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*Corresponding author: Sultan Saad Alsubaie, Consultant Psychiatrist, Depart-
ment of Psychiatry, Armed Forces Hospital, Southern Region, Khamis Mushayt,
Saudi Arabia; Tel: +96 6503799971; E-mail: dr.sl4444@gmail.com
Citation: Alsubaie SS, Almathami M, Abouelyazid A, Alqahtani MM, Alshehri
W, et al. (2020) Prevalence of Obsessive Compulsive Disorder: A Survey with
Southern Saudi Arabian Samples. J Psychiatry Depress Anxiety 6: 031.
Received: April 12, 2020; Accepted: April 20, 2020; Published: April 27, 2020
Copyright: © 2020 Alsubaie SS, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits un-
restricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
Introduction
Obsessive Compulsive Disorder (OCD) according to the Diag-
nostic and Statistical Manual of Mental Disorders(DSM-5) is char-
acterized by the presence of obsessions and/or compulsions [1]. Ob-
sessionsare recurrent and persistent thoughts, urges, or images that
are experienced as intrusiveand unwanted, whereas compulsionsare
repetitive behaviors or mental acts that an individualfeel driven to
perform in response to an obsession or according to rules that must be
applied rigidly [1]. Obsessions increase the anxiety, and compulsions
usually reduce it. Patients with OCD were almost universally charac-
terized by a predominance of females, a relatively early age of onset,
and a preponderance of mixed obsessions and compulsions [2]. Also,
some data showed that late adolescence is the period of increased vul-
nerability for the development of OCD; OCD affects predominantly
female adults and male children and adolescents; and that those who
are unmarried or abusing drugs are more likely to present with OCD
[3]. Individuals with OCD may have additional problems. Some of
the problems may be associated with OCD - others may exist in addi-
tion to OCD but not be caused by it [4].
There is a lack of data estimating either the prevalence or the inci-
dence of this disorder within the Kingdom of Saudi Arabia (KSA)[5].
It is estimated that 2-4% of individuals in the general population will
develop OCD before the age of 18 years, and epidemiologic research
studies have revealed that OCD has a lifetime prevalence of 2-3%
[6-8]. The peak ages of onset appear to be from 10-19 years, closely
followed by the ages of 20 and 29 [9]. Throughout adulthood, OCD
symptoms follow a chronic course, with exacerbations accompanying
periods of life stress [5].
To our knowledge, there are no previous investigations that have
examined the prevalence of OCD in southern region of Saudi Arabian
population. Essential to such investigations is the use of valid mea-
surement instruments sensitive to cultural nuances. However, studies
in non-Western countries have tended to use Western-developed mea-
sures for primary assessment.
Therefore, our study aims to investigate the prevalence of OCD
in Asser province southern Saudi Arabia, to correlate the prevalence
of OCD with different demographic data and to validate an Arabic
version of Obsessive-Compulsive Inventory - Revised (OCI-R) short
form among a sample of adults in KSA.
Methods
The current study was conducted among King Khalid Universi-
ty (KKU) students, workers in the governor and private sector and
Alsubaie SS, et al., J Psychiatr Depress Anxiety 2020, 6: 031
DOI: 10.24966/PDA-0150/100031
HSOA Journal of
Psychiatry, Depression & Anxiety
Research Article
Sultan Saad Alsubaie1*, Mohammed Almathami1, Ahmed
Abouelyazid2, Mohammed M Alqahtani1, Wafa Alshehri3 and
Asya Alamri3
1Department of Psychiatry, Armed Forces Hospital,Southern Region, Khamis
Mushayt, Saudi Arabia
2Department of Community Medicine, Armed Forces Hospital, Southern
Region, Khamis Mushayt, Saudi Arabia
3Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
Prevalence of Obsessive Com-
pulsive Disorder: A Survey with
Southern Saudi Arabian Samples
Abstract
Objectives: We examined the prevalence of Obsessive Compulsive
Disorder (OCD) among individuals in Asser province, southern Sau-
di Arabia. We also studied the sociodemographic proles for these
individuals. Furthermore, we validated an Arabic version of an Ob-
sessive-Compulsive Inventory–Revised (OCI-R) short form during
the study.
Methods: A cross-sectional study was conducted among subjects
(n=1000) in Asser Province, southern Saudi Arabia using an Arabic
version of an OCI-R short form. The data were analyzed by SPSS
22 package program. Pearson’s chi-squared test is used to examine
the association between the categorical outcome variables A p-value
less than 0.05 was considered statistically signicant.
