MedicalResearch.com Interview with:
Ana Pérez-Vigil MD
Department of Clinical Neuroscience
Child and Adolescent Psychiatry Research Center
MedicalResearch.com: What is the background for this study?
Response: Everyone who regularly works with persons who have obsessive-compulsive disorder (OCD) has seen that their patients often struggle with school work. It is not uncommon for these individuals to have poor school attendance and severe patients can be out of the education system altogether. This applies to persons of all ages, from school children to young adults who may be at university.
On the other hand there is a group of patients who, against all odds, working 10 times as hard as everybody else, manage to stay in education and eventually get a degree. So we have long suspected that OCD has a detrimental impact on the person’s education, with all the consequences that this entails (worse chances to enter the labour market and have a high paid job). But we did not really know to what extent OCD impacts education. So we wanted to know what is the actual impact of OCD on educational attainment using objectively collected information from the unique Swedish national registers. Previous work had been primarily based on small clinical samples from specialist clinics, using either self or parent report and cross-sectional designs. Previous work also tended not to control for important confounders such as psychiatric comorbidity or familial factors (genetic and environmental factors that could explain both OCD and the outcomes of interest).
MedicalResearch.com: What are the main findings?
The main findings of the study were:
1- OCD was associated with pervasive academic underachievement across the lifespan, compared to matched population controls. Persons with OCD were approximately 40-60% less likely to complete each of the measured educational milestones.
2- This was also true in the sibling control models, which effectively control for familial factors that are shared between siblings.
3- The association was global rather than being specific to a particular school subject. We found that patients were more likely to fail every single course/subject at the end of compulsory education, including each of the core subjects.
4- As expected, the association was stronger in those individuals first diagnosed in childhood/adolescence, though patients with later age of onset were still substantially impaired across the board.
5- These results were not merely explained by the presence of early onset neuropsychiatric disorders such as ADHD/ASD/Tourette. Excluding them from the cohort resulted in attenuated estimates but OCD patients were still substantially impaired across the board.
MedicalResearch.com: What should readers take away from your report?
Response: OCD, particularly when it has an early age of onset, has a global and profound impact across all educational levels.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: First, these entirely novel findings emphasize the relevance of early detection of OCD since it is likely that the profound educational underachievement observed in this study has a direct impact on the socioeconomic status of the affected individuals and, indirectly, society at large.
Second, examining whether access and receipt of evidence-based treatment for OCD (behavior therapy including ERP and SSRIs) increases the chances of these patients to fulfil their educational potential is the next question for future research.
Finally, school based strategies like educating school staff to detect OCD in the classroom, creating guidelines for schools so that they know where to refer if they suspect a case, etc may be interesting venues to explore in the future.
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Ana Pérez-Vigil, Lorena Fernández de la Cruz, Gustaf Brander, Kayoko Isomura, Andreas Jangmo, Inna Feldman, Eva Hesselmark, Eva Serlachius, Luisa Lázaro, Christian Rück, Ralf Kuja-Halkola, Brian M. D’Onofrio, Henrik Larsson, David Mataix-Cols. Association of Obsessive-Compulsive Disorder With Objective Indicators of Educational AttainmentA Nationwide Register-Based Sibling Control Study. JAMA Psychiatry. Published online November 15, 2017. doi:10.1001/jamapsychiatry.2017.3523
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