Obsessive-compulsive symptoms and obsessive-compulsive
					disorder in adolescents: a population-based study

Vivan, Analise de Souza; Rodrigues, Lidiane; Wendt, Guilherme; Bicca, Mônica Giaretton; Braga, Daniela Tusi; Cordioli, Aristides Volpato

doi:10.1590/1516-4446-2013-1113

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Brazilian Journal of Psychiatry

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Original Articles • Rev. Bras. Psiquiatr. 36 (02) • 13 May 2014 • https://doi.org/10.1590/1516-4446-2013-1113 copy

Obsessive-compulsive symptoms and obsessive-compulsive disorder in adolescents: a population-based study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

To estimate the prevalence of obsessive-compulsive symptoms (OCS) and disorder (OCD) among adolescents and to describe OCD characteristics according to gender.

Methods:

Participants were selected by cluster sampling at seven high-schools in southern Brazil. In the first stage, 2,323 students were screened for OCS; in the second stage, adolescents scoring ≥ 21 on the OCI-R scale were individually interviewed. OCD diagnosis was established using a semi-structured interview (Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version - K-SADS-PL).

Results:

The past-month estimated prevalence of OCS was 18.3%, and the point estimated prevalence of OCD, 3.3%. Girls showed higher scores (OCS: 24.8 vs. 14.4%; OCD: 4.9 vs. 1.4%; p < 0.001). Only 9.3% of OCD adolescents had been diagnosed and 6.7% received treatment. The most frequent/severe DY-BOCS dimensions were miscellaneous (86.7%; mean score 6.3±3.8) and symmetry (85.3%; 5.9±3.8). Female OCD adolescents predominantly showed depression (p = 0.032), and male adolescents, tic disorders (p = 0.006).

Conclusions:

OCD is underdiagnosed in adolescents, and few are treated. Future studies should investigate the relationship between OCS and the onset of OCD.

Obsessive-compulsive disorder; obsessive-compulsive symptoms; adolescents; epidemiology; gender

Variables	Total (n=75)	Boys (n=16)	Girls (n=59)	p-value
Age (years), mean ± SD	16.2±1.1	16.3±0.7	16.1±1.2	0.570^* * Student's t test;
Skin color, n (%)				1.000^† † Fisher's exact test;
White	64 (85.3)	14 (87.5)	50 (84.7)
Non-white	11 (14.7)	2 (12.5)	9 (15.3)
Socioeconomic class, n (%)				0.825^‡ ‡ Chi-square test.
A/B	38 (50.6)	9 (56.3)	29 (49.2)
C/D	37 (49.4)	7 (43.8)	30 (50.8)
Age at onset of OCS, mean ± SD	9.7±3.4	9.6±3.7	9.7±3.3	0.970^* * Student's t test;
Age at onset of OCD, mean ± SD	13.8±2.4	14.3±1.8	13.6±2.6	0.299^* * Student's t test;
Prior knowledge of OCD, n (%)	7 (9.3)	2 (12.5)	5 (8.5)	0.637^† † Fisher's exact test;
Previous treatment, n (%)	5 (6.7)	1 (6.3)	4 (6.8)	1.000^† † Fisher's exact test;
Suicide attempt, n (%)	15 (20.0)	3 (18.8)	12 (20.3)	1.000^† † Fisher's exact test;
Suicidal ideation (current), n (%)	7 (9.3)	2 (12.5)	5 (8.5)	0.637^† † Fisher's exact test;
Y-BOCS, mean ± SD	21.1±4.1	20.4±3.0	21.3±4.4	0.429^* * Student's t test;
Obsessions	10.1±2.4	9.9±1.9	10.2±2.5	0.728^* * Student's t test;
Compulsions	10.9±2.8	10.4±2.6	11.1±2.8	0.378^* * Student's t test;
CGI, mean ± SD	3.8±0.7	3.8±0.8	3.9±0.7	0.636^* * Student's t test;
BAI, mean ± SD	17.8±10.9	14.8±8.9	18.7±11.4	0.205^* * Student's t test;
BDI-II, mean ± SD	20.8±11.5	16.1±8.7	22.1±11.9	0.032^* * Student's t test;

