Distinct Long-term OCD Symptom Severity Trajectories, Related Predictors, and Quality of Life over Three Years

Objectives<br/><br/>The aim of the present study was to investigate long-term OCD symptom severity trajectories in the NordLOTS sample during and up to three years after stepped-care treatment and to detect predictors of trajectory group membership. Further, the aim was to investigate quality of life over three years in the trajectory groups.<br/><br/>Methods<br/><br/>Long-term symptom severity trajectories were investigated using latent class growth analysis (LCGA) on data from all 269 patients from the NordLOTS who were assessed at seven time points over three years: Pre-CBT, mid-treatment, post-CBT and 6, 12, 24, and 36 months after treatment. Symptom severity was assessed using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Predictors of class membership were investigated using multivariate analysis. Patient and parent proxy ratings of quality of life were assessed at the same seven time points (n = 220).<br/><br/>Results<br/><br/>Three distinct long-term OCD symptom severity trajectory groups were identified: a) acute, sustained responders (54.6%); b) slow, continued responders (23.4%); and c) limited long-term responders (21.9%). Baseline predictors of group membership pertained to age, symptom severity, contamination/cleaning, and anxiety symptoms. Further, the groups showed differences in quality of life over the three years compared to norm levels.<br/><br/>Conclusions<br/><br/>Clinical attention is required for adolescent OCD patients showing less convincing response to first-line CBT as well as contamination/cleaning and anxiety symptoms. They may have reached the established clinician-rated cut-off for treatment response, yet patient-rated quality of life assessment after treatment could detect patients in need of further care.