Long‐term outcome of pediatric obsessive–compulsive disorder: a meta‐analysis and qualitative review of the literature

<jats:p><jats:bold>Objective: </jats:bold> To review the extant literature on the long‐term outcome of child/adolescent‐onset obsessive–compulsive disorder (OCD).</jats:p><jats:p><jats:bold>Method: </jats:bold> Medline and Psychlit databases were systematically searched for articles regarding long‐term outcomes of child/adolescent‐onset OCD. Meta‐analysis regression was applied to evaluate predictors and persistence of OCD.</jats:p><jats:p><jats:bold>Results: </jats:bold> Sixteen study samples (<jats:italic>n</jats:italic> = 6–132; total = 521 participants) in 22 studies had follow‐up periods ranging between 1 and 15.6 years. Pooled mean persistence rates were 41% for <jats:italic>full</jats:italic> OCD and 60% for <jats:italic>full</jats:italic> or <jats:italic>subthreshold</jats:italic> OCD. Earlier age of OCD onset (<jats:italic>z</jats:italic> = −3.26, <jats:italic>P</jats:italic> = 0.001), increased OCD duration (<jats:italic>z</jats:italic> = 2.22, <jats:italic>P</jats:italic> = 0.027) and in‐patient vs. out‐patient status (<jats:italic>z</jats:italic> = 2.94, <jats:italic>P</jats:italic> = 0.003) predicted greater persistence. Comorbid psychiatric illness and poor initial treatment response were poor prognostic factors. Although psychosocial function was frequently compromised, most studies lacked comprehensive outcome measures.</jats:p><jats:p><jats:bold>Conclusion: </jats:bold> Long‐term persistence of pediatric OCD may be lower than believed. Future studies should include broader measures of outcome including symptomatic persistence and functional impairment in multiple domains.</jats:p>