Elsevier

Comprehensive Psychiatry

Volume 51, Issue 2, March–April 2010, Pages 193-200
Comprehensive Psychiatry

Clinical predictors of health-related quality of life in obsessive-compulsive disorder

https://doi.org/10.1016/j.comppsych.2009.03.004Get rights and content

Abstract

Background

Obsessive-compulsive disorder (OCD) is a serious mental disorder that has severe impact on a person's quality of life and those living with a person with OCD. This study systematically examined the clinical variables that are predictive of several domains of quality of life in a large, well-characterized sample of patients attending a specialized treatment unit in Italy.

Methods

The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to 151 patients with OCD and their scores were compared to published Italian norms. A principal component analysis was performed on the 13 major categories of the Yale-Brown Obsessive-Compulsive Scale (YBOCS) Symptom Checklist to derive symptom dimension scores. The association between various domains of quality of life and a wide range of clinical variables, including symptom dimension scores, was examined using multiple regression models.

Results

Compared to published Italian norms, patients with OCD showed impairment in most domains of quality of life, particularly social functioning. The principal component analysis of the YBOCS Symptom Checklist yielded 5 symptom dimensions that were identical to those previously identified in the international literature. Fewer years of education, higher depression scores (Hamilton Rating Scale for Depression), higher YBOCS obsessions scores, and higher scores on the contamination/washing symptom dimension independently predicted a poorer score on the physical health component of the SF-36. Higher YBOCS compulsions scores, the presence of a current mood disorder, and higher anxiety scores (Hamilton Rating Scale for Anxiety) predicted a poorer score on the mental health component of the SF-36.

Conclusions

Our study confirms that quality of life is severely impaired in patients with OCD. The identification of predictors of quality of life in OCD can help clinicians to adapt their treatment protocols to cater for the individual needs of their patients.

Introduction

Obsessive-compulsive disorder (OCD) is a common mental disorder, twice as prevalent as schizophrenia or bipolar disorder, with an estimated lifetime prevalence rate of approximately 2% to 3% worldwide [1]. It has generally an early age at onset, during childhood or early adult life [2], [3], [4], and when untreated it tends to show a chronic waxing and waning course (approximately 75% of cases); moreover, the delay between onset of symptoms and help-seeking behavior is reported to be of approximately 10 years [5].

The quality of life of patients with OCD is severely affected, as shown by several studies using different instruments, both in epidemiologic and clinical samples [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. Obsessive-compulsive disorder, moreover, results in a significant impairment of quality of life even among healthy family members who live with and care for the patients [17], [18]. Although most studies agree that quality of life is affected in OCD, there are some differences across studies regarding the type and degree of impairment. For example, Spanish patients appeared to have a greater quality-of-life impairment than US patients in several domains of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a widely used quality-of-life instrument [8], [9]. These differences may be attributable to differences in severity of the patients included in each study (eg, in terms of greater OCD symptoms severity, higher number of comorbid conditions, or greater severity of depressive symptoms). It is also possible that cultural differences might partly account for the different perception of quality of life, and thus it is imperative to compare quality-of-life measurements with normative data of the country where patients live. The areas most affected by OCD may also vary depending on the patients' cultural context. For example, in Spain, patients with OCD were most impaired in social functioning [9], whereas in the United States, social functioning only ranked fourth [8].

Some, but not all, of the studies investigating quality of life in OCD have also examined predictors or determinants of quality of life. Among demographic factors, there is consistent evidence that age, sex, and educational level do not predict poorer quality of life; however, one study [19] found that older age is related to a lower score on the physical well-being subscale of the World Health Organization Quality of Life (WHOQOL)-BREF, another widely used measure of quality of life. Marital status (being unmarried) has been found to predict a poorer quality of life (Q-LES-Q score) in one study [12], but 2 other studies did not confirm this effect using the Illness Intrusiveness Rating Scale [20] or the SF-36 [13]. Among clinical characteristics, there is consistent evidence that age at onset and duration of the disorder before evaluation do not influence health-related quality of life [10], [11], [12], [13], [14], [20]. There is also consistent evidence that the greater the severity of the disorder is, as expressed by the Yale-Brown Obsessive-Compulsive Scale (YBOCS) total score, the poorer the perceived quality of life is. With regard to the specific effect of obsessions and compulsions, however, results are contradictory: severity of obsessions (as expressed by the obsessive subscale score of the YBOCS) has been found to predict a poorer quality of life in 4 studies [10], [12], [13], [20], whereas another one failed to find an effect [19]. Severity of compulsions (as expressed by the compulsions subscale score of the YBOCS) has been found to be related to poorer quality of life in 3 studies [10], [13], [19], whereas 2 other investigations failed to confirm this association [12], [20].

Another variable consistently associated with poorer quality of life is depression. Measures of quality of life have consistently been found to negatively correlate with self-rated [10], [19], [20] as well as clinician-rated [10], [12], [13] depressive symptoms. Similarly, the presence of comorbid major depressive disorder is associated with poorer quality of life [11], [21]. Less consistent is the evidence that other factors such as Axis I comorbidity [13], anxiety disorder comorbidity [11], number of obsessions and compulsions [10], or being unemployed [19] predict a poorer quality of life.

