Associations between COVID-19-related stress and obsessive-compulsive disorder symptoms among adolescents in Southern...

The COVID-19 pandemic led to widespread public health measures such as quarantine and social distancing. While critical for disease mitigation, these interventions might have exacerbated stress, anxiety, and other adverse mental health outcomes among youth. This study examined the association between COVID-19-related stressors and Obsessive-Compulsive Disorder (OCD) symptoms among adolescents.

Data were drawn from three waves of a cohort study in Southern California, collected during lockdown due to COVID-19 (spring 2021; n=2,235), and in the following two years (spring 2022; n=3,765; spring 2023; n=3,917). Adjusted logistic regression models estimated cross-sectional associations between COVID-19-related stressors (participant COVID diagnosis [2021-2022], disease severity among friends/family [2021-2022], perceived COVID-related stress [2021, 2023], life stressors during lockdown [2021]), and OCD symptoms measured using the Revised Children's Anxiety and Depression Scale (RCADS).

The prevalence of OCD symptoms declined over time, from 15.1 % in 2021 to 9.7 % in 2023. In 2021, adolescents who had COVID themselves, had friends or family who died from COVID, expressed extreme stress related to COVID, or experienced any of several COVID life stressors had higher odds of OCD symptoms (OR range=1.48-15.8; p<0.05). In 2022, having friends or family who had severe COVID (OR=1.42; 95 % CI=1.00, 2.00), required hospitalization (OR=1.82; 95 % CI=1.17, 2.82), or died from COVID (OR=1.68; 95 % CI=1.14, 2.47) was associated with greater odds of OCD symptoms. In 2023, adolescents reporting somewhat (OR=1.56; 95 % CI=1.11, 2.18), very (OR=2.28; 95 % CI=1.43, 3.64), or extremely high stress over COVID-19 (OR=3.02; 95 % CI=1.58, 5.75) had significantly elevated odds of OCD symptoms.

These findings underscore the significant association of pandemic-related stressors and adolescent OCD symptoms, even several years after the onset of the pandemic. Targeted mental health interventions are needed to support vulnerable youth during and after public health crises.