Variables	Total (n=75)	Boys (n=16)	Girls (n=59)	p-value
Frequency, n (%)
Aggression	51 (68)	12 (75)	39 (66.1)	0.708^* * Chi-square test;
Sexual/Religious	35 (46.7)	9 (56.3)	26 (44.1)	0.559^* * Chi-square test;
Symmetry	64 (85.3)	12 (75)	52 (88.1)	0.233^† † Fisher's exact test;
Contamination	48 (64)	11 (68.8)	37 (62.7)	0.879^* * Chi-square test;
Hoarding	56 (74.7)	12 (75)	44 (74.6)	1.000^† † Fisher's exact test;
Miscellaneous	65 (86.7)	14 (87.5)	51 (86.4)	1.000^† † Fisher's exact test;
DY-BOCS Scores, mean ± SD
Global Score	16.9±5.0	16.4±5.0	17.0±5.1	0.711^‡ ‡ Student's t test.
Aggression	4.8±4.2	5.4±3.9	4.6±4.2	0.475^‡ ‡ Student's t test.
Sexual/Religious	2.9±3.7	4.2±4.5	2.5±3.4	0.102^‡ ‡ Student's t test.
Symmetry	5.9±3.8	4.7±3.8	6.2±3.8	0.162^‡ ‡ Student's t test.
Contamination	4.4±4.0	4.9±3.9	4.3±4.0	0.543^‡ ‡ Student's t test.
Hoarding	4.1±3.3	3.1±2.5	4.3±3.5	0.111^‡ ‡ Student's t test.
Miscellaneous	6.3±3.8	5.3±3.4	6.5±3.9	0.257^‡ ‡ Student's t test.

Variables	Total (n=75)	Boys (n=16)	Girls (n=59)	p-value
Presence of any comorbid disorder	42 (56.0)	9 (56.3)	33 (55.9)	1.000^* * Chi-square test;
No. of comorbidities, mean ± SD	1.0±1.1	1.3±1.3	0.9±1.0	0.250^† † Student's t test;
Affective disorders	16 (21.3)	3 (18.8)	13 (22.0)	1.000^‡ ‡ Fisher's exact test.
Major depressive disorder	13 (17.3)	1 (6.3)	12 (20.3)	0.276^‡ ‡ Fisher's exact test.
Bipolar disorder	3 (4.0)	2 (12.5)	1 (1.7)	0.113^‡ ‡ Fisher's exact test.
Anxiety disorders	19 (25.3)	4 (25.0)	15 (25.4)	1.000^‡ ‡ Fisher's exact test.
Specific phobia	7 (9.3)	0 (0.0)	7 (11.9)	0.334^‡ ‡ Fisher's exact test.
Social phobia	3 (4.0)	1 (6.3)	2 (3.4)	0.519^‡ ‡ Fisher's exact test.
Panic disorder	2 (2.7)	1 (6.3)	1 (1.7)	0.383^‡ ‡ Fisher's exact test.
Generalized anxiety disorder	9 (12,0)	2 (12.5)	7 (11.9)	1.000^‡ ‡ Fisher's exact test.
Post-traumatic stress disorder	2 (2.7)	1 (6.3)	1 (1.7)	0.383^‡ ‡ Fisher's exact test.
Impulse control disorders	16 (21.3)	4 (25.0)	12 (20.3)	0.735^‡ ‡ Fisher's exact test.
Trichotillomania	5 (6.7)	2 (12.5)	3 (5.1)	0.288^‡ ‡ Fisher's exact test.
Skin picking	7 (9.3)	2 (12.5)	5 (8.5)	0.637^‡ ‡ Fisher's exact test.
Kleptomania	1 (1.3)	0 (0.0)	1 (1.7)	1.000^‡ ‡ Fisher's exact test.
Impulsive-compulsive buying disorder	1 (1.3)	0 (0.0)	1 (1.7)	1.000^‡ ‡ Fisher's exact test.
Impulsive-compulsive internet usage disorder	3 (4.0)	1 (6.3)	2 (3.4)	0.519^‡ ‡ Fisher's exact test.
Video game use disorder	2 (2.7)	0 (0.0)	2 (3.4)	1.000^‡ ‡ Fisher's exact test.
Attention deficit hyperactivity disorder	6 (8.0)	2 (12.5)	4 (6.8)	0.602^‡ ‡ Fisher's exact test.
Tic disorders	5 (6.7)	4 (25.0)	1 (1.7)	0.006^‡ ‡ Fisher's exact test.
Chronic tic disorder	3 (4.0)	3 (18.8)	0 (0.0)	0.008^‡ ‡ Fisher's exact test.
Tourette's disorder	2 (2.7)	1 (6.3)	1 (1.7)	0.383^‡ ‡ Fisher's exact test.
Other disorders	4 (5.3)	1 (6.3)	3 (5.1)	1.000^‡ ‡ Fisher's exact test.

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[1] Correspondence: Analise de Souza Vivan, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Rua Mariante, 288, sala 408, CEP 90430-180, Porto Alegre, RS, Brazil, E-mail: anavivan@gmail.com