Data_Sheet_5_Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis.PDF

Comorbidities are seen with obsessive-compulsive disorder (OCD) across the lifespan. Neurodevelopmental comorbidities are common in young children, followed by mood, anxiety, and obsessive-compulsive related disorders (OCRDs) in children, adolescents and adults, and neurological and degenerative disorders in the elderly. Understanding comorbidity prevalence and patterns has clinical and research implications. We conducted a systematic review and meta-analysis on comorbidities in OCD across the lifespan, with the objective to, first, estimate age-wise pattern and prevalence of comorbidities with OCD and, second, to examine associations of demographic (age at assessment, gender distribution) and clinical characteristics (age of onset, illness severity) with comorbidities. Four electronic databases (PubMed, EMBASE, SCOPUS, and PsycINFO) were searched using predefined search terms for articles published between 1979 and 2020. Eligible studies, across age, reported original findings on comorbidities and had an OCD sample size of ≥100. We excluded studies that did not use standardised diagnostic assessments, or that excluded patients on the basis of comorbidity. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol has been registered on the International Prospective Register of Systematic Reviews. A comorbidity rate of 69% was found in a pooled sample of more than 15,000 individuals. Mood disorders (major depressive disorder), anxiety disorders (generalised anxiety disorder), neurodevelopmental disorders (NDDs) and OCRDs were the commonest comorbidities. Anxiety disorders prevailed in children, mood disorders in adults, whereas NDDs were similarly prevalent. Higher comorbidity with any psychiatric illness, NDDs, and severe mental disorders was seen in males, vs. females. Illness severity was inversely associated with rates for panic disorder, tic disorders, OCRDs, obsessive compulsive personality disorder, and anorexia nervosa. This systematic review and meta-analysis provides base rates for comorbidities in OCD across the lifespan. This has implications for comprehensive clinical evaluation and management planning. The high variability in comorbidity rates suggests the need for quality, multi-centric, large studies, using prospective designs.
Systematic Review Registration: Unique Identifier: CRD42020215904.

强迫症（obsessive-compulsive disorder, OCD）患者在全生命周期中均存在共病现象。幼儿群体中以神经发育类共病最为常见，儿童、青少年与成人群体则依次以情绪障碍、焦虑障碍及强迫相关障碍（obsessive-compulsive related disorders, OCRDs）为主要共病类型，而老年群体则以神经系统退行性疾病为主要共病。明确共病的患病率与分布模式具有临床与研究价值。本研究针对全生命周期内强迫症的共病情况开展了系统综述与元分析，目标一是估算不同年龄段强迫症共病的分布模式与患病率，二是探究人口统计学特征（评估年龄、性别分布）与临床特征（发病年龄、疾病严重程度）与共病情况的关联。研究检索了PubMed、EMBASE、SCOPUS及PsycINFO共4个电子数据库，使用预设检索词筛选1979年至2020年间发表的相关文献。纳入标准为：涵盖全年龄段人群、报告了共病的原始研究结果、强迫症样本量≥100。排除未采用标准化诊断评估或基于共病情况排除患者的研究。本研究遵循《系统综述与元分析首选报告条目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses）指南开展，研究方案已在国际系统综述前瞻性注册平台完成注册。合并样本量超15000名个体的研究结果显示，强迫症共病率达69%。心境障碍（重性抑郁障碍）、焦虑障碍（广泛性焦虑障碍）、神经发育障碍（neurodevelopmental disorders, NDDs）及强迫相关障碍为最常见的共病类型。儿童群体中焦虑障碍占比最高，成人群体中心境障碍占比最高，而神经发育障碍在各年龄段的患病率较为均衡。相较于女性，男性群体与任意精神障碍、神经发育障碍及重型精神障碍的共病率更高。疾病严重程度与惊恐障碍、抽动障碍、强迫相关障碍、强迫型人格障碍及神经性厌食症的共病率呈负相关。本系统综述与元分析明确了全生命周期内强迫症共病的基础患病率数据，可为全面的临床评估与治疗规划提供参考。本次研究中共病率存在较高异质性，提示未来需开展高质量、多中心、大样本的前瞻性研究。系统综述注册信息：唯一标识符：CRD42020215904。