Obsessive-compulsive disorder in the World Mental Health surveys

Abstract

BACKGROUND: National surveys have suggested that obsessive-compulsive disorder (OCD) is a prevalent and impairing condition. However, there are few cross-national data on OCD, with data particularly scarce in low- and middle-income countries. Here we employ data from the World Mental Health surveys to characterize the onset, course, severity, and treatment of OCD across a range of countries in different geographic regions of the world. METHODS: Data came from general population surveys carried out in 10 countries (Argentina, Australia, Colombia, Iraq, Poland, People's Republic of China, Portugal, Romania, Saudi Arabia, Spain) using a consistent research protocol and interview. A total of 26,136 adults were assessed for OCD in face-to-face interviews and were included in the present analyses. We examined lifetime and 12-month prevalence as well as age of onset, persistence, severity, and treatment of DSM-IV OCD in six high-income countries (HICs) and four low- or middle-income countries (LMICs). We also investigated socio-demographic variables and temporally prior mental disorders as predictors of OCD onset, persistence, severity, and treatment. RESULTS: Across the 10 countries surveyed, OCD has a combined lifetime prevalence of 4.1%. The 12-month prevalence (3.0%) is nearly as high, suggesting a highly persistent course of illness. Age of onset is early, with more than 80% of OCD cases beginning by early adulthood. Most OCD cases in the community are mild (47.0%) or very mild (27.5%), with a smaller percentage designated as moderate (22.9%) or severe (2.7%) by the Yale-Brown Obsessive-Compulsive Scale. Only 19.8% of respondents with OCD received any mental health treatment in the past year, with treatment rates much higher in HICs (40.5%) than LMICs (7.0%). Cross-nationally, OCD commonly emerges in adolescence or early adulthood against a backdrop of earlier-occurring mental disorders. With few exceptions (e.g., prior social phobia), the socio-demographic and psychopathological risk factors for OCD onset, persistence, severity, and treatment are distinct. CONCLUSIONS: These cross-national data underscore clinical lessons regarding the importance of early diagnosis of OCD and comprehensive evaluation of comorbidity; draw attention to OCD as an undertreated disorder, particularly in LMIC contexts; and emphasize the public health significance of this often-overlooked condition.