Obsessive-Compulsive Symptoms and Its Association with Psychological Strain Among Chinese University Students

Obsessive-Compulsive Symptoms and Its Association with Psychological Strain Among Chinese University Students | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Obsessive-Compulsive Symptoms and Its Association with Psychological Strain Among Chinese University Students View ORCID Profile Ziyan Chen , View ORCID Profile Jiaqi Yang , Xiner Li , Yongsheng Li , Yuwen Huang , Harold G. Koenig , View ORCID Profile Zhizhong Wang , Lunchi Huang doi: https://doi.org/10.1101/2025.08.01.25332558 Ziyan Chen a Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University , Dongguan 560001, PRC Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Ziyan Chen Jiaqi Yang a Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University , Dongguan 560001, PRC Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Jiaqi Yang Xiner Li a Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University , Dongguan 560001, PRC Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yongsheng Li b Department of Preventive Medicine, the Seventh People’s hospital of Dongguan , Dongguan 523808, PRC Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yuwen Huang b Department of Preventive Medicine, the Seventh People’s hospital of Dongguan , Dongguan 523808, PRC Find this author on Google Scholar Find this author on PubMed Search for this author on this site Harold G. Koenig d Departments of Psychiatry and Medicine. Duke University Medical Center , Durham, North Carolina, USA 27705 Find this author on Google Scholar Find this author on PubMed Search for this author on this site Zhizhong Wang c Department of Health Sociology, School of Humanity and Management at Guangdong Medical University , Dongguan 523808, PRC Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Zhizhong Wang For correspondence: wzhzh_lion{at}126.com 199485445{at}qq.com Lunchi Huang b Department of Preventive Medicine, the Seventh People’s hospital of Dongguan , Dongguan 523808, PRC Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: wzhzh_lion{at}126.com 199485445{at}qq.com Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Objectives Obsessive-compulsive symptoms (OCS) are commonly seen in non-clinical populations but receive considerably less attention compared to obsessive-compulsive disorder and other mental health issues. This study examined the prevalence and characteristics of OCS and its relationship with psychological strain among Chinese college students. Methods A cross-sectional online survey was conducted in April 2024 involving 3,322 participants; the Yale-Brown Obsessive-Compulsive Scale and Coping Strain scale were administered. Results The prevalence of OCS was 6.5%, non-medical major students (OR, 1.471; 95%CI, 1.027-2.017) were at a higher prevalence risk than medical students. Participants with stronger OCS were statistically and positively associated with the higher severity of coping strain (OR, 5.115; 95%CI, 3.438-7.609; p < 0.001). Conclusion OCS and psychological strain may mutually contribute to the maintenance and/or reinforcement of each other among Chinese college students, suggesting a new interventional model that may help to promote mental health among this population. Introduction Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by the presence of persistent obsessions and/or compulsions that affect 1% to 3% of the global population ( Brock et al., 2025 ) and 1.6% of adults in China ( Huang et al., 2019 ). OCD can cause significant disability, with the World Health Organization (WHO) ranking it as one of the 10 most debilitating conditions ( Bobes et al., 2001 ). Meanwhile, young adults represent a significant proportion of new OCD diagnoses ( Sharma et al., 2021 ), with an increasing trend (from 1.9% in 2009 to 2.4% in 2015) among college students ( Oswalt et al., 2020 ). It is reported that obsessive-compulsive symptoms (OCS) are seen in 80% of non-clinical populations. These do not amount to a disorder by themselves ( Rachman and de Silva, 1978 ), and the average duration of untreated illness has been estimated to be 17 years ( Hollander et al., 1998 ). A recent study indicated that OCD patients’ symptoms are not fundamentally distinct from those in normal populations, and OCS receives very limited awareness by society ( Hu et al., 2023 ). In China, a study using the SCL-90 showed that OCS scores were significantly higher in 2015 compared to those collected in 1986 ( Liu et al., 2018 ). A cross-national survey found that OCD onset averages at 17.9 years, typically emerging in late