Results: Most of the participants were young adults (22.04 ± 4.4
years) and single females with university level of education who are
originally from southern Saudi Arabia. The prevalence of OCD symp-
toms was 3.4%. When the association between OCD and different
demographic characters was tested, no signicant relation between
OCD and any factors except educational level (P=0.04) which was
more common in university educational level.
Conclusion: In Asser Province, the prevalence of OCD symptoms
is like other studies reported in some parts of Saudi Arabia. Further
research is needed to explore the impact of this problem at the
national level.
Keywords: Obsessive compulsive disorders; Prevalence; South-
ern Saudi Arabia
Citation: Alsubaie SS, Almathami M, Abouelyazid A, Alqahtani MM, Alshehri W, et al. (2020) Prevalence of Obsessive Compulsive Disorder: A Survey with
Southern Saudi Arabian Samples. J Psychiatry Depress Anxiety 6: 031.
• Page 2 of 5 •
J Psychiatr Depress Anxiety ISSN: 2573-0150, Open Access Journal
DOI: 10.24966/PDA-0150/100031
Volume 6 • Issue 1 • 100031
visitors to shopping centers in Asser province, southern Saudi Ara-
bia, from December 1, 2015, to November 28, 2016. The study in-
cludes all individuals 16 years and older, both males and females who
are originally from southern Saudi Arabia. The study design was a
cross-sectional study that obtained all required ethical approval from
the ethical review committee from Armed Forces Hospital Southern
Region (AFHSR), Khamis Mushayt, KSA. The data collected includ-
ed age, gender, marital status, level of education, occupation, monthly
income, and health status.The studied subjects were required to give
written consent to participate in the study. The investigators uphold
the fundamental principles regarding research on human subjects:
respect for persons, benecence, and justice. For all data collection
activities, informed consent sought from the eligible participants fol-
lowing full disclosure regarding the study before data collection was
done.
We administered an OCI-R short form, Arabic Version after it was
validated during the study, to all participants. The OCI-R is a brief
(18-item), score equal to or greater than 21 is the cut-off score, adapt-
ed from the 42-item OCI that assesses distress associated with com-
mon OCD symptoms. In addition to yielding a total score, the OCI-R
has six subscales: washing, checking, ordering, obsessing, hoarding,
and neutralizing [10-12].
The number of participants for all phases depends on the type of
validation method. Phase one which focuses on face validity, 80 stu-
dents were recruited. Phase two, for construct validity in the sample
size, was calculated based on Gorsuch’s suggested that total numbers
of items in an instrument are multiplied to 5 to obtain the required
number of participants [13]. For reliability testing, the required sam-
ple size was calculated based on the Cronbach’s alpha formula. With
consideration of the estimated 10 percent dropout, the higher of the
two resulting calculations was taken as the required sample size. As-
suming the prevalence of OCD is 2-3% according toat CI 95% the
total sample was 752 [8].We increased the sample size to 1000 to
increase study power. In the test-retest phase (phase three), a method
for sample size based on the interclass correlation coefcient (ICC),
was chosen. The minimally acceptable ICC value (r1=0.7) versus an
alternative ICC value reecting the expectations (r1=0.8) was chosen.
With a power of 80% (b=0.2) and a signicance level of 5%, a sample
size of at least 601 participants was required [14].
The planned procedures for translating was based on the guide-
lines for translation and cross-cultural adaptation by Beaton et al.
[15].Translation and back translation was conducted to conrm the
accuracy and appropriateness of wording of the Questionnaire. The
instrument was translated by two independent persons from English
into Arabic at the same time. One of them was aware of the study’s
purpose and goals, and the other one wasn’t. Both translators had
discussed the differences between their translations to resolve any
differences until they develop a consensus about the Arabic word-
ing of each item. Two back translations into English were done by
two independent persons. The back translation was conducted with
no prior exposure to the English-language version of the question-
naire. Then, the Expert Committee Review was conducted. Principal
investigator, translators, Arabic language expert, social expert, and
psychiatrist discussed any discrepancies found between the original
one and items and the back-translated versions the questionnaire. The
committee also assessed the suitability of the instrument to be used
at the level of adults. To avoid any limitation of the applicability of
this version of the scale, the nal translation was in classical Arabic,
which can be used in other Arab countries with different dialects. Fi-
nal approval letter was received through e-mail by the OCI-R author.