No studies, to our knowledge, examined the potential effect of a personality disorder diagnosis on quality-of-life measures in OCD.

Another area that has received little attention is the potential effect of specific obsessive-compulsive symptom dimensions on quality of life. Obsessive-compulsive disorder is a heterogeneous disorder, consisting of multiple potentially overlapping symptom dimensions, which are associated with distinct patterns of comorbidity, genetic transmission, neural substrates and treatment response [22]. It is therefore plausible that different symptom dimensions are associated with impairment in different areas of quality of life. To date, only one study examined the differential effect of OCD symptom subtypes on quality of life [10]. The authors found that being a washer, compared to all other subtypes of OCD, was associated with a poorer quality of life on the SF-36 domains of social functioning, general health, physical functioning, and role limitations due to emotional problems; being a checker (vs not being a checker) correlated with a lower score on the dimensions of mental health and role limitations due to emotional problems. Because “pure” subtypes of OCD are rare (eg, washers, checkers), a multidimensional approach, whereby each patient can score on one or more symptom dimensions, is required to fully address this question.

The aims of the present study were (1) to compare health-related quality of life of Italian patients with OCD to published Italian norms and (2) to examine the independent contribution of a wide range of variables, including Axis I and II comorbidity and symptom dimension scores to various domains of quality of life in a large sample of well-characterized patients.

Section snippets

Participants

We enrolled all consecutive patients with a principal diagnosis of OCD and with a YBOCS total score of 16 or greater who were referred to the Mood and Anxiety Disorders Unit of the University of Turin, Italy. This is a tertiary referral center located within the university hospital and specialized in the treatment of patients with OCD.

The protocol was reviewed and approved by the local ethical committee. All patients gave their informed consent before enrollment in the study.

The normative

Sample characteristics

The sociodemographic and clinical characteristics of the 151 patients included in the study are provided in Table 1. These are comparable to other clinical samples of referred patients with OCD. Compared to the normative Italian sample [23], our sample had a similar sex distribution (53% vs 49% men), was slightly younger (mean age, 36 vs 47 years), and less likely to be married (40% vs 67%).

Symptom structure of the YBOCS Symptom Checklist

The principal components analysis yielded a five-factor solution which accounted for 68.26% of the total

Discussion

The aims of the present study were to compare the health-related quality of life of Italian patients with OCD to published Italian norms and to examine the independent contribution of a wide range of sociodemographic and clinical variables, including Axis I and II comorbidity and symptom dimension scores, to various domains of quality of life in a large sample of well-characterized patients.

As expected, compared to Italian general population, the quality of life of Italian patients with OCD is

References (41)

  • OkashaA.

    Diagnosis of obsessive-compulsive disorder: a review

  • HollanderE. et al.

    Psychosocial function and economic costs of obsessive-compulsive disorder

    CNS Spectr

    (1997)
  • GrabeH.J. et al.

    Prevalence, quality of life and psychosocial function in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany

    Eur Arch Psychiatry Clin Neurosci

    (2000)
  • AngstJ. et al.

    Obsessive-compulsive severity spectrum in the community: prevalence, comorbidity and course

    Eur Arch Psychiatry Clin Neurosci

    (2004)
  • KoranL.M. et al.

    Quality of life for patients with obsessive-compulsive disorder

    Am J Psychiatry

    (1996)
  • BobesJ. et al.

    Quality of life and disability in patients with obsessive-compulsive disorder

    Eur Psychiatry

    (2001)
  • RapoportM.H. et al.

    Quality-of-life impairment in depressive and anxiety disorders

    Am J Psychiatry

    (2005)
  • Rodriguez-SalgadoB. et al.

    Perceived quality of life in obsessive-compulsive disorder: related factors

    BMC Psychiatry

    (2006)
  • Stengler-WenzkeK. et al.

    Subjective quality of life of patients with obsessive-compulsive disorder

    Soc Psychiatry Psychiatr Epidemiol

    (2006)
  • DidieE.R. et al.

    A comparison of quality of life and psychosocial functioning in obsessive-compulsive disorder and body dysmorphic disorder

    Ann Clin Psychiatry

    (2007)
  • Cited by (75)

    • Quality of life in patients with hoarding disorder

      2019, Journal of Obsessive-Compulsive and Related Disorders
    • Clinical predictors of quality of life in a large sample of adult obsessive-compulsive disorder outpatients

      2018, Comprehensive Psychiatry
      Citation Excerpt :

      So far, the published literature assessing QoL in OCD patients present very different methodologies, limiting the comparison of their results. For instance, some used the Medical Outcome Short-Form questionnaire - SF-36 [5,10,13–26]; others used the World Health Organization Quality of Life – WHOQOL [27–40]; and a few used other scales, such as the Sheehan Disability Scale (SDS) [41–43], or the Quality of Life Scale Lehman (QOL) [44,45]. Some characteristics that have been associated with worse QoL in OCD patients were: an older age [16,18,27]; female gender [12,13,19]; marital status [23]; unemployment [17,28]; fewer years of education [19]; lower social economic status and lower social support [32].

    View all citing articles on Scopus
    View full text