Effects of inpatient, residential, and day-patient treatment on obsessive–compulsive symptoms in persons with obsessive–compulsive disorder: A systematic review and meta-analysis

• Published in: Journal of psychiatric research 2024-08, Vol.176, p.182-197
• Main Authors: Zisler, Eva M., Meule, Adrian, Endres, Dominique, Schennach, Rebecca, Jelinek, Lena, Voderholzer, Ulrich
• Format: Article
• Language: English
• Subjects: Cognitive Behavioral Therapy; Day Care, Medical; Day-patient treatment; Humans; Inpatient treatment; Inpatients - statistics & numerical data; Meta-analysis; Obsessive-Compulsive Disorder - therapy; Obsessive–compulsive disorder; Outcome Assessment, Health Care; Residential Treatment
• ISSN: 0022-3956; 1879-1379; 1879-1379
• DOI: 10.1016/j.jpsychires.2024.06.007

Patients with severe or treatment-refractory obsessive–compulsive disorder (OCD) often need an extensive treatment which cannot be provided by outpatient care. Therefore, we aimed to estimate the effects and their moderators of inpatient, residential, or day-patient treatment on obsessive–compulsive symptoms in patients with OCD. PubMed, PsycINFO, and Web of Science were systematically screened according to the PRISMA guidelines. Studies were selected if they were conducted in an inpatient, residential, or day-patient treatment setting, were using a number of pre-defined instruments for assessing OCD symptom severity, and had a sample size of at least 20 patients. We identified 43 eligible studies in which inpatient, residential, or day-patient treatment was administered. The means and standard deviations at admission, discharge, and—if available—at follow-up were extracted. All treatment programs included cognitive-behavioral treatment with exposure and response prevention. Only one study reported to not have used psychopharmacological medication. Obsessive–compulsive symptoms decreased from admission to discharge with large effect sizes (g = −1.59, 95%CI [−1.76; −1.41]) and did not change from discharge to follow-up (g = 0.06, 95%CI [−0.09; 0.21]). Length of stay, age, sex, and region did not explain heterogeneity across the studies but instrument used did: effects were larger for clinician-rated interviews than for self-report measures. Persons with OCD can achieve considerable symptom reductions when undertaking inpatient, residential, or day-patient treatment and effects are—on average—maintained after discharge.