Effects of the COVID-19 Pandemic on Obsessive-Compulsive Symptoms Among University Students: Prospective Cohort Survey Study

Abstract

Background The COVID-19 pandemic is associated with common mental health problems. However, evidence for the association between fear of COVID-19 and obsessive-compulsive disorder (OCD) is limited. Objective This study aimed to examine if fear of negative events affects Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores in the context of a COVID-19–fear-invoking environment. Methods All participants were medical university students and voluntarily completed three surveys via smartphone or computer. Survey 1 was conducted on February 8, 2020, following a 2-week-long quarantine period without classes; survey 2 was conducted on March 25, 2020, when participants had been taking online courses for 2 weeks; and survey 3 was conducted on April 28, 2020, when no new cases had been reported for 2 weeks. The surveys comprised the Y-BOCS and the Zung Self-Rating Anxiety Scale (SAS); additional items included questions on demographics (age, gender, only child vs siblings, enrollment year, major), knowledge of COVID-19, and level of fear pertaining to COVID-19. Results In survey 1, 11.3% of participants (1519/13,478) scored ≥16 on the Y-BOCS (defined as possible OCD). In surveys 2 and 3, 3.6% (305/8162) and 3.5% (305/8511) of participants had scores indicative of possible OCD, respectively. The Y-BOCS score, anxiety level, quarantine level, and intensity of fear were significantly lower at surveys 2 and 3 than at survey 1 (P<.001 for all). Compared to those with a lower Y-BOCS score (<16), participants with possible OCD expressed greater intensity of fear and had higher SAS standard scores (P<.001). The regression linear analysis indicated that intensity of fear was positively correlated to the rate of possible OCD and the average total scores for the Y-BOCS in each survey (P<.001 for all). Multiple regressions showed that those with a higher intensity of fear, a higher anxiety level, of male gender, with sibling(s), and majoring in a nonmedicine discipline had a greater chance of having a higher Y-BOCS score in all surveys. These results were redemonstrated in the 5827 participants who completed both surveys 1 and 2 and in the 4006 participants who completed all three surveys. Furthermore, in matched participants, the Y-BOCS score was negatively correlated to changes in intensity of fear (r=0.74 for survey 2, P<.001; r=0.63 for survey 3, P=.006). Conclusions Our findings indicate that fear of COVID-19 was associated with a greater Y-BOCS score, suggesting that an environment (COVID-19 pandemic) × psychology (fear and/or anxiety) interaction might be involved in OCD and that a fear of negative events might play a role in the etiology of OCD.

The impact of the coronavirus pandemic on specific symptom dimensions and severity in OCD: A comparison before and during COVID-19 in the context of stress responses

“…It is worth noting, however, that perceptions of threat and danger, including exaggerated danger-related stress responses to COVID-19, do not necessarily indicate a specific obsessional response, which has been suggested to depend on more specific perceived self-related vulnerabilities ( Aardema, 2020 ; Aardema & Wong, 2020 ). Nonetheless, results support that these danger-related stress reactions are associated with an increase in symptoms among those with OCD ( Ji et al, 2020 ; Nissen et al, 2020 ; Yassa et al, 2020 ), likely through similar mechanisms by which symptoms may be exacerbated in non-clinical and other clinical populations ( Song, 2020 ; Montano & Acebes, 2020 ; Taylor et al, 2020a ; Taylor et al, 2020c ).…”

Correlates of Psychological Distress Among Pakistani Adults During the COVID-19 Outbreak: Parallel and Serial Mediation Analyses

“…This concurs with the recent findings of a Turkish study (Satici et al, 2020 ) which reported a significant role of fear of COVID-19 on life satisfaction via different psychological distress measures (i.e., depression, anxiety, and stress). Additionally, fear of COVID-19 has been reported to be a strong indicator of obsession and compulsion in the specific context of the COVID-19 pandemic (Ji et al, 2020 ).…”

Presentation and management of anxiety in individuals with acute symptomatic or asymptomatic COVID-19 infection, and in the post-COVID-19 recovery phase

“…ASQ may be used in clinical and college settings to detect anxiety and depression. An essential screening tool for obsessive-compulsive disorder is the Yale Brown Obsessive Compulsive Scale, Y-BOCS, which can be part of the evaluation of patients with pre-existing obsessive-compulsive disorder, or for long-term follow up of anxiety resulting from COVID-19 infection (Davide et al 2020;Ji et al 2020).…”