Comorbidity of obsessive-compulsive disorder in bipolar spectrum disorders: Systematic review and meta-analysis of its prevalence

Background Obsessive-compulsive disorder (OCD) is often comorbid with Bipolar Disorder (BD), complicating its presentation and management. OCD prevalence rates in BD vary widely across studies and recent meta-analyses. Objective We performed a comprehensive systematic review and meta-analysis of studies reporting cross-sectional or lifetime OCD prevalence in BD, assessed by meta-regression various determinants of estimated prevalence and compared it with major depressive disorder (MDD) patients and general population subjects included in extracted studies. Methods Relevant articles published up to January 2019 in PubMed/MEDLINE were retrieved. Prevalence rates underwent Freeman–Tukey double arcsine transformation before meta-analysis. Results We included 29 studies reporting cross-sectional prevalence (N = 6109) and 39 studies reporting lifetime prevalence (N = 8205); eight studies reported both. The pooled lifetime and cross-sectional prevalence of comorbid OCD in BD was estimated at 10.9% (95% CI: 7.8–14.4%) and 11.2% (7.6–15.3%), respectively, in the random-effects model. Respective estimates in the general population were 2.5% and 1.6%. Study setting (epidemiological or clinical), diagnostic criteria and procedures, gender, BD subtype and remission status could not explain heterogeneity of prevalence estimates in meta-regressions. Age had a small yet significant negative correlation with lifetime prevalence. OCD prevalence in BD was not significantly different than in MDD. Limitations Search was limited to English-language literature. Conclusions Lifetime OCD prevalence in BD was 4.4 times higher than in the general population. Cross-sectional prevalence was as high as lifetime, suggesting that OCD in BD is more chronic/ persistent than in the general population, where cross-sectional stands at about two thirds the lifetime prevalence.