Obsessive–compulsive disorder is characterized by the presence of obsessions (recurrent, persistent, intrusive thoughts, urges, or images) and/or compulsions (repetitive behaviours). It is estimated that 1.6 to 2.3% of adults (1 in 50) have had OCD at some time in their life (lifetime prevalence). Based on a Statistics Canada population-based health survey, the prevalence of diagnosed OCD in Canada is 0.93%, or 1 in 100 people aged 15 or older. Among children, OCD is more common in boys; but among adults, men and women are equally affected.
The disabling symptoms of OCD contribute to a poorer quality of life, not only for people with OCD, but also for their families. The debilitating symptoms and considerable functional impairment associated with OCD lead to a higher risk of suicidal ideation and suicide attempts. About one-quarter of people with OCD have attempted suicide.
Obsessive–compulsive disorder also contributes to the considerable economic burden that mental health and addictions have on society. In 2015, Canada’s estimated public and private mental health expenditure was $15.8 billion.
In 2018, 12.3% of adults and 21.6% of children and youth in Ontario with OCD had their first contact for OCD in the emergency department (ED), which means that they had not accessed mental health or addictions services from a physician in the 2 years prior (NACRS, DAD, OMHRS, and OHIP Claims Database, provided by ICES, 2019*). In 2018, 460 adults and 299 children and youth visited the ED for OCD (NACRS, provided by ICES, 2019*). Further, for people who visited the ED for OCD, the rate of unscheduled ED revisits within 30 days for mental health and addictions was 22.4% (NACRS, provided by ICES, 2019*). Emergency department revisits were more common in females than in males (27.2% versus 16.8%; NACRS, provided by ICES, 2019*).
In 2017, there were 343 hospitalizations for OCD, with the number ranging from 1–5 to 59 across regions in Ontario (DAD, OMHRS, provided by ICES, 2019*). For people in Ontario with a hospital admission for OCD, the rate of unscheduled hospital readmissions within 30 days for mental health and addictions was 10.9%. There was variation in the hospital readmission rate across regions in Ontario, with the highest rate at 20.1% in the Mississauga Halton local health integration network (LHIN) compared with 0% in the Erie St. Clair, South East, and South West LHINs. These findings may reflect people getting care from providers who are not physicians, people unable to access mental health and addictions services delivered by physicians, and potential missed opportunities for mental health services in primary and community care.
Several equity factors—including gender, income, comorbidity, Indigenous identity, and geography—may affect specific populations with OCD. The lowest neighbourhood income quintile had the highest proportion of people who reported a diagnosis of OCD or an anxiety disorder (Canadian Community Health Survey, Mental Health, 2012). As well, more people in rural areas reported a diagnosis of OCD or an anxiety disorder than people in urban areas (7.5% versus 4.8%, respectively; Canadian Community Health Survey, Mental Health, 2012).
There are substantial gaps in the health care system when it comes to treating people with OCD. Health care professionals do not always recognize the different ways OCD can present or know what the appropriate treatments are; this represents a knowledge gap and opportunity for education. Many primary care physicians see patients with mental health and addictions needs, but few report feeling well prepared to care for them. Further, people with OCD can be embarrassed about their obsessions and compulsions or can be unaware of where to find help; either can result in them not seeking professional help. In a literature review examining the factors associated with non-treatment or delayed treatment seeking, the research studies found that people with OCD delay seeking treatment for many years, ranging from 3 to 17 years.
These factors all contribute to delays in diagnosis and treatment. Although effective treatments exist, on average 52.8% of people aged 15 years and older globally who require care for OCD do not receive treatment. In adults, the mean time from first experiencing minor symptoms to the onset of OCD is 6 years, and an additional 11 years passes before they receive treatment. There are many opportunities to improve OCD care in Ontario so that people have timely access to appropriate, evidence-based treatment.