Pandemic-related selective increase in obsessive-compulsive symptoms in UK study

COVID-19 has now been around for almost a year and has caused enormous stress among the developed nations of the Western world. A devastating new study shows how a large-scale wave of increased obsessive-compulsive (OC) symptoms affected public behavior, such as seeking information about the pandemic and following government guidelines. This could predict long-term sustained disruptions of mental health as an unexpected sequel to the pandemic.

This study was published in the pre-print server medRxiv*.

Study Results

Study Results. Image Credit: https://www.medrxiv.org/content/10.1101/2020.12.08.20245803v1.full.pdf

Stress and Psychiatric Symptoms

All life events associated with significant stress cause an upsurge of ill mental health. The COVID-19 pandemic was no exception. It ushered in an era of disrupted finances, social interactions, and health. Predictably, all psychiatric symptoms increased over the first wave of the pandemic. This includes symptoms in already diagnosed patients with anxiety, depression, bipolar disease, schizophrenia, and obsessive-compulsive disorders (OCD).

Members of the general public also showed a significant increase in symptoms of anxiety and depression. However, in typical situations, once the individual adapts to the situation, such symptoms return to the baseline. This is mediated by the re-appraisal of the situation and the evolution of coping strategies.

OCD is a mental condition that is selectively cultivated by pandemic conditions because the campaign to contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread pivots around the need to prevent and remove contamination by cleaning. This pervasive fear of an invisible foe which spreads by contamination and is combated by cleaning and other non-pharmaceutical interventions (NPIs), including face mask use and social distancing, caters to OCD behavior.

“These news coverages and governmental guidelines may thus give validity to OCD-symptomatic behavior, potentially intensifying or triggering them.”

This may lead to a wave of OC symptoms in the general public as well, as more attention is paid to the area of contamination and cleaning.

Study Details

To assess this risk, the researchers carried out a longitudinal study on the impact of COVID-19 on OC, anxiety, and depression. They followed psychiatric scores in these three areas for several months from May to August 2020. They also observed any correlations between OC symptoms, information-seeking about COVID-19, and the following government guidelines.

The first data collection was from April 24, 2020, to May 7, 2020, the peak of the first wave. Here, standardized questionnaires were used to record the three types of symptoms among 416 participants, and information-seeking behavior, along with their use of news and social media. They also had a mental ability test.

This assessment was repeated at the second time point, between July 15 and August 15, 2020, with an additional assessment of how well they followed COVID-19 guidelines. At this time, the largest relaxation of pandemic restrictions had just occurred, and thus the effects of a significant change in the environment could also be measured. At this point, there were 304 participants.

The researchers used self-administered questionnaires to measure OC (Padua Inventory-Washington State University Revision (PI-WSUR)), with anxiety and depression (Hospital Anxiety and Depression Scale (HADS)). They also asked about the average use of news and social media pre-pandemic. At the second assessment, they asked also how far the respondents observed pandemic-related recommendations by the authorities.

Initial Rise in Psychiatric Scores

The investigators found that all psychiatric scores were initially elevated, some components of the PI-WSUR being scored at OCD level. With the HADS, too, about half and 40%, respectively, met the cut-off for anxiety and depression, respectively.

The corresponding population-level rates for the latter conditions before the pandemic, in one of the largest studies, was around 20% for both, showing high symptoms scores during the first wave of COVID-19.

Selective Increase in OC Symptoms in Later Phase

Over time, however, only the OC symptoms showed a further rise, even when items related to contamination and cleaning were excluded from the analysis. Thus, normal adaptation did not occur concerning OC symptoms during the lockdown, but instead, they continued to rise. Curiously, anxiety, and depression showed the expected drop, due to adaptation.

Increased Adherence to Guidelines

The third area of investigation was the role of these symptoms in causing pandemic-related behavior, especially since people with high OC symptoms were seen to be engaged in increased information-seeking behavior. They found that most of such behavior in respondents occurred at the beginning of the lockdown, and was due to the lack of knowledge about the pandemic.

The researchers also looked at the link between information seeking and psychiatric symptoms. They found that OC symptoms were related to a higher expression of this behavior at both early and late time points. The same was also true of anxiety scores but to a smaller extent. This was true even after adjusting for age, gender, and social media use unrelated to the pandemic.

What are the Implications?

When analyzed using all the psychiatric symptoms as potential predictors for information-seeking behavior, the only consistent association was found to be with OC symptoms. The association with anxiety disappeared in this analysis. Thus, although information-seeking decreased over time, the reverse was observed in connection with OC symptoms. This favors the role of OC symptoms as the main reason for pandemic-related information seeking.

Again, the increase in information seeking related to OC symptoms was found to result in the increased tendency to adhere to government COVID-19 guidelines even after the relaxation of restrictions. Both these behaviors were independently predictive of the tendency to follow these guidelines.

The benefit to society from such OC symptoms is obvious, with respect to viral containment, though they do impose a burden of care on the individual. On the other hand, the rise and prolonged duration of such symptoms suggest the need to put policies in place to follow up on individuals with a high risk of developing OCD. Interventions are necessary to prevent and treat the condition before long-term mental ill-health sets in.

Our findings highlight that OC symptoms are disproportionally affected by the pandemic by documenting their selective increase throughout the pandemic for the first time, which may result in serious adverse long-term consequences.”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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