adolescence and aligning with university entry in China ( Brakoulias et al., 2017 ). One study reported that the prevalence of OCS measured by the Obsessive-Compulsive Inventory-Revised was 24.1% among Chinese college students ( Liu et al., 2020 ). Meanwhile, the emergence of the COVID-19 pandemic and the subsequent containment measures had profound impacts on individual and societal daily lives ( Chaturvedi et al., 2021 ). There is a lack of studies focusing on the OCS during and post-pandemic among university students. In the Strain Theory of Suicide and Mental Disorder, a psychological strain must consist of at least two conflicting facts, and if the two facts are non-contradictory, there would be no strain ( Zhang et al., 2014 ). The motivation to control obsessive-compulsive symptoms and the inability to achieve such control constitute two contradictory forces, which generate psychological strain. Individuals with OCS often experience increased risk of suicidal thoughts and behaviors among university students ( Hu et al., 2023 ), although how it increases the risk of suicidal behaviors is not well known ( Huz et al., 2016 ). One possible explanation can be understood through the strain theory. Psychological strain may cause greater distress in individuals with OCS and affect the nature of these symptoms. More research is needed on the relationship between OCS and psychological strain, particularly in non-clinical samples. This study aims to a) estimate the prevalence of OCS among university students in China; b) describe the characteristics of OCS in Chinese university students; and c) explore the association between obsessive-compulsive symptoms and psychological strain. Methods Participants and procedure Participants (undergraduates, postgraduates, and doctoral candidates) were recruited through Chinese social media, email lists, and electronic newsletters. Inclusion criteria were: 1) those currently enrolled in an undergraduate program or higher in mainland China; 2) no major physical disease; and 3) voluntary participation in the study. Exclusion criteria were: 1) non-full-time enrolled students; 2) those with a clinically diagnosed severe psychotic illness; and 3) those incapable of independently using electronic devices to complete online questionnaires due to visual impairment or other disabilities. Four universities from each of China’s four major regions (East, Central, West, and Northeast) were selected based on their willingness to participate. Students were provided a link to an online questionnaire through WeChat (one of China’s most popular social media platforms). Those who responded to the invitation were encouraged to forward the invitation letter to peers and post it on social media sites. The invitation letter was initially sent to 6,213 potential participants by the WeChat network, of whom 4,341 responded to the invitation; 30 participants refused after reading the informed consent form, resulting in 4,311 completed questionnaires ( Fig. 1 ). Of those, 989 records were excluded during the data cleaning process, leaving a final sample of 3322 participants in the analysis. Download figure Open in new tab Figure 1. The flowchart of the participants’ enrollment The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The survey was anonymous, and online informed consent was obtained by asking participants to check a box on the device’s screen with the response (I agree to participate in the study, or I do not agree to participate in the survey). A small amount of money was offered for their time when the questionnaire finished. The study was approved by the institutional review board of Ningxia Medical University (approval #2017-171, 2020-112). Measures Demographic characteristics Information was collected on age, gender, living area, living city line, ethnicity (Han versus minorities), grade, major, marital status, number of siblings, self-scaled academic performance (poor, moderate, or good), self-scaled family economic status (poor, moderate, or good), hours of sleep, late sleeping behavior (before versus after 23:00) and family history of OCD. Obsessive-compulsive symptom severity The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was originally developed by Goodman et al (1989) , and is a clinician-administered instrument designed to evaluate the severity of obsessive-compulsive symptoms. The instrument has five items for obsessions and five items for compulsions, each item is rated on a 5-point Likert Scale ranging from 0 (no symptoms) to 4 (extreme symptoms), with the total score ranging from 0 to 40 correspondingly. Higher scores