Pooled frequency meta-analysis of family-accommodation (FA) in obsessive-compulsive disorder (OCD): A pervasive phenomenon

Introduction Family accommodation (FA) in obsessive-compulsive disorder (OCD) refers to caregivers’ involvement in the OCD symptomatology affecting a relative or a loved one. FA has a detrimental impact on caregivers' quality of life. This meta-analysis, for the first time, aims to define pooled estimates of how frequent FA and specific accommodating behaviors are in OCD. Materials and methods Our protocol was pre-registered with PROSPERO (CRD42024566821) and we followed PRISMA-guidelines. To be eligible, studies were required to include patients diagnosed with OCD and at least one caregiver, and to include data describing the presence or absence of FA. Meta-analysis of proportions based on random-effects (Der-Simonian-and-Laird-method) was used to derive the pooled estimates. Results A total of 39 studies were included in the meta-analysis. FA was found to occur on a monthly and weekly basis in over 90 % of OCD cases, and in nearly 50 % of cases on a daily basis. The most frequent FA behaviors involved providing reassurance and waiting for compulsions completion. No significant associations were found between FA frequency and OCD severity or treatment outcome. Meta-regression analyses showed a positive association between male gender in caregivers and the pooled-rate frequencies of several accommodating behaviors. Conclusions Family accommodation is a pervasive and intrinsic feature of OCD, though its presence may not be linked to symptom severity or treatment response. Male figures may be more frequently involved in FA behaviors compared to females. FA could be considered an epiphenomenon and a marker of OCD, and part of its diagnostic framework.