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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Fabrício Bruno Cardoso, Roberta Sasha Guedes Vieira
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DOI:10.17265/2159-5542/2026.03.002
Universidade Federal do Rio de Janeiro (UFRJ), Joinville, Brazil; Joinville Municipal Department of Education, Joinville, Brazil
The relationship between onychophagia (nail biting) and anxiety has been widely discussed in clinical literature, yet evidence specific to the Brazilian population remains fragmented. This systematic review and meta-analysis aimed to synthesize available data on the association between nail biting and anxiety symptoms among Brazilian children, adolescents, and adults. A thorough search was performed for observational studies reporting continuous anxiety scores among individuals with and without onychophagia. The primary outcome was the standardized mean difference in anxiety symptoms between groups. From the included studies, we derived effect sizes and aggregated them applying a random-effects model. One study, Leme et al. In 2014, data were collected from 147 participants between 8 and 14 years of age, with anxiety assessed via the Revised Children’s Manifest Anxiety Scale. The pooled analysis produced a standardized mean difference of 0.36 (95% CI: -0.01 to 0.74), which suggests a moderate but non-significant trend toward higher anxiety in the nail-biting group (p = 0.05). Heterogeneity was substantial (I² = 27.82), indicating variability across the limited available evidence. These findings indicate that, although a positive link between onychophagia and anxiety may occur in the Brazilian population, the current evidence is insufficient to establish a statistically meaningful association. Further research with larger, more diverse samples and standardized anxiety assessments is needed to clarify this association. This review highlights the need for culturally specific investigations into behavioral health markers in Brazil.
onychophagia, anxiety, body-focused repetitive behaviors, Brazil
Fabrício Bruno Cardoso, Roberta Sasha Guedes Vieira. (2026). The Relationship Between Onychophagia and Anxiety in the Brazilian Population: A Systematic Review and Meta-analysis. Psychology Research, May-June 2026, Vol. 16, No. 3, 113-123. doi:10.17265/2159-5542/2026.03.002.
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