Article2001

The Prevalence of Clinically Recognized Obsessive-Compulsive Disorder in a Large Health Maintenance Organization

BRUCE H. FIREMAN · Lorrin M. Koran · Jeanne Leventhal Alexander · Alice S. Jacobson

135 citations0/0 files storedAmerican Journal of Psychiatry

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Obsessive-Compulsive Spectrum Disorders Psychoanalysis and Psychopathology Research Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Abstract

OBJECTIVE: Little is known about the prevalence of obsessive-compulsive disorder (OCD) as recognized in clinical settings. The authors report data on the prevalence of clinically recognized OCD in a large, integrated, group practice health maintenance organization (HMO). METHOD: The authors examined the database of outpatient diagnoses for the 1.7 million people (age >or=6) in the San Francisco Bay Area and Sacramento who were continuously enrolled in Kaiser Permanente from May 1995 through April 1996. OCD diagnoses were confirmed by chart review. RESULTS: The 1-year prevalence of clinically recognized OCD was 84/100,000 (95% confidence interval: 80-89/100,000), or 0.084%. It varied among the 19 clinics within the HMO but was nowhere higher than 150/100,000. Prevalence was higher among women than among men but was higher among boys than among girls. Above age 65, OCD prevalence decreased markedly in both genders. Period prevalence rates increased by 60% as the length of the study period doubled from 1 to 2 years, more than would be expected for a chronic disease requiring regular care. About three-quarters of both children and adults with OCD had comorbid psychiatric diagnoses; major depression was common in both groups. CONCLUSIONS: Although previously reported prevalences of 1%-3% from community studies may have included many transient or misclassified cases of OCD not requiring treatment, the very low prevalence of clinically recognized OCD in this population suggests that many individuals suffering from OCD are not receiving the benefits of effective treatment.

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References

1989The Yale-Brown Obsessive Compulsive Scale 1993The de Facto US Mental and Addictive Disorders Service System 1988One-Month Prevalence of Mental Disorders in the United States 1992Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology.1988The Epidemiology of Obsessive-Compulsive Disorder in Five US Communities 1992The Epidemiology and Clinical Features of Obsessive Compulsive Disorder 1994The Cross National Epidemiology of obsessive-compulsive disorder 1999A 40-Year Follow-up of Patients With Obsessive-compulsive Disorder

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