The prevalence of diagnosed obsessive compulsive disorder and associated comorbidities: A population-based Canadian study
Introduction
Obsessive-compulsive disorder (OCD) is a mental health disorder, which is characterized by obsessive thoughts (recurrent and persistent unwanted, intrusive thoughts that the individual attempts to ignore or suppress through some other thought or action) and/or compulsive behaviors (repetitive rituals performed in response to an obsession with the behaviors aimed at preventing or reducing anxiety/prevent a dreaded event or situation) (American Psychiatric Association, 2000). Obsessions frequently focus on issues of contamination, aggression, symmetry/exactness, religion and somatic concerns (Tükel et al., 2002). Compulsions often involve checking, cleaning/washing, repeating, counting and ordering/arranging. The pathogenesis OCD has been proposed to include dysfunction of the serotonergic and glutamatergic systems, as well as disruption of the cortico-striato-thalamo-cortical loops (Goodman et al., 2014), and twin and family studies strongly suggest that both genetic and environmental determinants play a causal role. Primary treatment options include cognitive behavioral therapy (CBT), which comprises both exposure and response prevention and cognitive therapy which are demonstrated to be equal or superior to pharmacological options (Katzman et al., 2014). Pharmacological treatment relies on the use of selective serotonin reuptake inhibitors (SSRIs) as the primary method. The estimated prevalence of OCD in the United States is 2.3% for lifetime OCD and 1.2% for 12-month criteria (Ruscio et al., 2010), but the literature examining Canadian prevalence is very limited (Kolada et al., 1994, Preville et al., 2008). Most people with OCD are diagnosed with at least one additional condition. The most common comorbid disorders that occur with OCD include major depressive disorder, obsessive compulsive personality disorder, generalized anxiety disorder, phobias, attention-deficit/hyperactivity disorder and Tourette syndrome/chronic tic disorder, although comorbid diagnoses vary with age and have variable effects on disease course (Brakoulias et al., 2017, de Mathis et al., 2013).
The objective of this study was to determine the prevalence of diagnosed OCD and associated comorbidities using a population-based data source, the Canadian Community Health Survey- Mental Health (CCHS-Mental Health). Sociodemographic factors and health service utilization were also examined. Obtaining a prevalence estimate gives us a better understanding of the proportion of Canadians diagnosed with OCD, while the information on co-morbidities, healthcare utilization and childhood experiences provides a more complete picture of the challenges facing people who are diagnosed globally. This examination allows us to reveal treatment gaps and understand how to meet the health care needs of those diagnosed with OCD.
Section snippets
Methods
This study was approved by the Social Sciences and Humanities Research Council of Canada.
Demographics
267 respondents answered yes to having ever received a diagnosis of OCD, while 24,830 respondents answered no, leading to an estimated prevalence of 0.93% (95% CI 0.75–1.11). Within the female population, we calculated an estimated prevalence of 1.04% (95% CI 0.75–1.35) and within the male population the estimated prevalence was 0.81% (95% CI 0.60–1.03). The OCD group consisted of a significantly younger population (M = 37.35 years; 95% CI 34.55–40.15 years) compared to the control population (
Discussion
Our current study found an estimated lifetime prevalence of OCD in Canadians age 15 and older of 0.93%. A systematic review of the lifetime prevalence of OCD in the general population included fourteen studies conducted in Iran, Germany, Netherlands, Hong Kong, USA, Germany, Italy, New Zealand, Taiwan, Canada, Korea and Puerto Rico. Lifetime prevalence reported in these studies ranged from 0.3 to 3.2%, with a best estimate overall prevalence of 1.3% (95% CI 0.86–1.8) (Somers et al., 2006). We
Conclusions
The current study provides important information on the prevalence of OCD, associated comorbid conditions, health care utilization, and childhood trauma. Overall, the diagnosis of OCD in Canada is associated with lower socioeconomic status, and the diagnosis of comorbid mental health conditions. Those diagnosed with OCD are more likely to utilize a variety healthcare services, and are less likely to feel as if they are receiving adequate help for problems that they are experiencing.
Data access
Data for this study came from the Statistics Canada Prairie Regional Data Centre. These data require special access.
Acknowledgments
Paul Arnold has an Alberta Innovates Health Solutions (AIHS) Translational Health Chair in Child and Youth Mental Health.
Conflict of interest disclosure
None of the study authors has conflicts of interest to disclose.
Funding
This research was supported by the Owerko Centre Neurodevelopmental Disorders Initiative.
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