The study questionnaire included sociodemographic characteristics of
the study participants: age, gender, marital status, origin, educational
level, occupation, monthly income and health status.
The predictor variables were OCD and demographics. The data
were analyzed using SPSS for the IBM version 22 software system.
Descriptive statistics were used to describe the quantitative, categor-
ical, and outcome variables. Pearson’s chi-squared test was used to
study the association between the categorical outcome variables. A p
value of <0.05 was used to report the statistical signicance and pre-
cision of the estimates. Then, data analysis for construct validity and
reliability testing was carry out.To explore the construct validity of
the translated instrument, conrmatory factor analysis was performed
using principal component analysis with varimax rotation to assess
the factor structure of the translated version of the questionnaire. The
preliminary analysis for factor analysis was evaluated by using the
value of the Kaiser-Meyer-Olkin (KMO) Measure of Sampling Ade-
quacy, individual Measure of Sampling Adequacy (MSA) and Bart-
lett’s test of sphericity [16].
To assess the reliability of the Arabic version of the questionnaire,
the internal consistency and test-retest reliability of the translat-
ed instrument was measured. The internal consistency reliability of
the instruments is represented by Cronbach’s alpha coefcient (α).
Subsequently, Pearson’s correlation coefcient (r) was calculated to
evaluate the test-retest reliability. The correlation coefcient was cal-
culated for the total score of the translated instrument.
Results
Sociodemographic characteristics
The mean age of the 1000 study subjects was 22 years, with a
higher proportion of females (61.4%) than males (38.6%). There
were more single subjects (84.7%) than other subjects). Most of the
subjects were originally from the southern region of Saudi Arabia
(98.8%), university students (84.8%) and with good monthly incomes
(66.7%). The subjects who were healthy constituted (97.8%) of the
sample.
Total OCD and Score and Prevalence of OCD symptoms:Most in-
dividuals had OCD score less than twenty-one, 96.6%; on the other
hand, about 3.4% of the individuals had OCD score equal or more
than twenty-one (Table 1).
Association between OCD and different socio-demograph-
ic factors
About 58.8% of the OCD subjects were females whereas 41.2%
of the OCD subjects were males. Approximately76.5% of OCD indi-
viduals were single. All the OCD subjects 100% were originally from
the Southern region and students. Most of the OCD group 61.8% had
enough monthly income. OCD subjects with university educational
levels were 70.6% of the OCD subjects which means that OCD symp-
toms are more common in high educational levels (P=0.04). Most
OCD individuals 94.1% were healthy (Table 2).
Citation: Alsubaie SS, Almathami M, Abouelyazid A, Alqahtani MM, Alshehri W, et al. (2020) Prevalence of Obsessive Compulsive Disorder: A Survey with
Southern Saudi Arabian Samples. J Psychiatry Depress Anxiety 6: 031.
• Page 3 of 5 •
J Psychiatr Depress Anxiety ISSN: 2573-0150, Open Access Journal
DOI: 10.24966/PDA-0150/100031
Volume 6 • Issue 1 • 100031
Discussion
Our study showed that OCD symptoms were prevalent in 3.4% of
subjects, in contrast, Khalid S. Al Gelban found obsessive-compul-
sive behavior in 12.3% of Saudi Secondary School girls in Abha by
using the Arabic version of the symptom-revised checklist 90 (SCL
90-R) [17]. Dalia El- Sayed Desouky found OC symptoms in 23.1%
out of 1024 secondary school girls in Taif, Saudi Arabia [18]. Differ-
ently, the previous two studies restricted to female adolescents, which
led to an inability to determine sex-specic psychopathology.
Our ndings showed that OCD was higher in women than men
with female to male ratio 1.4/1, most of them were single, which were
similar to other studies in Saudi Arabia that examined the pattern of
OCD in KSA and found to be similar to those reported in Western
studies [19-20].
All the individuals in our study are Muslims and their ndings
were like those examined the OCD and culture. De Bilbao F and Gi-
annakopoulos P evaluated the effect of religious upbringing on OCD
symptoms and claimed a variety of symptoms related to religious
thoughts are more prevalent in clinical populations from countries in
which religion is at the central core of the society, particularly in Mus-
lim and Jewish Middle Eastern cultures, as compared with clinical
populations from the West [19-21].
