Baseline chronicity in obsessive–compulsive disorder heightens risk of remaining chronic
Individuals with obsessive–compulsive disorder (OCD) with a chronic illness course are at greater risk of remaining chronic, which, in turn, is associated with poor clinical outcome, according to a study.
The study included 270 adults (mean age 37.08 years; 53.3 percent female) with a current diagnosis of OCD (mean age at onset, 17.81 years), with the mean severity of illness being moderate (mean score on the Yale-Brown Obsessive Compulsive Severity Scale, 20.86). About half of the participants (55.2 percent) were employed, and 62.3 percent had a partner.
Illness course at baseline was nonchronic in 100 participants (37 percent) and chronic in 170 (63 percent). At the 2-year follow-up, 21 in the nonchronic group and 78 in the chronic group met the criteria for chronicity and thus became chronic (nCB–CFU).
In logistic regression analysis, baseline chronicity status emerged as a significant predictor of chronicity status at follow-up (p<0.001). Specifically, the odds of having a chronic course at 2 years were 3.19 times (95 percent CI, 1.81–5.63) greater for individuals with a chronic illness course at baseline than for those with a nonchronic course at baseline.
Other factors significantly associated with the risk of becoming chronic at follow-up included psychotrauma (odds ratio [OR], 1.98; 1.22–3.22; p=0.006), recent negative life events (OR, 1.42; 1.01–2.01; p=0.043) and presence of a partner (OR, 0.28; 0.09–0.85; p=0.025).
Likewise, a longer duration of illness (OR, 1.46; 1.08–1.96; p=0.013) and a higher illness severity (OR, 1.09; 1.03–1.16; p=0.003) were independently associated with a heightened risk of meeting the criteria for chronicity at follow-up and, thus, of maintaining a chronic course of illness.
The findings show that baseline chronicity is an important predictor of future chronicity in OCD. Researchers noted that individuals with a chronic course of illness have a significantly worse outcome in terms of OCD symptoms, severity of comorbid anxiety and depressive symptoms, and quality of life compared with those with a nonchronic course.
Therapeutic strategies aimed at alleviating stress and boosting social support may be implemented to prevent chronicity from occurring in the first place, as factors involved in maintaining chronicity (ie, illness duration and severity) are potentially difficult to modify, researchers said.