To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
A multitude of risk/protective factors for anxiety and obsessive-compulsive disorders have been proposed. We conducted an umbrella review to summarize the evidence of the associations between risk/protective factors and each of the following disorders: specific phobia, social anxiety disorder, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder, and to assess the strength of this evidence whilst controlling for several biases.
Publication databases were searched for systematic reviews and meta-analyses examining associations between potential risk/protective factors and each of the disorders investigated. The evidence of the association between each factor and disorder was graded into convincing, highly suggestive, suggestive, weak, or non-significant according to a standardized classification based on: number of cases (>1000), random-effects p-values, 95% prediction intervals, confidence interval of the largest study, heterogeneity between studies, study effects, and excess of significance.
Nineteen systematic reviews and meta-analyses were included, corresponding to 216 individual studies covering 427 potential risk/protective factors. Only one factor association (early physical trauma as a risk factor for social anxiety disorder, OR 2.59, 95% CI 2.17–3.1) met all the criteria for convincing evidence. When excluding the requirement for more than 1000 cases, five factor associations met the other criteria for convincing evidence and 22 met the remaining criteria for highly suggestive evidence.
Although the amount and quality of the evidence for most risk/protective factors for anxiety and obsessive-compulsive disorders is limited, a number of factors significantly increase the risk for these disorders, may have potential prognostic ability and inform prevention.
Maternal polycystic ovary syndrome (PCOS) has been proposed as a model for investigating the role of prenatal androgen exposure in the development of neuropsychiatric disorders. However, women with PCOS are at higher risk of developing psychiatric conditions and previous studies are likely confounded by genetic influences.
A Swedish nationwide register-based cohort study was conducted to disentangle the influence of prenatal androgen exposure from familial confounding in the association between maternal PCOS and offspring attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD), and Tourette's disorder and chronic tic disorders (TD/CTD). PCOS-exposed offspring (n = 21 280) were compared with unrelated PCOS-unexposed offspring (n = 200 816) and PCOS-unexposed cousins (n = 17 295). Associations were estimated with stratified Cox regression models.
PCOS-exposed offspring had increased risk of being diagnosed with ADHD, ASD, and TD/CTD compared with unrelated PCOS-unexposed offspring. Associations were stronger in girls for ADHD and ASD but not TD/CTD [ADHD: adjusted hazard ratio (aHR) = 1.61 (95% confidence interval (CI) 1.31–1.99), ASD: aHR = 2.02 (95% CI 1.45–2.82)] than boys [ADHD: aHR = 1.37 (95% CI 1.19–1.57), ASD: aHR = 1.46 (95% CI 1.21–1.76)]. For ADHD and ASD, aHRs for girls were stronger when compared with PCOS-unexposed cousins, but slightly attenuated for boys.
Estimates were similar when accounting for familial confounding (i.e. genetics and environmental factors shared by cousins) and stronger in girls for ADHD and ASD, potentially indicating a differential influence of prenatal androgen exposure v. genetic factors. These results strengthen evidence for a potential causal influence of prenatal androgen exposure on the development of male-predominant neuropsychiatric disorders in female offspring of women with PCOS.
The impact of obsessive–compulsive disorder (OCD) on objective indicators of labour market marginalisation has not been quantified.
Linking various Swedish national registers, we estimated the risk of three labour market marginalisation outcomes (receipt of newly granted disability pension, long-term sickness absence and long-term unemployment) in individuals diagnosed with OCD between 2001 and 2013 who were between 16 and 64 years old at the date of the first OCD diagnosis (n = 16 267), compared with matched general population controls (n = 157 176). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regression models, adjusting for a number of covariates (e.g. somatic disorders) and stratifying by sex. To adjust for potential familial confounders, we further analysed data from 7905 families that included full siblings discordant for OCD.
Patients were more likely to receive at least one outcome of interest [adjusted HR = 3.63 (95% CI 3.53–3.74)], including disability pension [adjusted HR = 16.36 (95% CI 15.34–17.45)], being on long-term sickness absence [adjusted HR = 3.07 (95% CI 2.95–3.19)] and being on long-term unemployment [adjusted HR = 1.72 (95% CI 1.63–1.82)]. Results remained similar in the adjusted sibling comparison models. Exclusion of comorbid psychiatric disorders had a minimal impact on the results.
Help-seeking individuals with OCD diagnosed in specialist care experience marked difficulties to participate in the labour market. The findings emphasise the need for cooperation between policy-makers, vocational rehabilitation and mental health services in order to design and implement specific strategies aimed at improving the patients’ participation in the labour market.
Obsessive–compulsive disorder (OCD) has similar prevalence rates across
ethnic groups. However, ethnic minorities are underrepresented in
clinical trials of OCD. It is unclear whether this is also the case in
To explore whether ethnic minorities with OCD are underrepresented in
secondary and tertiary mental health services in the South London and
Maudsley (SLaM) NHS Foundation Trust.
The ethnic distribution of patients with OCD seen between 1999 and 2013
in SLaM (n = 1528) was compared with that of the general
population in the catchment area using census data. A cohort of patients
with depression (n = 22 716) was used for comparative
Ethnic minorities with OCD were severely underrepresented across services
(–57%, 95% CI –62% to –52%). The magnitude of the observed inequalities
was significantly more pronounced than in depression (–29%, 95% CI–31%
There is a clear need to understand the reasons behind such ethnic
inequalities and implement measures to reduce them.
Hoarding disorder is typified by persistent difficulties discarding possessions, resulting in significant clutter that obstructs the individual's living environment and produces considerable functional impairment. The prevalence of hoarding disorder, as defined in DSM-5, is currently unknown.
To provide a prevalence estimate specific to DSM-5 hoarding disorder and to delineate the demographic, behavioural and health features that characterise individuals with the disorder.
We conducted a two-wave epidemiological study of 1698 adult individuals, originally recruited via the South East London Community Health (SELCoH) study. Participants screening positively for hoarding difficulties in wave 1, and who agreed to be re-contacted for wave 2 (n = 99), underwent in-home psychiatric interviews and completed a battery of self-report questionnaires. Current DSM-5 diagnoses were made via consensus diagnostic procedure.
In total, 19 individuals met DSM-5 criteria for hoarding disorder at the time of interview, corresponding to a weighted prevalence of 1.5% (95% CI 0.7–2.2). Those with hoarding disorder were older and more often unmarried (67%). Members of this group were also more likely to be impaired by a current physical health condition (52.6%) or comorbid mental disorder (58%), and to claim benefits as a result of these issues (47.4%). Individuals with hoarding disorder were also more likely to report lifetime use of mental health services, although access in the past year was less frequent.
With a lower-bound prevalence of approximately 1.5%, hoarding disorder presents as a condition that affects people of both genders and is associated with substantial adversity.
Email your librarian or administrator to recommend adding this to your organisation's collection.