Quality of Life Outcomes in Patients With Obsessive-Compulsive Disorder: Relationship to Treatment Response and Symptom Relapse

Objective: Data were analyzed from 2 prospective, double-blind, placebo-controlled trials of escitalopram in obsessive-compulsive disorder (OCD) to characterize the baseline levels of functional disability and impairment in health-related quality of life (HRQoL) and to assess the relationship between treatment outcomes (response or relapse) and disability or HRQoL.

Method: Data from a 24-week, placebo-controlled, fixed-dose trial (N‘ ‰=‘ ‰466) of escitalopram (10-20 mg/d) or paroxetine (40 mg/d) and from a 40-week, flexible-dose (escitalopram 10-20 mg/d), placebo-controlled relapse-prevention trial (N‘ ‰=‘ ‰468) were analyzed. Obsessive-compulsive disorder symptoms (DSM-IV criteria) were assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS), functioning was assessed using the Sheehan Disability Scale (SDS), and HRQoL was assessed using the Medical Outcomes Study Short Form (SF-36). Baseline data were pooled for patients across both studies. For patients in the fixed-dose study, SDS and SF-36 scores were compared across treatment groups and for responders versus nonresponders. In the relapse-prevention trial, SDS and SF-36 scores were compared for relapsed versus nonrelapsed patients.

Results: Patients with more severe baseline symptoms (YBOCS‘ ‰≥‘ ‰27) reported significantly greater impairment on the SDS (P‘ ‰<‘ ‰.001) and SF-36 (except for bodily pain). Patients receiving escitalopram or paroxetine reported significant improvements on most SF-36 dimensions and on the SDS compared to placebo; however, improvements in work-related functioning were seen earlier for patients receiving escitalopram (20 mg/d). At the study endpoints, SDS and SF-36 scores were significantly better for patients who were responders (versus nonresponders) and for patients who did not relapse (versus relapsers).

Conclusions: Obsessive-compulsive disorder is associated with significant impairment in functioning and HRQoL. Significant differences in disability and HRQoL between responders and nonresponders or relapsers and nonrelapsers suggest a relationship between symptomatic and functional outcomes.

Trial Registration: lundbecktrials.com Identifiers: 10205 and 10193

J Clin Psychiatry 2010;71(6):784-792

Submitted: December 14, 2009; accepted February 11, 2010.

Online ahead of print: May 4, 2010 (doi:10.4088/JCP.09m05911blu).

Corresponding author: Eric Hollander, MD, Montefiore Medical Center University Hospital for Albert Einstein College of Medicine Child Psychiatry Annex, 111 E. 210th St, Bronx, NY 10467-2490 ([email protected]).