. 2025 Jul 9;23(1):416.

doi: 10.1186/s12916-025-04209-5.

Obsessive-compulsive disorder in the World Mental Health surveys

Dan J Stein^#¹, Ayelet Meron Ruscio^#², Yasmin Altwaijri³, Wai Tat Chiu⁴, Nancy A Sampson⁴, Sergio Aguilar-Gaxiola⁵, Ali Al-Hamzawi⁶, Jordi Alonso^{7

8

9}, Stephanie Chardoul¹⁰, Oye Gureje^{11

12}, Chiyi Hu¹³, Elie G Karam^{14

15}, John J McGrath^{16

17

18}, Fernando Navarro-Mateu^{19

20

21}, Kate M Scott²², Juan Carlos Stagnaro²³, Yolanda Torres²⁴, Cristian Vladescu^{25

26}, Jacek Wciórka²⁷, Miguel Xavier²⁸, Ronald C Kessler⁴; World Mental Health Survey collaborators

Collaborators, Affiliations

Collaborators

World Mental Health Survey collaborators:
Yasmin A Altwaijri, Laura Helena Andrade, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Ronny Bruffaerts, Brendan Bunting, Jose Miguel Caldas-de-Almeida, Graça Cardoso, Louisa Degenhardt, Giovanni de Girolamo, Josep Maria Haro, Meredith G Harris, Hristo Hinkov, Chiyi Hu, Peter de Jonge, Aimee Nasser Karam, Georges Karam, Alan E Kazdin, Norito Kawakami, Andrzej Kiejna, Viviane Kovess-Masfety, Maria Elena Medina-Mora, Jacek Moskalewicz, Daisuke Nishi, Marina Piazza, José Posada-Villa, Annelieke Roest, Margreet Ten Have, Nathan Tintle, Maria Carmen Viana, Daniel V Vigo, David R Williams, Bogdan Wojtyniak, Alan M Zaslavsky

Affiliations

¹ SAMRC Unit On Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa. dan.stein@uct.ac.za.
² Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
³ Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
⁴ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁵ Department of Internal Medicine, Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA.
⁶ College of Medicine, University of Al-Qadisiya, Al Diwaniyah, Diwaniya Governorate, Iraq.
⁷ Health Services Research Unit, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
⁸ Department of Medicine and Life Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
⁹ Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹⁰ Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
¹¹ Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
¹² Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
¹³ Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China.
¹⁴ Institute for Development, Research, Advocacy and Applied Care (IDRAAC), ResearchBeirut, Lebanon.
¹⁵ Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon.
¹⁶ Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.
¹⁷ Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia.
¹⁸ National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.
¹⁹ Unidad de Docencia, Investigacion y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, Murcia Health Service, C/Lorca, nº 58. - El Palmar, Murcia, 30120, Spain.
²⁰ Instituto Murciano de Investigación Biosanitaria - Pascual Parrilla (IMIB-Pascual Parrilla), Hospital Virgen de la Arrixaca, El Palmar, Murcia, 30120, Spain.
²¹ Centro de Investigación Biomédica en ERed en Epidemíologia y Salud Pública (CIBERESP), Madrid, 28029, Spain.
²² Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
²³ Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
²⁴ Center for Excellence On Research in Mental Health, CES University, Medellín, Colombia.
²⁵ National Institute for Health Services Management, Bucharest, Romania.
²⁶ University Titu Maiorescu, Bucharest, Romania.
²⁷ Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
²⁸ Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.

^# Contributed equally.

PMID: 40629326
PMCID: PMC12239380
DOI: 10.1186/s12916-025-04209-5

Obsessive-compulsive disorder in the World Mental Health surveys

Dan J Stein et al. BMC Med. 2025.

. 2025 Jul 9;23(1):416.

doi: 10.1186/s12916-025-04209-5.

Authors

Collaborators

World Mental Health Survey collaborators:
Yasmin A Altwaijri, Laura Helena Andrade, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Ronny Bruffaerts, Brendan Bunting, Jose Miguel Caldas-de-Almeida, Graça Cardoso, Louisa Degenhardt, Giovanni de Girolamo, Josep Maria Haro, Meredith G Harris, Hristo Hinkov, Chiyi Hu, Peter de Jonge, Aimee Nasser Karam, Georges Karam, Alan E Kazdin, Norito Kawakami, Andrzej Kiejna, Viviane Kovess-Masfety, Maria Elena Medina-Mora, Jacek Moskalewicz, Daisuke Nishi, Marina Piazza, José Posada-Villa, Annelieke Roest, Margreet Ten Have, Nathan Tintle, Maria Carmen Viana, Daniel V Vigo, David R Williams, Bogdan Wojtyniak, Alan M Zaslavsky

Affiliations

¹ SAMRC Unit On Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa. dan.stein@uct.ac.za.
² Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
³ Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
⁴ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁵ Department of Internal Medicine, Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA.
⁶ College of Medicine, University of Al-Qadisiya, Al Diwaniyah, Diwaniya Governorate, Iraq.
⁷ Health Services Research Unit, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
⁸ Department of Medicine and Life Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
⁹ Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹⁰ Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
¹¹ Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
¹² Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
¹³ Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China.
¹⁴ Institute for Development, Research, Advocacy and Applied Care (IDRAAC), ResearchBeirut, Lebanon.
¹⁵ Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon.
¹⁶ Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.
¹⁷ Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia.
¹⁸ National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.
¹⁹ Unidad de Docencia, Investigacion y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, Murcia Health Service, C/Lorca, nº 58. - El Palmar, Murcia, 30120, Spain.
²⁰ Instituto Murciano de Investigación Biosanitaria - Pascual Parrilla (IMIB-Pascual Parrilla), Hospital Virgen de la Arrixaca, El Palmar, Murcia, 30120, Spain.
²¹ Centro de Investigación Biomédica en ERed en Epidemíologia y Salud Pública (CIBERESP), Madrid, 28029, Spain.
²² Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
²³ Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
²⁴ Center for Excellence On Research in Mental Health, CES University, Medellín, Colombia.
²⁵ National Institute for Health Services Management, Bucharest, Romania.
²⁶ University Titu Maiorescu, Bucharest, Romania.
²⁷ Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
²⁸ Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.

