":"Br. J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/S0090-4295(98)00106-X","article-title":"Childhood nocturnal enuresis in The Netherlands","volume":"51","author":"Hirasing","year":"1998","journal-title":"Urology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1046\/j.1440-1754.2003.00105.x","article-title":"Epidemiology of childhood nocturnal enuresis in Malaysia","volume":"39","author":"Kanaheswari","year":"2003","journal-title":"J. Pediatr. Child. Health"},{"key":"ref_17","first-page":"669","article-title":"Prevalence of nocturnal enuresis in school-age children in Saudi Arabia","volume":"3","author":"Sherah","year":"2019","journal-title":"Int. J. Med. Dev. Ctries."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1111\/j.1651-2227.1999.tb01053.x","article-title":"Prevalence of nocturnal enuresis and accompanying factors in children aged 7\u201311 years in Turkey","volume":"88","author":"Vurgun","year":"1999","journal-title":"Acta Paediatr."},{"key":"ref_19","first-page":"2893","article-title":"Risk Factors for Nocturnal Enuresis in School-Age Children","volume":"182","author":"Sureshkumar","year":"2009","journal-title":"JURO"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s00345-016-1879-2","article-title":"Prevalence of nocturnal enuresis and related risk factors in school - age children in Egypt: An epidemiological study","volume":"35","author":"Hamed","year":"2017","journal-title":"World J. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1080\/00365590410025371","article-title":"Investigating the three systems approach to complex childhood nocturnal enuresis Medical treatment interventions","volume":"38","author":"Butler","year":"2004","journal-title":"Scand. J. Urol. Nephrol."},{"key":"ref_22","first-page":"199","article-title":"Therapeutic options in childhood nocturnal enuresis","volume":"59","author":"Zaffanello","year":"2007","journal-title":"Minerva Urol. Nefrol. Ital. J. Urol. Nephrol."},{"key":"ref_23","first-page":"893","article-title":"The Pattern of Management of Nocturnal Enuresis in a Tertiary Hospital in Sudan","volume":"44","author":"Salih","year":"2022","journal-title":"Bahrein Med. Bull."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2580","DOI":"10.1097\/01.ju.0000110521.20103.14","article-title":"Vande An assessment of internalizing problems in children with enuresis","volume":"171","author":"Hoebeke","year":"2004","journal-title":"J. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e4462","DOI":"10.17795\/ijpbs-4462","article-title":"The relationship between child anxiety related disorders and primary nocturnal enuresis","volume":"10","author":"Salehi","year":"2016","journal-title":"Iran. J. Psychiatry Behav. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"152208","DOI":"10.1016\/j.comppsych.2020.152208","article-title":"Behavioral problems in children with primary monosymptomatic nocturnal enuresis","volume":"104","author":"Hamed","year":"2021","journal-title":"Compr. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.3389\/fneur.2019.01054","article-title":"Parental Stress and Parental Ratings of Behavioral Problems of Enuretic Children","volume":"10","author":"Roccella","year":"2019","journal-title":"Front. Neurol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1016\/j.juro.2009.05.102","article-title":"Problem behavior, parental stress and enuresis","volume":"182","author":"Verbeken","year":"2009","journal-title":"J. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Alanazi, A.N.H., Alanazi, R.S.M., Alanazi, E.N., Alanazi, R.M., and Rabbani, U. (2022). Prevalence of Nocturnal Enuresis Among Children and Its Association With the Mental Health of Mothers in Northern Saudi Arabia. Cureus, 14.","DOI":"10.7759\/cureus.22232"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s00467-007-0605-0","article-title":"An evaluation of quality of life of mothers of children with enuresis nocturna","volume":"23","author":"Egemen","year":"2008","journal-title":"Pediatr. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jaac.2016.12.007","article-title":"Predictors and Outcomes of Childhood Primary Enuresis","volume":"56","author":"Kessel","year":"2017","journal-title":"J. Am. Acad. Child. Adolesc. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/B978-1-4832-3131-0.50006-8","article-title":"Theory and research on anxiety","volume":"1","author":"Spielberger","year":"1966","journal-title":"Anxiety Behav."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1007\/s11255-011-0087-7","article-title":"The quality of life of mothers of children with monosymptomatic enuresis nocturna","volume":"44","author":"Meydan","year":"2012","journal-title":"Int. Urol. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/ped.12242","article-title":"Effects of enuresis nocturna on parents of affected children: Case-control study","volume":"56","author":"Tanriverdi","year":"2014","journal-title":"Pediatr. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"62.e1","DOI":"10.1016\/j.jpurol.2016.06.018","article-title":"Psychiatric dimensions in mothers of children with primary nocturnal enuresis: A controlled study","volume":"13","author":"Durmaz","year":"2017","journal-title":"J. Pediatr. Urol."},{"key":"ref_36","first-page":"3","article-title":"Development of the Spanish edition of the State-Trait Anxiety Inventory","volume":"5","author":"Spielberger","year":"1971","journal-title":"Interam. J. Psychol."},{"key":"ref_37","unstructured":"Spielberger, C.D., Gorsuch, R.C., Lushene, R.E., Vagg, P.R., and Jacobs, G.A. (1983). Manual for the State-Trait Anxiety Inventory, Consulting Psychologists Press."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_39","unstructured":"Mexican Gobernation Secretary (2022, June 20). General Health Law. Official Gazzette of the Federation, Available online: https:\/\/www.diputados.gob.mx\/LeyesBiblio\/pdf\/LGS.pdf."},{"key":"ref_40","unstructured":"R Core Team (2019). R: A Language and Environment for Statistical Computing, R Core Team."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1214\/09-SS051","article-title":"Wilcoxon-Mann-Whitney or t-test? On assumptions for hypothesis tests and multiple interpretations of decision rules","volume":"4","author":"Fay","year":"2010","journal-title":"Stat. Surv."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1177\/13591045211033175","article-title":"State and trait anxiety in children with incontinence and their parents","volume":"26","author":"Hussong","year":"2021","journal-title":"Clin. Child. Psychol. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1016\/j.juro.2012.07.012","article-title":"Health related quality of life for monosymptomatic enuretic children and their mothers","volume":"188","author":"Naitoh","year":"2012","journal-title":"J. Urol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2545","DOI":"10.1097\/01.ju.0000111504.85822.b2","article-title":"Nocturnal enuresis: An international evidence based management strategy","volume":"171","author":"Hjalmas","year":"2004","journal-title":"J. Urol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/8\/1232\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:08:51Z","timestamp":1760141331000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/8\/1232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,15]]},"references-count":44,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["children9081232"],"URL":"https:\/\/doi.org\/10.3390\/children9081232","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,15]]}}}