Prevalence of OCD among Iraqi undergraduate medical students

1. Welcome

2. Prevalence of obsessive-compulsive disorder (OCD)
among Iraqi undergraduate medical students in time of
COVID-19 pandemic

3. Dr. Imdadul Magfur
MD(Phase-B) resident
Psychiatry
Sylhet M.A.G Osmani Medical College

4. Authors
 Taqi Mohammed
 Shaymaa Abdul Lateef
 Ali A. Abutiheen
 Hasanain Faisal Ghazi
 Naeem Shami Abood

5. doi.org/10.1186/s430
45-021-00086-9
● Received: 18 December,2020
● Accepted: 18 January,2021
● Published online: 08 February,2021
● Published on: Middle East Current
Psychiatry
● Publisher:SpringerLink.
(https://www.springer.com/in)
Journal Information
Source

6. Abbreviations
 OCD: Obsessive-compulsive disorder;
 OCI-R: Obsessive-Compulsive Inventory Revised scale
 COVID-19: Coronavirus disease

7. Background

8. • Obsessive-compulsive disorder (OCD) is reported to be the fourth most
frequent mental disorder worldwide (Asghar MA, et al., 2020).
• It causes unwanted thoughts (obsessions) and repetitive actions
(compulsions)
• OCD lifetime prevalence is estimated to be 2.3% ranging from 1.1-3.3%
(APA,2017).

9. (Contd.)
• Patients with OCD can have one or more groups OCD symptoms. These
symptoms can include an obsession with contamination and washing
rituals, frequent checking, persistent nasty or religious thoughts,
uniformity and ordering, and others (Raynal P, et al., 2019).
• Patients with OCD might be with other co-existing mental hazards such
as anxiety disorder, post-traumatic stress disorder, depression,
substance use, eating disorder, and suicidal thoughts (Fenske JN, et al.,
2015; Assareh M,et al.,2016).

10. (Contd.)
● Onset of OCD develops mainly during adolescence and late teens
with a median age of onset of 19-20 years. That makes high school
and university students a remarkable target for screening for OCD
and OCD symptoms. (2)
● Studies reported double rates of OCD among university students in
comparison to general population.(15)

11. (Contd.)
● This age group is more prone to other mental hazards including
substance use and suicidal attempts that are explained to be
associated comorbidities for OCD [ 16].
● Undergraduate Medical students are at an increased risk for OCD, due
to the stressful nature of medical schools as part of the heavy
curriculum & less leisure time.(4)

12. (Contd.)
● Moreover, medical students are taught, trained and asked to be
more precise, perfect, and obsessive a little bit more.(12)
● On the other hand, OCD can adversely affect academic
performance, general well-being, social interaction, and suicidal
thoughts. Issues that might have a huge impact on life unless
being diagnosed early and properly managed [17].

13. • COVID-19 pandemic is expected to have a negative effect on OCD
patients and medical students as a general stressor on health and
communities ;by closure of medical schools and the shifting toward
online learning, and by the increasing efforts of handwashing and
general hygiene as an essential step in COVID-19 prevention which
might trigger the obsession with contamination and compulsive
washing of hands. [18, 19, 20].
(Contd.)

14. Objective of Study
● Estimate the prevalence of the suggestive symptom of OCD among
a sample of medical students in Iraqi medical colleges during the
COVID-19 pandemic era and to assess the associated psychological
symptoms.
● association of the probability of being OCD with the related
sociodemographic features and other psycho-logical symptoms.

15. Methods

16. Study design
Analytic cross-sectional study
Sampling method
convenient sampling
August 2020 to October 2020
Study period

17. Study place and participants
 the study included all medical students attending different Iraqi
medical colleges except Kurdistan (north of Iraq)
 The total sample size was 1644

18. Data collection tools
 Structured questionnaire containing sociodemographic features and
associated risk factors
 Obsessive-Compulsive Inventory-Revised scale (OCI-R)

19. Data collection procedure
 Data were collected by a structured questionnaire submitted online
through different groups for medical students including Facebook,
telegram, and WhatsApp groups for 2 weeks period.
 OCI-R was applied to all the students and out of 72, score more
than 27 was considered as probable OCD.

20. Statistical analysis
 Descriptive statistics examined mean and standard deviation (SD) for
numerical data while categorical data were presented by frequency table.
 Association between categorical variables was performed by the chi square
test and the difference between means was performed by an independent
sample t test
 A value of less than 0.05 was considered statistically significant.
 Data were analyzed using SPSS version 23.

21. Ethics
 The study was approved by the ethical review committee of
the Medical Research Bioethical Committee
 Informed written consents were taken from all participants.

