Abstract
BackgroundThe 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.ObjectiveThis 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.MethodsAll 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.ResultsIn 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).ConclusionsOur 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.
Highlights
At the end of 2019, an outbreak of COVID-19, caused by the novel coronavirus SARS-CoV-2 was reported in Wuhan, China [1]
The multiple regression analysis showed that both the Self-Rating Anxiety Scale (SAS) standard score and intensity of fear significantly contributed to variations in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score. These findings suggest that the intensity of fear of COVID-19 played a role in obsessive-compulsive disorder (OCD) and that the interactions between fear, anxiety, and pandemic-induced quarantine may be risk factors for an increase in Y-BOCS score
Not all participants with fear of COVID-19 were categorized as possible OCD based on Y-BOCS score, our findings indicate that a higher intensity of fear was related to a higher prevalence of possible OCD
Summary
At the end of 2019, an outbreak of COVID-19, caused by the novel coronavirus SARS-CoV-2 was reported in Wuhan, China [1]. Public education on disease prevention and environmental hygiene was emphasized across the country. Information outlets, such as the internet, television, radio, newspapers, cellphones, and social media (eg, WeChat), were used to disseminate advice on how to prevent infection (eg, stay at home, wear face masks, wash hands frequently, and/or sanitize hands). The rapid transmission of COVID-19, its approximately 2% fatality rate, lack of effective treatments and vaccines, and mass quarantine measures are associated with common mental health problems (eg, fear, anxiety, depression, and sleep problems) in subpopulations, including COVID-19 patients, those with close contact to infectees, the public, and health care professionals [2,3]. There is a lack of research on the effects of the COVID-19 pandemic on specific mental disorders, such as obsessive-compulsive disorder (OCD). Evidence for the association between fear of COVID-19 and obsessive-compulsive disorder (OCD) is limited
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