Help-Seeking Intention in Obsessive-Compulsive Disorder: Predictors and Barriers in South Africa

Help-seeking behavior, treatment barriers and facilitators, attitudes and access to first-line treatment in German adults with obsessive-compulsive disorder

BACKGROUND

Individuals with obsessive-compulsive disorder (OCD) face both personal and system-based barriers in receiving first-line treatment, i.e. cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). The present study comprehensively investigated help-seeking behavior, treatment barriers and facilitators, attitudes and access to gold-standard treatment in adults with OCD in Germany. We aimed to characterize the care situation and examine the influence of clinical and sociodemographic variables on help-seeking behavior and receiving treatment.

METHODS

An anonymous online survey was performed in individuals with OCD who were recruited in- and outside the psychiatric healthcare system. The survey included a wide range of questions regarding help-seeking behavior, treatment barriers and facilitators, attitudes towards different treatment options and access to treatment. Sociodemographic and clinical characteristics were also collected. The final sample comprised 276 individuals with OCD.

RESULTS

The mean delay to seeking psychotherapeutic treatment was M = 5.15 years (SD = 6.88) and the mean delay to recognition of OCD was M = 5.58 years (SD = 7.16). Of those 211 who had ever received CBT, 49.5% reported that therapist-guided ERP had been performed at some point during treatment. Indicators of poor healthcare, such as longer delay to recognition or a larger number of treatments before receiving ERP were significantly associated with increased symptom severity. Moreover, a younger age was associated with a shorter delay to recognition of OCD. Taboo thoughts (60.9%) and checking (52.9%) were the most commonly reported symptom dimensions, and individuals with current taboo thoughts were significantly more likely to be treated with CBT. Educational websites were identified as the most important facilitators in recognizing OCD and providing information on effective treatment options. Lack of knowledge about treatment options was reported as the most common barrier to seeking/receiving ERP-based treatment.

CONCLUSIONS

Delays to the recognition of OCD and to seeking help still exceed 5 years on average, but were reduced in younger individuals, potentially reflecting increased mental health literacy. Although our sample may not be fully representative, our results fill the gap between epidemiological surveys and previous studies in outpatients. Options for improving the care situation are discussed.

Enhancing healthcare utilization and reducing preventable hospitalizations: exploring the healthcare-seeking propensity of patients with non-communicable diseases in Rural China

OBJECTIVE

Understanding healthcare-seeking propensity is crucial for optimizing healthcare utilization, especially for patients with chronic conditions like hypertension or diabetes, given their substantial burden on healthcare systems globally. This study aims to evaluate hypertensive or diabetic patients' healthcare-seeking propensity based on the severity of symptoms, categorizing symptoms as either major or minor. It also explores factors influencing healthcare-seeking propensity and examines whether healthcare-seeking propensity affects healthcare utilization and preventable hospitalizations.

METHODS

A cross-sectional study was conducted in 2023 in rural areas of Dangyang city, Hubei province, and Xishui county, Guizhou province. A sample of 780 patients, including those with hypertension, diabetes, or both, was obtained using multistage stratified cluster sampling. Healthcare-seeking propensity was evaluated using a questionnaire with two subscales for major and minor symptoms, which were analyzed separately. Multiple linear regression was used to identify factors influencing healthcare-seeking propensity, while logistic regression was employed to examine the relationship between healthcare-seeking propensity and healthcare utilization, as well as preventable hospitalizations.

RESULTS

Rural Chinese patients had an average healthcare-seeking propensity score of 5.43 ± 1.99 for major symptoms and 8.04 ± 1.66 for minor symptoms. Factors such as age, education level, income, accessibility to healthcare, and enrollment in family doctor services influenced healthcare-seeking propensity for both types of symptoms. Patients' self-rated health status and the type of disease affected their healthcare-seeking propensity for major symptoms, while primary healthcare service quality solely impacted the propensity for seeking care for minor symptoms. Logistic regression demonstrated that after accounting for confounding factors, a higher propensity for seeking care for minor symptoms was associated with increased healthcare service utilization (AOR = 1.402, 95% CI: 1.259-1.562), whereas a higher propensity for major symptoms remarkably reduced preventable hospitalizations (AOR = 0.501, 95% CI: 0.428-0.587).

