Psychosocial Function and Economic Costs of Obsessive-Compulsive Disorder

Abstract

The study presented was conducted to analyze the effects of obsessive-compulsive symptoms on patients' quality of life and the costs incurred by patients and society for the treatment of obsessive-compulsive disorder (OCD). To accomplish this, a detailed 410-item questionnaire of psychosocial function and economic cost was sent to every fourth member of the Obsessive Compulsive Foundation. Of the 2,670 members who received the survey, 701 (26.9%) returned it.Outcome measures included symptomatology, course of illness, impact of illness on psychosocial and other functioning, effects of diagnosis and treatment, and economic consequences. The demographics of this group were similar to those in smaller treatment-seeking clinical samples, but not necessarily to OCD sufferers within the US population as a whole. More than half of the patients reported moderate to severe interference in family relationships, socializing, and ability to study or work, secondary to OCD symptoms. A 10.2-year gap was observed between the onset of symptoms and the first attempt to seek professional help, and a 17.2-year gap was observed between the onset of symptoms and receipt of effective treatment. Specific treatments, such as serotonin reuptake inhibitors and behavior therapy, showed greater symptom improvement, and significantly reduced the total annual fees incurred by OCD patients when compared with nonspecific treatments.Our study results indicate that OCD has a profound effect on psychosocial functioning and quality of life. Large direct costs for OCD and even larger indirect costs due to lost wages and underemployment were found. Greater awareness of OCD among practitioners may result in earlier diagnosis and more appropriate and cost-effective treatments.

Compulsive Aspects of Impulse-Control Disorders

“…Although studies of small OCD samples have reported PG rates ranging from 2.2% to 2.6% [14,15], a recently completed study of a large sample of subjects who had primary OCD (n = 293) found rates of current (0.3%) and lifetime (1.0%) PG [16] that were no greater than those in the general population (0.7-1.6%) [13]. These recent findings are consistent with those from a sample of more than 2000 individuals who had OCD in which both current and past rates of PG were lower than 1% [17]. Similarly, a family study of OCD probands did not find evidence of a significant relationship between OCD and PG or OCD and ICDs in general (with the exception of grooming and eating disorders) [18].…”

The Obsessive-Compulsive Disorder

“…People with the disorder have long delays in accessing effective treatments-17 years on average in one study. 4 They frequently present to non-psychiatrists for treatment (table 1), and psychiatric symptoms go undetected. Greater awareness of the condition is needed in a range of non-psychiatric healthcare settings, and clinicians need to be confident about recognising it.…”

Qualidade de vida no transtorno obsessivo-compulsivo: uma revisão

“…Desconhecimento e medo podem ainda contribuir para a demora em buscar ajuda. Hollander et al (1996Hollander et al ( , 1997 estimaram em 10 anos o tempo médio até o tratamento e em 17 anos a demora até a obtenção de tratamento adequado, o que, sem dúvida, prolonga o sofrimento. Além disso, sabe-se que alguns casos não melhoram substancialmente com o tratamento, mesmo que adequado, e que os efeitos colaterais dos psicofármacos também podem afetar a QV .…”

“…Dessa forma, seriam conseqüências comuns do TOC, apontadas por diferentes autores (Steketee et al, 1987;Hollander et al, 1996Hollander et al, , 1997Stein et al, 2000;Lochner et al, 2003;Moritz et al, 2005;Eisen et al, 2006): diminuição da auto-estima e do bem-estar subjetivo, interferência negativa na vida estudantil, profissional, familiar, afetiva e social, com menos conquistas acadê-micas, menores aspirações de carreira, dificuldades de relacionamento, menos amigos, menor capacidade para apreciar atividades de lazer, além dos custos indiretos para a família e para a sociedade. Em casos graves, pode haver dificuldade ou incapacidade completa para atividades diárias rotineiras e alguns portadores podem ficar totalmente presos em casa, em função de comportamentos de esquiva dos estímulos temidos.…”

“…Rapaport et al (2005) descreveram que 26% dos pacientes com TOC apresentavam grave comprometimento da QV, o que ocorreu em menor proporção em portadores de transtorno de pânico e fobia social, e maior nos quadros depressivos. Entre os 701 membros da Obsessive-Compulsive Foundation avaliados por Hollander et al (1997) quanto à interferência sócio-ocupacional do TOC, 70% relataram dificuldades na relação conjugal, 63% na socialização/ capacidade de fazer amizades, 60% na capacidade de trabalho, 59% na capacidade de estudo, 58% admitiam envolvimento de familiares nos rituais, 57% já haviam pensado em suicídio e 12% já tinham tido pelo menos uma tentativa de suicídio. Metade dos membros de uma associação de portadores de TOC da África do Sul referiu ideação suicida, e três quartos, baixa auto-estima .…”