Recognition of Obsessive-Compulsive Disorder by Non-Specialist Health Workers in India: Treatment Delay as a Modifiable Outcome : A Narrative Review

Jayamala S Goudar

doi:10.46795/ijhcbs.v7i3.984

Jayamala S. Goudar Assistant Professor, Department of Mental Health Nursing, Shree Sapthagiri Institute of Nursing Sciences, Hosapete 583111, Vijayanagara District, Karnataka, India.

DOI https://doi.org/10.46795/ijhcbs.v7i3.984

Abstract

Background: Obsessive-compulsive disorder (OCD) is a treatable mental health condition frequently recognised late. Patients often first present to general health settings, where non-specialist health workers play a crucial role in early identification.

Objective: To synthesise evidence on treatment delay in OCD, examine barriers to recognition in non-specialist settings, and assess the potential role of the general health workforce in reducing delays in the Indian context.

Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar to identify literature published between 2005 and 2025. Search terms included OCD, duration of untreated illness, help-seeking, recognition, misdiagnosis, mental health literacy, health workers, nurses, and India. Relevant national survey reports were also reviewed. Studies were selected based on relevance rather than systematic eligibility criteria.

Findings: Pooled estimates indicate a mean age at help-seeking of 28.66 years, compared with an onset age of approximately 19.5 years, with a pooled duration of untreated illness of 80.23 months. Prolonged untreated illness is associated with poorer treatment response. Under-recognition, symptom concealment, and professional misdiagnosis contribute to delays. In India, an estimated 84.5% treatment gap for mental disorders and psychiatrist availability of approximately 0.3 per 100,000 population highlight the importance of non-specialist healthcare providers. Mental compulsions, scrupulosity, and intrusive postnatal aggressive thoughts may be particularly difficult to recognise.

Conclusion: Evidence on OCD knowledge among Indian non-specialist health workers remains limited. Integrating symptom recognition, brief screening, and cadre-specific training into general healthcare may improve early identification. Descriptive research is urgently needed to establish baseline knowledge and inform targeted interventions.

Keywords: Obsessive-compulsive disorder, duration of untreated illness, mental health literacy, case detection, nursing, primary health care, India

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References

1. Altamura AC, Buoli M, Albano A, Dell'Osso B. Age at onset and latency to treatment (duration of untreated illness) in patients with mood and anxiety disorders: a naturalistic study. International clinical psychopharmacology. 2010 May 1;25(3):172-9.
2. Matsumoto Y, Nakamae T, Abe Y, Watanabe A, Narumoto J. Duration of untreated illness of patients with obsessive–compulsive disorder in Japan. Early intervention in psychiatry. 2021 Dec;15(6):1644-9.
3. Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India, 2015-16: prevalence, patterns and outcomes. Bengaluru: National Institute of Mental Health and Neuro Sciences; 2016. (NIMHANS Publication No. 129).
4. World Health Organization. Mental health atlas 2020. Geneva: World Health Organization; 2021.
5. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular psychiatry. 2010 Jan;15(1):53-63.
6. Reddy YJ, Rao NP, Khanna S. An overview of Indian research in obsessive compulsive disorder. Indian journal of psychiatry. 2010 Jan;52(Suppl1):S200.
7. Pradeep BS, Gururaj G, Varghese M, Benegal V, Rao GN, Sukumar GM, Amudhan S, Arvind B, Girimaji S, K T, P M. National mental health survey of India, 2016-rationale, design and methods. PloS one. 2018 Oct 25;13(10):e0205096.
8. Pal V, Ramdurg S, Chaukimath S, PAL V. Assessment of the Prevalence and Types of Mental Compulsions in Patients With Obsessive-Compulsive Disorder in North Karnataka: A Cross-Sectional Study. Cureus. 2024 Oct 20;16(10).
9. Pellegrini L, Giobelli S, Burato S, di Salvo G, Maina G, Albert U. Meta-analysis of age at help-seeking and duration of untreated illness (DUI) in obsessive-compulsive disorder (OCD): The need for early interventions. Journal of Affective Disorders. 2025 Jul 1;380:212-25.
10. Senter MS, Patel SR, Dixon LB, Myers RW, Simpson HB. Defining and addressing gaps in care for obsessive-compulsive disorder in the United States. Psychiatric Services. 2021 Jul 1;72(7):784-93.
11. Albert U, Barbaro F, Bramante S, Rosso G, De Ronchi D, Maina G. Duration of untreated illness and response to SRI treatment in obsessive-compulsive disorder. European Psychiatry. 2019 May;58:19-26.
12. Brakoulias V, Pampaloni I, Fineberg NA. Obsessive–compulsive disorder (OCD): often a missed diagnosis and misdiagnosed. The British Journal of Psychiatry. 2026 Feb 16:1-3.
13. Wahl K, Kordon A, Kuelz KA, Voderholzer U, Hohagen F, Zurowski B. Obsessive-Compulsive Disorder (OCD) is still an unrecognised disorder: A study on the recognition of OCD in psychiatric outpatients. European Psychiatry. 2010 Nov 1;25(7):374-7.
14. Wongbusarakum K, Schug E, Visher TC, Sulivan-Pascual K, Mirkis M, Rhee P, Frank AC. Factors associated with delays in assessment and treatment of obsessive-compulsive disorder: A scoping review. Journal of obsessive-compulsive and related disorders. 2025 Oct 22:100982.
15. Rana S, Kaur KN, Narad P, Walia K, Saeed S, Chandra A, Shannawaz M, Singh H. Knowledge, attitudes and practices of antimicrobial resistance awareness among healthcare workers in India: a systematic review. Frontiers in Public Health. 2024 Jul 22;12:1433430.
16. Arvind BA, Gururaj G, Rao GN, Pradeep BS, Mathew V, Benegal V, et al. Framework and approach for measuring performance and progress of mental health systems and services in India: National Mental Health Survey 2015–2016. Int J Ment Health Syst. 2020;14:20.