CONCLUSIONS

Rural Chinese patients exhibited different healthcare-seeking propensity depending on the type of symptoms. The healthcare-seeking propensity in the western region was lower than that in the central region, highlighting regional disparities. Seeking care for minor symptoms results in more outpatient visits, whereas addressing major symptoms reduces preventable hospitalizations. Establishing a robust network of primary healthcare facilities and emphasizing the role of family doctors can boost patients' propensity to seek healthcare.

CLINICAL TRIAL NUMBER

Not applicable.

Duration of Untreated Illness in Obsessive-Compulsive Disorder and its Associated Factors

Introduction

The period before effective treatment is administered, is known as the duration of untreated illness (DUI). It has been found to relate to prognoses and sensitivity to treatment. The DUI is yet to be fully investigated in relation to obsessive-compulsive disorder (OCD).

Method

The present study examined a sample of 89 patients who presented with OCD over a span of two years and who were treated at a clinic in Khartoum, the capital city of Sudan. We examined the mean DUI before the patients received an effective psychiatric intervention. We also gauged different sociodemographic and clinical presentations associated with DUI.

Results

The sample comprised 55 male (61.8%) and 34 female patients (38.2%). Around 75% were single (N = 67); 34 participants (38.2%) were students; 28 (31.5%) were employed; and 27 (30.3%) were unemployed. The mean age of the participants was 27.12 years (SD ± 8.72) and the mean age at the first onset of the disorder was 21.72 years (SD ± 7.51). The mean of DUI was 5.41 years (SD ± 5.53). There was no significant difference in DUI in respect of age or gender. It was significantly longer in unemployed patients (7.59 years ± 5.93) than in employed (6.37 years ± 6.64) or students (2.88 years ± 2.59); p = 0.002. Married OCD patients had a longer DUI than single patients.

Conclusion

The present study highlighted a considerable delay before OCD patients received effective treatment. Although many intractable cultural and socioeconomic factors were tested, the strongest associations were found to be unemployment and marital status.

Enhancing mental health literacy in obsessive-compulsive disorder and reducing stigma via smartphone: A randomized controlled trial protocol

BACKGROUND

Obsessive-compulsive disorder (OCD) is a disabling disorder that can be successfully treated. However, individuals with OCD do not seek or delay seeking treatment. This delay may be explained by poor mental health literacy and stigmatizing attitudes toward OCD in community. In order to work on these variables, a gamified mental health mobile application (app) called esTOCma has been developed. The purpose of this study is to describe the protocol for a study to test the efficacy of esTOCma, increasing mental health literacy and help-seeking intention, reducing the stigmatizing attitudes and social distance suffered by people with OCD, as well as the distress associated with obsessive-compulsive symptoms.

METHODS

A randomized controlled trial with a crossover design with two conditions (immediate-use App group versus delayed-use App group) will be conducted on a non-clinical adult sample of the community of a minimum size of 200 participants. Participants in the immediate-use App group will start using the app at baseline until completion (10 days); whereas participants in the delayed-use App group will wait 10 days, and then start using the app until completion (10 days). The outcomes will be measured at four assessment points (baseline; 10 days from baseline; and 20 days from baseline; and after 3 months). The following instruments will be administered: Attribution Questionnaire, General Help-Seeking Questionnaire, Social Distance Scale, Mental Health Literacy, Psychoeducation Questionnaire, Social Desirability Scale, Single-Item Self-esteem Scale, and Obsessive-Compulsive Inventory-Revised.

DISCUSSION

This protocol presents the first study to describe a randomized control trial of a mental health app focused on changing mental health literacy, stigmatizing attitudes, social distance and help-seeking intention associated with OCD. An app intervention of these characteristics is especially relevant nowadays as the COVID-19 pandemic has increased obsessive-compulsive symptoms and severity. An improvement in general knowledge about OCD and a reduction in stigma could be associated with earlier OCD detection and an increase in help-seeking intention, which could result in greater wellbeing. Moreover, normalizing intrusions and knowledge about the cognitive OCD model could serve as a protective variable in vulnerable individuals.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04777292. Registered February 23, 2021, https://clinicaltrials.gov/ct2/show/NCT04777292.