Effects Of Child Neglect,Coping Style,Attributional Style And Their Interactions On Obsessive-Compulsive Disorder

BackgroundObsessive-compulsive disorder（OCD）is a chronic mental disorder characterized by recurrent obsessions and/or compulsions.OCD patients can’t control these unnecessary and meaningless obsessions or compulsions and have a strong desire to get rid of them,which make them very distressed.The lifetime prevalence of OCD is 0.8%～3.0%world widely.In China the latest epidemiological survey shows that the lifetime prevalence of OCD is up to 2.4%.The etiology of OCD is still unclear.Many studies have suggested that factors including neurobiochemical,genetic,personality defects,mental stress,social,and psychological ones are involved in OCD.Regarding to the psychological factors,previous studies have shown that child neglect has an impact on individual’s psychological development.However,the effects of child neglect,coping style,attributional style and their interactions on OCD remain unclear.In this study we speculated that the individual’s immature attribution style or coping style might serve as mediators between child neglect may be related and the symptoms of OCD.Objectives1.To examine the characteristics of child neglect,coping style and attributional style in patients with OCD,compared with healthy controls and to analyze their influences on OCD to provide a basis for the social psychological factors of OCD.2.To explore the relationships between OCD patients’demographic data,child neglect,coping style,attributional style and severity of OCD to provide new ideas for psychotherapy of OCD.3.To analyze the mediating role of coping style in the relationship between child neglect and severity of OCD to understand the relationship between child neglect and OCD.MethodsIn this cross-sectional survey,82 patients with OCD,using convenient and cluster sampling method,and 101 matched healthy controls（HCs）were recruited in the Second Affiliated Hospital of Xinxiang Medical University.All participants completed the general situation questionnaire,Yale-Brown obsessive compulsive scale（Y-BOCS）,child neglect scale（CNS）,coping style scale（CSQ）,attributional style scale（ASQ）.SPSS 25.0 statistical software package was used to analyze the influencing factors for OCD,and the relationships between OCD symptom severity,child neglect,coping style and attributional style.Amos 25.0 was used to analyze the mediation effect of coping style between child neglect and OCD severity.Results1.Compared with HCs,OCD patients had significantly higher scores in safety neglect（t=3.211,P=0.002）,communication neglect（t=3.438,P=0.001）,physical neglect（t=3.478,P=0.001）,emotional neglect（t=2.716,P=0.007）and total neglect（t=3.762,P<0.001）.2.The score of problem-solving factor（t=-6.729,P<0.001）and help-seeking factor（t=-7.680,P<0.001）were significantly lower in OCD patients than in HCs.The scores of self-accusation（t=5.925,P<0.001）,fantasy（t=4.672,P<0.001）,and avoidance（t=2.256,P=0.025）were significantly higher in OCD patients than in HCs.The score of rationalization factor was significantly higher in OCD patients than in HCs（t=2.101,P=0.037）.3.The stability score of positive event（t=8.598,P<0.001）and negative event（t=10.821,P<0.001）were significantly higher in OCD patients than in HCs.The globality score of positive event was significantly lower in OCD patients than in HCs（t=-3.464,P=0.001）.There was no significant difference in the scores of positive event internality,negative event internality and negative event globality between OCD group and HC group（P>0.05）.4.Forward:LR method was used to analyze 13 factors of CNS,CSQ and ASQ,and the Logistic regression equation was obtained:Logit P=-6.786+0.158X₁+0.270X₂-0.652X₃+0.988X₄+1.079X₅.The model chi-square value was 137.131,P=0.000,and the prediction accuracy was 86.9%.5.The total score of Y-BOCS was significantly higher in female OCD group than in male group（t=-4.092,P<0.001）,and the total score of Y-BOCS was significantly higher in married group than in unmarried group and divorced group（P=0.004,P=0.015）.6.The score of emotional neglect was significantly higher in only-child group than that in the non-only-child group（t=3.191,P=0.004）;The communication neglect score was significantly higher in urban group than in town group and rural group（P=0.010,P=0.004）,and the emotional neglect score was significantly higher in urban group than in town group and rural group（P=0.002,P=0.003）.The score of communication neglect was significantly higher in the group with family history than in the group without family