^# Contributed equally.

PMID: 40629326
PMCID: PMC12239380
DOI: 10.1186/s12916-025-04209-5

Abstract

Background: National surveys have suggested that obsessive-compulsive disorder (OCD) is a prevalent and impairing condition. However, there are few cross-national data on OCD, with data particularly scarce in low- and middle-income countries. Here we employ data from the World Mental Health surveys to characterize the onset, course, severity, and treatment of OCD across a range of countries in different geographic regions of the world.

Methods: Data came from general population surveys carried out in 10 countries (Argentina, Australia, Colombia, Iraq, Poland, People's Republic of China, Portugal, Romania, Saudi Arabia, Spain) using a consistent research protocol and interview. A total of 26,136 adults were assessed for OCD in face-to-face interviews and were included in the present analyses. We examined lifetime and 12-month prevalence as well as age of onset, persistence, severity, and treatment of DSM-IV OCD in six high-income countries (HICs) and four low- or middle-income countries (LMICs). We also investigated socio-demographic variables and temporally prior mental disorders as predictors of OCD onset, persistence, severity, and treatment.

Results: Across the 10 countries surveyed, OCD has a combined lifetime prevalence of 4.1%. The 12-month prevalence (3.0%) is nearly as high, suggesting a highly persistent course of illness. Age of onset is early, with more than 80% of OCD cases beginning by early adulthood. Most OCD cases in the community are mild (47.0%) or very mild (27.5%), with a smaller percentage designated as moderate (22.9%) or severe (2.7%) by the Yale-Brown Obsessive-Compulsive Scale. Only 19.8% of respondents with OCD received any mental health treatment in the past year, with treatment rates much higher in HICs (40.5%) than LMICs (7.0%). Cross-nationally, OCD commonly emerges in adolescence or early adulthood against a backdrop of earlier-occurring mental disorders. With few exceptions (e.g., prior social phobia), the socio-demographic and psychopathological risk factors for OCD onset, persistence, severity, and treatment are distinct.

Conclusions: These cross-national data underscore clinical lessons regarding the importance of early diagnosis of OCD and comprehensive evaluation of comorbidity; draw attention to OCD as an undertreated disorder, particularly in LMIC contexts; and emphasize the public health significance of this often-overlooked condition.

Keywords: Community epidemiology; Global mental health; Obsessive-compulsive disorder; World Mental Health surveys.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: At all survey sites, the local ethics or institutional review committee reviewed and approved the protocol to ensure protection of human subjects, in line with appropriate international and local guidelines. Details of the ethics committees for the WMH surveys can be viewed at this link: http://www.hcp.med.harvard.edu/wmh/ftpdir/WMH_Ethics_approval.pdf . Consent for publication: Not applicable. Competing interests: In the past 3 years, Dr. Kessler was a consultant for Cambridge Health Alliance, Canandaigua VA Medical Center, Child Mind Institute, Holmusk, Massachusetts General Hospital, Partners Healthcare, Inc., RallyPoint Networks, Inc., Sage Therapeutics and University of North Carolina. He has stock options in Cerebral Inc., Mirah, PYM (Prepare Your Mind), Roga Sciences and Verisense Health. Dr. Stein has received consultancy honoraria from Discovery Vitality, Johnson & Johnson, Kanna, L’Oreal, Lundbeck, Orion, Servier, Seaport Therapeutics, Takeda, Vistagen, and Wellcome. All other authors report no conflicts of interest related to this manuscript.

Figures

**Fig. 1**
Age of onset of OCD by sex Abbreviation OCD obsessive-compulsive disorder Cumulative age-of-onset distributions for first obsession or compulsion, shown separately for female and male respondents with lifetime OCD

See this image and copyright information in PMC

Update of

Obsessive-compulsive disorder in the World Mental Health surveys.
Stein DJ, Ruscio AM, Altwaijri Y, Chiu WT, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Chardoul S, Gureje O, Hu C, Karam EG, McGrath JJ, Navarro-Mateu F, Scott KM, Stagnaro JC, Torres Y, Vladescu C, Wciórka J, Xavier M, Kessler RC. Stein DJ, et al. Res Sq [Preprint]. 2025 Mar 3:rs.3.rs-6090427. doi: 10.21203/rs.3.rs-6090427/v1. Res Sq. 2025. Update in: BMC Med. 2025 Jul 9;23(1):416. doi: 10.1186/s12916-025-04209-5. PMID: 40092437 Free PMC article. Updated. Preprint.

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Obsessive-compulsive disorder in the World Mental Health surveys

Collaborators

Affiliations

Obsessive-compulsive disorder in the World Mental Health surveys

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

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