Chronic obsessive–compulsive disorder: prognostic factors

• Published in: Psychological medicine 2018-10, Vol.48 (13), p.2213-2222
• Main Authors: van Oudheusden, Lucas J. B., Eikelenboom, Merijn, van Megen, Harold J. G. M., Visser, Henny A. D., Schruers, Koen, Hendriks, Gert-Jan, van der Wee, Nic, Hoogendoorn, Adriaan W., van Oppen, Patricia, van Balkom, Anton J. L. M.
• Format: Article
• Language: English
• Subjects: Adult; Anxiety; Chronic Disease; Cohort analysis; Comorbidity; Confidence intervals; Disease Progression; Female; Follow-Up Studies; Humans; Illnesses; Male; Medical diagnosis; Medical prognosis; Mental health; Middle Aged; Negative events; Negative life events; Netherlands - epidemiology; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - epidemiology; Original Articles; Risk Factors; Severity; Severity of Illness Index; Social interactions; Social support; Time Factors; Treatment methods
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291717003701

The course of illness in obsessive-compulsive disorder (OCD) varies significantly between patients. Little is known about factors predicting a chronic course of illness. The aim of this study is to identify factors involved in inducing and in maintaining chronicity in OCD. The present study is embedded within the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study, an ongoing multicenter naturalistic cohort study designed to identify predictors of long-term course and outcome in OCD. For this study, 270 subjects with a current diagnosis of OCD were included. Chronicity status at 2-year follow-up was regressed on a selection of baseline predictors related to OCD, to comorbidity and to stress and support. Psychotrauma [odds ratio (OR) 1.98, confidence interval (CI) 1.22-3.22, p = 0.006], recent negative life events (OR 1.42, CI 1.01-2.01, p = 0.043), and presence of a partner (OR 0.28, CI 0.09-0.85, p = 0.025) influenced the risk of becoming chronic. Longer illness duration (OR 1.46, CI 1.08-1.96, p = 0.013) and higher illness severity (OR 1.09, CI 1.03-1.16, p = 0.003) increased the risk of remaining chronic. External influences increase the risk of becoming chronic, whereas the factors involved in maintaining chronicity are illness-related. As the latter are potentially difficult to modify, treatment should be devoted to prevent chronicity from occurring in the first place. Therapeutic strategies aimed at alleviating stress and at boosting social support might aid in achieving this goal.