Emerging scientific literature from various parts of the world speculate that there could be significant worsening of Obsessive-Compulsive Disorder (OCD) in the context of the current COVID-19 pandemic. (Santos, 2020; Banerjee, 2020; Shanmugam et al., 2020; Fineberg et al., 2020).
Studies on the general population through surveys during the H1N1 pandemic of 2009-10 have shown high health anxiety and compensatory behaviours (Wheaton et al, 2012) and obsessive-compulsive symptoms and beliefs (Brand et al 2012). Similarly, contamination-related threat estimates were found to predict high anxiety in another study conducted during the Zika virus outbreak of 2015-2016 (Blakey & Abramowitz, 2017).
A recent study from Denmark looked for keywords related to COVID-19 within the clinical notes of 11,072 patients with psychiatric diagnosis. Of the 918 patients whose clinical notes contained terms related to COVID-19, only 36 had a diagnosis of OCD. (Rohde et al, 2020)
There is no systematic data on the course of OCD in the context of COVID-19 or any other pandemic. Hence, we wish to study the course of OCD during this pandemic, in patients who have been in regular follow up at the OCD clinic, NIMHANS. We also wish to study predictors of worsening, if any.
- To assess for current worsening in the severity of OCD in a cohort of patients who have been on follow-up at the OCD Clinic
- To assess if current symptomatology of OCD are related to fears of COVID-19
- To look for factors associated with worsening of OCD following the COVID-19 pandemic & relapse in those who previously responded/remitted with treatment
- This is a telephonic/electronic survey of OCD patients and general population
- Both groups will be assessed for COVID related health anxiety and their Work/Social adjustment during the pandemic
- Clinical data from the OCD group regarding illness severity and symptomatology will also be reviewed and compared with baseline severity and last documented follow up records.
As part of the clinical services for maintaining continuum of care following the COVID-19 pandemic, patients are being routinely called telephonically, by the Senior Residents and consultants of the OCD Clinic. During this telephonic follow-up, we assess patients using the same protocol followed in the regular OCD Clinic, that is, using the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Clinical Global Impression (CGI), and other routine clinical questions for assessing treatment adherence, overall well-being, etc.
As part of this study we additionally plan to ask patients about COVID-19 related health anxiety, along with changes in socio-occupational functioning that have occurred following the pandemic, using structured assessment scales (detailed below)
The study sample will include all patients who visited the OCD Clinic, at NIMHANS between November 1st 2019 to February 29th 2020, that is, before the onset of the COVID-19 pandemic in India.
- Having a diagnosis of OCD, diagnosed using MINI (Mini International Neuropsychiatric Interview 7.0.0)
- Baseline YBOCS (Yale-Brown Obsessive-Compulsive Scale) checklist and severity ratings available from the clinical records
- Age >18 years
Exclusion Criterion: Presence of comorbid severe mental illness (schizophrenia or bipolar disorder)
General Population Control Group:
Controls will be contacted by disseminating the invitation to participate over social media, those who express interest will be contacted telephonically or sent an online survey form that contains the self-rated assessments.
Inclusion Criterion: Age > 18 years; Exclusion Criterion: Nil
Following completion of the telephonic clinical follow-up, patients will be explained about the current research study, as per the script detailed below. After explaining the purpose/rationale, their right to withdrawal, confidentiality of information collected, and the time involved (10 minutes) they will be asked if they could participate. Upon communication of consent, the interviewer will proceed with the assessments.
For healthy controls, the statement explaining the study will be sent over email & social media, and those interested to participate may express their consent by clicking on a link, and then can specify if they can fill the form (in English) or have a telephonic interview (5 – 10 minutes). Attempts will be made to match the control sample with the OCD sample for age, gender education & socio-economic class.
Description of Assessments:
COVID-19 Threat Scale
Consists of 9 questions to be rated on a Likert scale of 1 to 5. The questions pertain to the preoccupation and fear of contracting COVID-19 infection and the measures taken to prevent it. This has been modified (with permission) for use in the Indian context. This will take 2-3 minutes to apply (appended below).
Work and Social Adjustment Scale – Modified
This is modified to elicit significant changes that have taken place in people’s lives, in various domains after the COVID-19 pandemic and measures such as lockdown and quarantine Consists of 5 questions, rated on a Likert of 0 to 8. This will also take around 2-3 minutes to apply (also appended below).
Outcomes & Implications:
Anxiety about COVID-19 may fuel existing obsessive fears of contamination in some people with OCD. Additionally, the recommendations of handwashing and social distancing may further compound existing compulsive behaviours. Hence, this study will help in:
- Identifying the proportion of patients with OCD who may worsen/relapse will help understand the magnitude of impact of the pandemic on OCD
- Identifying risk factors associated with worsening & relapse will help in targeting towards specific interventions
- Understanding the nature of OCD and its relation to health-related anxiety
- The protocol will be submitted to the Ethics Committee of the NIMHANS, Bangalore, India for ethical approval.
- The participants will be subjected to the study interview only after explaining that the information is collected for research, and then obtaining their oral consent
- Confidentiality of information will be maintained throughout the study. No personal identifiers would be associated with the data obtained
- All collected research materials would be categorized by randomly assigned subject IDs only.
- This study involves no risk to the participants
- There is expected to be no direct benefit to study participants
- Fineberg, N.A., Van Ameringen, M., Drummond, L., et al., 2020. How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician’s guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive Research Network (OCRN) of the European College of Neuropsychopharmacology. Compr. Psychiatry 152174.
- Santos, C.F., 2020. Reflections about the impact of the SARS-COV-2/COVID-19 pandemic on mental health. Brazilian J. Psychiatry
- Banerjee, D.D., 2020. The other side of COVID-19: Impact on Obsessive Compulsive Disorder (OCD) and Hoarding. Psychiatry Res. 288, 112966.
- Shanmugam, H., Juhari, J. A., Nair, P., Ken, C. Y., N.C.G., Impacts of COVID-19 Pandemic on Mental Health in Malaysia: A Single Thread of Hope. Malaysian J. Psychiatry. URL: http://www.mjpsychiatry.org/index.php/mjp/article/view/536
- Wheaton, M.G., Abramowitz, J.S., Berman, N.C., Fabricant, L.E., Olatunji, B.O., 2012. Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cognit. Ther. Res. 36, 210–218.
- Brand, J., McKay, D., Wheaton, M.G., Abramowitz, J.S., 2013. The relationship between obsessive compulsive beliefs and symptoms, anxiety and disgust sensitivity, and Swine Flu fears. J. Obsessive. Compuls. Relat. Disord. 2, 200–206.
- Blakey, S.M., Abramowitz, J.S., 2017. Psychological Predictors of Health Anxiety in Response to the Zika Virus. J. Clin. Psychol. Med. Settings 24, 270–278.
- Goodman, W.K., Price, L.H., Rasmussen, S.A., et al, 1989. The Yale-Brown Obsessive Compulsive Scale: I. Development, Use, and Reliability. Arch. Gen. Psychiatry 46, 1006–1011.
- Busner, J., Targum, S.D., 2007. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont). 4, 28–37.
- Wheaton, M.G., Ward, H.E., Sanders, P. R., Reel, J.E., & Van Meter, A.R. (2020). Media effects on concerns about the spread of the novel coronavirus (COVID-19) in the United States. Frontiers in Psychology. manuscript under review
- Mundt, J.C., Marks, I.M., Shear, M.K., Greist, J.H., 2002. The Work and Social Adjustment Scale: A simple measure of impairment in functioning. Br. J. Psychiatry 180, 461–464.