SalwaErfan and Mona Rakhawy, evaluated 44 OCD patients (22
Saudi and 22 Egyptian) were compared to 43 control subjects (19
Saudi and 24 Egyptian) matching age, sex, social class and education
of patients, their ndings were approximately like our ndings in re-
gard to sociodemographic data [22].
There are some limitations that need to be acknowledged regard-
ing the present study. The rst limitation concerns about the self-rated
questionnaire. Self-reported answers may be exaggerated; respon-
dents may be too embarrassed to reveal private details; various bi-
ases may affect the results. Therefore, using clinician-rated scale or
structural clinical interview would be better. The second limitation
is the use of convenience sampling may not accurately represent the
population under study; in our sample, we had a higher proportion of
female participants than male participants, which may be due to the
reluctance of males to participate in such a study, especially in shop-
ping centers.
In conclusion, although the studies that examined the prevalence
of OCD in various parts of KSA are limited, the prevalence of OCD
symptoms in Asser Province is like other studies reported in some
parts of Saudi Arabia. Further research is needed to explore the mag-
nitude and impact of OCD and to identify potential supporting coun-
seling and cognition-behavior therapy of this problem. To reach this,
a national program for mental health in this area is crucial.
Acknowledgment
The authors would like to acknowledge the support from Ethical
Review Committee from Armed Forces Hospital Southern Region in
Asser province, southern Saudi Arabia.
Table 1: Sociodemographic characters of studied group.
Variables
No. (%)
Age (years) Mean (SD)[min:max] = 22.04±4.4[16:52]
Gender
Males 386(38.6)
Females 614(61.4)
Marital Status
Single 847(84.7)
Married 148(14.8%)
Widowed 5(0.5%)
Origin
Southern Region 988(98.8%)
Other places 12(1.2%)
Educational Level
Illiterate and Primary 4(0.4%)
Intermediate and Secondary 148(14.8%)
University 848(84.8%)
Monthly Income
Good 667(66.7%)
Average 305(30.5%)
Poor 28(2.8%)
Occupation
Student 909(90.9%)
Working 55(5.5%)
Not working 36(3.6%)
Health Status
Healthy 978(97.8%)
Not Healthy 22(2.2%)
Table 2: Association between OCD and different socio-demographic fac-
tors.
Variables ≥ 21 OCD N=34 < 21 Not OCD N=966 P value
Age (years) Mean ± (SD) 22.4±2.4 22.1±7.02 < 0.85
Gender
Males 14(41.2) 372(38.2)
< 0.75
Females 20(58.8) 594(61.5)
Marital Status
Single 26(76.5) 821(85)
< 0.32 Married 8(32.8) 140(14.5)
Widowed 0 5(0.5)
Origin
Southern Region 34(100) 954(98.8)
< 0.51
Other places 0 12(1.2)
Educational Level
Illiterate and Primary 0 4(0.4)
< 0.04* Intermediate and Secondary 10(29.4) 138(14.3)
University 24(70.6) 824(85.3)
Monthly Income
Good 21(61.8) 646(66.9)
<0.82 Average 12(35.3) 293(30.3)
Poor 1(2.9) 27(2.8)
Occupation
Student 34(100) 875(90.6)
<0.31 Working 0 55(5.7)
Not working 0 36(3.7)
Health Status
Healthy 32(94.1) 946(97.9)
< 0.51
Not Healthy 2(5.9) 20(2.1)
Citation: Alsubaie SS, Almathami M, Abouelyazid A, Alqahtani MM, Alshehri W, et al. (2020) Prevalence of Obsessive Compulsive Disorder: A Survey with
Southern Saudi Arabian Samples. J Psychiatry Depress Anxiety 6: 031.
• Page 4 of 5 •
J Psychiatr Depress Anxiety ISSN: 2573-0150, Open Access Journal
DOI: 10.24966/PDA-0150/100031
Volume 6 • Issue 1 • 100031
Source of Funding
None
Conict of Interest
None
Grant Support & Financial Disclosures
None
Author’s Contribution
Sultan Saad Alsubaie: Making the study proposal, supervised all
steps of the study andparticipated in writing the manuscript.
Mohammed Almathami: Participated in data collection and writing
the manuscript.
Ahmed Abouelyazid: Doing the data entry & analysis and participat-
ed in writing the manuscript.
Mohammed M Alqahtani: Participated in data collection and writ-
ing the manuscript.
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