history（t=-2.127,P=0.037）,and the score of physical neglect was significantly lower in the group with family history than in the group without family history（t=3.210,P=0.004）.7.The problem-solving factor score was significantly higher in male group than in female group（t=2.700,P=0.008）,the withdrawal factor score was significantly higher in female group than in male group（t=-2.497,P=0.015）,and the self-accusation factor score was significantly higher in married group than in unmarried and divorced group（P=0.013,P=0.036）.The scores of rationalization factor was significantly higher in secondary school and below group than in high school and technical secondary education group and junior college and above group（P=0.045,P=0.001）.The help-seeking score was significantly lower in worker group than in civil servant group,student group and businessman group（P=0.012,P=0.001,P=0.008）.The help-seeking score was significantly lower in farmer group than in civil servant group,student group and businessman group（P=0.018,P=0.001,P=0.012）.8.The attributional internality score of positive event scorewas significantly higher in male group than in female group（t=2.109,P=0.038）,and the attributional externality score of negative event was significantly higher in female group than in male group（t=-1.311,P=0.011）.The score of attributional stability of negative event were significantly higher in divorced group than in unmarried and married group（P=0.012,P<0.001）.The attributional globality scores of positive event（P=0.002,P=0.005）and negative event（P=0.004,P=0.002）were significantly higher in junior college and above group than in secondary school and below group and high school and technical secondary education group.The attributional stability score of positive event was significantly higher in civil servant group than in students group and businessman group（P=0.018,P=0.002）.The attributional integrity score of positive event was significantly higher in worker group than in civil servant group and businessman group（P=0.010,P=0.029）,and significantly higher in student group than in civil servant group and businessman group（P=0.005,P=0.007）.The attributional stability score of negative event was significantly higher in worker group than in student group and businessman group（P=0.036,P<0.001）,and significantly higher in civil servant group than in businessman group（P=0.001）.The attributional integrity score of negative event was significantly higher in worker group than in farmer group,civil servant group and businessman group（P=0.007,P=0.001,P=0.002）,and significantly higher in student group than in civil servant group and businessman group（P=0.003,P=0.007）.The attributional integrity score of positive event（t=-2.836,P=0.006）and negative event（t=-2.604,P=0.011）were significantly higher in group with family history of mental disorder than in group without family history.9.OCD severity was positively correlated with safety neglect（r=0.538,P<0.001）,communication neglect（r=0.400,P<0.001）,physical neglect（r=0.418,P<0.001）and emotional neglect（r=0.301,P=0.006）,negatively correlated with mature coping styles problem-solving（r=-0.735,P<0.001）and help-seeking（r=-0.324,P=0.003）,and positively correlated with immature coping styles self-accusation（r=0.666,P<0.001）,fantasy（r=0.520,P<0.001）,avoidance（r=0.492,P<0.001）,and there was no significant correlation with the factors of attributional style.10.Immature coping style had a complete mediating effect between child neglect and OCD severity,and the mediating effect was significant,with the effect value of0.384,95%CI[0.202,0.876].Mature coping style had a complete mediating effect between child neglect and OCD severity,and the mediating effect was significant,the effect value was 0.318,95%CI[0.137,0.646].Conclusions1.OCD patients in child neglect,coping style and attribution style have following characteristics:OCD patients reported to have more neglect in safety,communication,body and emotion during their childhood.They were more inclined to adopt immature coping styles（self-accusation,fantasy,avoidance）,less inclined to adopt mature coping styles（problem-solving,help-seeking）.Their positive event attributional style tended to be stable and specific,negative event attributional style tended to be stable.2.Child communication neglect,self-accusation coping style and stable attributional style were risk factors of OCD;help-seeking coping style was a protective factor of OCD.3.The severity of OCD was associated with child neglect and coping style.Child neglect affected the severity of OCD through the mediating role of coping style.