22. Results

23. ● The results showed that, According to the results mentioned in
Table 1, more than two-thirds (67.9%) of the participants were
females, only 3.5% were married, around one-third (32.3%) are
from the first stage.
● Less than one quarter (21.5%) mentioned that they have a family
member suffering from OCD.

24. Table 1: Frequency distribution of Socio-demographic features of study participants (n= 1644)
Categorial Variables Frequency Percentage
Gender
Male 528 32.1
Female 1116 67.9
Marital status
Single 1586 96.5
Married 58 3.5
College stages
First stage 531 32.3
Second stage 327 19.9
Third stage 336 20.4
Fourth stage 199 12.1
Fifth stage 133 8.1
Sixth stage 118 7.2

25. Categorical Variables Frequency Percentage
Place of living
Baghdad 186 11.3
Wasit 285 17.3
Karbala 333 20.3
Thi-qar 111 6.8
Nineveh 2 0.1
Qadisiyyah 60 3.6
Babil 82 5.0
Najaf 425 25.9
Muthanna 19 1.2
Basra 103 6.3
Kirkuk 1 0.1
Family history of OCD
No 1291 78.5
Yes 353 21.5

26. (Contd.)
Continuous Variables Mean Standard deviation
Age of participants (years)
20.73 1.83
Number of sleep hours
8.11 1.85

27. Table 2: Frequency distribution of other psychological symptoms
among the study sample
Associated psychological symptoms Responses (N) Percent(%)
Worry 674 25.9
Depression 465 17.9
Drug abuse 2 0.1
Sleeping disorders 476 18.3
Feeding disorders 283 10.9
Stress 617 23.7
Other 84 3.2
Total 2601 100

28. Figure 1: Frequency distribution of OCD categories among participant students (n-1644)

29. (Contd.)
 Regarding the items that represented obsessing symptoms, ”extremely or a
lot of was:
 upset by unpleasant thoughts that come into mind against will (51.8%)
 frequently get nasty thoughts & have difficulty in getting rid of them (42%)
 upset if objects are not arranged properly (40.9%)
 Check things more often than necessary (29.6%)
 Suffered from hoarding symptoms related to OCD (28%)
 had to wash or clean themselves simply because they feel they were
contaminated (19.4%)

32. Discussion

33.  This is one of the scarce worldwide studies conducted for assessment of
OCD and investigation of associated psychological symptoms and socio-
demographic features.
 Prevalence of probable OCD in this sample is 43% which is higher than
studies from other countries ranging from 3.8 to 35.8% in pre pandemic
period but in congruence with an online Canadian survey conducted
during CoVID-19 pandemic.
 Correlation of OCD with stress, anxiety and depressive symptoms was
reported by similar studies (4)

34. (Contd.)
 People with OCD often have other psychological comorbidities such as
depressive or bipolar disorder or an anxiety disorder (76%) (29)
 COVID-19 most probably acted as a stressor leading to higher
prevalence of OCD as well as other psychological symptoms in addition
to that medical students have relatively higher mental health problems
than the general population(31)

35. (Contd.)
 Statistically ,there is a highly significant association between OCD and
college years which aligns with the previous study conducted among
Brazilian medical students(4)
 Statistical analysis showed that there was no significant gender
difference according to the presence of OCD which is consistent with
the findings of other researchers(4,9)

36. (Contd.)
● A non-significant association was found between family history and
OCD frequency. This is in contrast to the finding of other authors [9,
23] who stated that a family history of OCD was more reported from
students with OCD than from normal ones. This finding could be
explained by the presence of additional environmental stressors
which may have triggered recent OCD cases rather than genetic
factors.

37. Strengths and Limitations

38. Limitations:
 The diagnosis of OCD was not
confirmed by clinical interview
 No causal association can be
ascertained
 Convenient sampling method
may limit generalization of
results
 The pandemic cannot be
confirmed as the exact cause of
OCD, so that Longitudinal
researches are necessary
Strengths:
 Included a large sample size
from different Iraqi cities
 Well-validated instrument had
been used.
 Prevalence of OCD and its
associated factors was
evaluated for the first time
during the COVID-19 outbreak
among medical students

39. Conclusion

40. ● High prevalence of OCD and other psychological symptoms among
medical students during COVID-19 outbreak.
● Symptoms of OCD often hidden, negatively influence many life aspect of
these students
● Efforts should be made by corresponding college authorities to early
identify & treat this condition
● Further studies are needed to both establish a causal relationship and
identify other psychological impact of the pandemic on both students
and the general population

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44. ThankYou