Comorbid clinical and biomarker outcomes in patients with obsessive-compulsive disorder: An umbrella review and evidence map
Clinical Snapshot
PICO Framework
| P — Population | Patients with obsessive-compulsive disorder (OCD) across 40 countries, 156,161 participants from 373 primary studies |
| I — Intervention | Presence of OCD diagnosis |
| C — Comparator | Control groups without OCD (varied across included meta-analyses) |
| O — Outcomes | 52 comorbid clinical and biomarker outcomes including autistic traits, suicidality, quality of life domains, neurobiological markers, and toxoplasmosis infection |
Bottom Line
This comprehensive umbrella review of 17 meta-analyses provides the most extensive evidence map to date of OCD-associated comorbidities, encompassing 156,161 participants across 40 countries. The strongest associations were found between OCD and autistic traits, particularly restricted/repetitive behaviors (large effect size), though this evidence was graded as Class IV (lowest certainty). More robust Class II evidence supports associations with suicidal attempts and impaired quality of life across multiple domains. The findings highlight OCD's broad impact beyond core symptoms, suggesting clinicians should routinely assess for autism spectrum traits, suicide risk, and functional impairment. However, the observational nature of underlying studies limits causal inference. The evidence supports integrated care approaches and comprehensive assessment protocols for OCD patients, though implementation should consider the varying certainty levels across different comorbidities.
Key Findings
P Value: Not explicitly reported for individual outcomes
Effect Size: Restricted/repetitive behaviors: eSMD 1.66; Total autism-spectrum quotient: eSMD 1.40
Primary Outcome: Autistic traits showed strongest associations with OCD
Nnt Or Sensitivity: Suicidal attempt association: eSMD 0.64 (95% CI 0.47-0.81, Class II evidence)
Confidence Interval: Restricted/repetitive behaviors: 95% CI 1.25-2.07; Autism quotient: 95% CI 1.06-1.81
Clinical Application
Findings support routine screening for autism spectrum traits, suicidality, and quality of life assessment in OCD patients Relevant to Australian mental health services under Medicare Better Access scheme, supports integrated care approaches recommended by RANZCP clinical practice guidelines for OCD Patients with diagnosed OCD across diverse healthcare settings, particularly relevant for psychiatric and primary care services
Abstract
BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition with diverse comorbidities, yet outcome research remains limited. Thus, we aimed to systematically review existing meta-analyses of OCD-associated comorbid outcomes and assess the strength of evidence. METHODS: We conducted an umbrella review of meta-analyses, searching PubMed/MEDLINE, Embase, CINAHL, and Google Scholar up to July 7, 2025. Although we intended to include all studies related to OCD-associated comorbid outcomes, only observational studies were available. Effect sizes were recalculated using random-effects models, and all estimates were converted to equivalent standardized mean differences (eSMD) with 95 % confidence intervals (CIs). The methodological quality of the included reviews was assessed using the AMSTAR 2 tool, and the class of evidence (CE) for each association was graded according to predefined criteria (Class I-IV). RESULTS: We identified 17 meta-analyses that included 373 primary studies, covering 52 outcomes in 156,161 participants across 40 countries. Patients with OCD were associated with autistic traits outcomes, including restricted and repetitive behaviors (eSMD, 1.66 [95 % CI, 1.25-2.07]; CE = IV), and total autism-spectrum quotient score (1.40 [1.06-1.81]; CE = IV). OCD also showed associations of varying strength with several other outcomes, including suicidal attempt (0.64 [0.47-0.81]; CE = II) and toxoplasmosis infection (0.37 [0.15-0.59]; CE = III). Furthermore, quality of life was decreased across multiple domains in individuals with OCD (emotional, -1.47 [-1.96 to -0.98]; CE = II; global, -0.79 [-1.02 to -0.55]; CE = II; work/social, -1.21 [-1.72 to -0.69]; CE = III). CONCLUSION: Our study highlights the comprehensive impact of OCD, indicating associations with autism, suicidality, social-cognitive deficits, impaired quality of life, and neurobiological markers. STUDY REGISTRATION: PROSPERO CRD420251124380.
References
- 1.Joo, H., Kong, J., Hong, S., Jo, Y., Son, Y., Lee, S., Yeo, D., Lee, K., Lee, H., Woo, H. G., Boyer, L., Fond, G., & Yon, D. K. (2026). Comorbid clinical and biomarker outcomes in patients with obsessive-compulsive disorder: An umbrella review and evidence map. Journal of Affective Disorders, 121058. https://doi.org/10.1016/j.jad.2025.121058
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