indicate greater severity of obsessive-compulsive symptoms; ≥ 16 was considered OCS positive. The Chinese version has high internal consistency and fair 1-week test-retest reliability in Chinese-speaking samples ( Zhang et al., 2019 ). Coping strain The psychological strain was assessed using the 40-item Psychological Strain Scale (PSS), which includes four dimensions: value strain, aspiration strain, deprivation strain, and coping strain. Therefore, only this dimension was included in this study to save time and improve the quality of questionnaire responses. The score of each item ranges from 1 to 5 (1 = strongly disagree, 2 = disagree, 3 = maybe, not sure, 4 = agree, and 5 = strongly agree). Higher scores indicate higher psychological strain (X. Zhang et al., 2017 ). Previous studies have shown that the PSS has good reliability and validity among Chinese college students, PSS ≥ 25 indicate positive ( Zhang et al., 2020 ). Statistical Analyses Descriptive statistics were performed by calculating means with standard deviations (SD) for Y-BOCS scores and frequencies with percentages for categorical variables. Frequency distributions were compared across three symptom subgroups: obsessive-only, compulsive-only, and combined obsessive-compulsive. The chi-square test was used to test the difference in the prevalence of OCS (Y-BOCS ≥ 16) among demographic variables. Binary logistic regression models were used to test the association after controlling for covariates. The adjusted ORs and their 95% confidence intervals (CIs) were calculated. The analyses were conducted using IBM SPSS version 23.0 software (SPSS Inc., Chicago, IL, USA). All statistical tests were two-tailed, with a type I error rate set at 0.05. Results Sociodemographic characteristics of the participants As presented in Table 1 . The sample comprised 3,322 Chinese university students, with 16.7% first-year, 23.3% second-year, 26.8% third-year, 13.0% fourth-year, 11.1% fifth-year undergraduates, and 9.1% postgraduates. A majority of participants were female (67.7%), from medical university (69.4%), of Han ethnicity (92.8%), and unmarried (99.5%). About a quarter (23.6%) of students had no siblings. 28.4% perceived their family economic status as good, 62.1% considered as moderate, and 9.5% as poor. View this table: View inline View popup Table 1. The demographic characteristics and psychological strain of university students by Y-BOCS score (N = 3322) The prevalence of OCS The probable prevalence of OCS was 6.5% (215/3322). Females had higher Y-BOCS scores and a higher prevalence of OCS. Those who studied non-medical majors, resided in first-tier cities, were from only-child families, with poor academic performance, with inadequate living expenses, and slept less than 6 hours, and the 21-year-old group had a higher prevalence of OCS. Besides, those with a family history of OCD had a higher prevalence of OCS ( p < 0.001). Distribution of the different OCS Symptoms As shown in Table 2 , the probable prevalences for obsessive-only, compulsive-only, and combined obsessive-compulsive symptoms were 4.27% (142/3322), 2.92% (97/3322), and 5.15% (171/3322), respectively. Female students had higher prevalences across all symptom categories. Those sleeping less than 6 hours had a remarkably higher prevalence of mixed obsessive-compulsive symptoms than those sleeping longer than 6 hours. Students with a family history of OCD also had a higher prevalence in all three categories. View this table: View inline View popup Table 2. Frequency distribution of demographic and behavioral characteristics across different obsessive-compulsive symptom categories Logistic Regression Analysis A logistic regression model of obsessive-compulsive symptoms (OCS) included the variables presented in Table 3 . Results showed that non-medical major students (OR, 1.471; 95%CI, 1.027-2.017) were at higher prevalence risk than their demographic counterparts. The family history of OCD was significantly associated with OCS (OR, 9.784; 95%CI, 4.446-21.533; p < 0.001). Compared with those living in the first-tier city, students living in second-tier (OR=0.440; 95%CI, 0.260-0.745) and new first-tier cities(OR=0.600; 95%CI, 0.394-0.914) have a lower prevalence risk of OCS. View this table: View inline View popup Download powerpoint Table 3. Logistic regression analysis of factors associated with OCS (N=3322) Besides, as shown in Table 4 , females (OR, 1.413; 95%CI, 1.206-1.655; p < 0.001) had a higher risk of coping strain than males. Non-medical major students (OR, 1.217; 95%CI, 1.031-1.436), those living in eastern China (OR, 1.240; 95%CI, 1.039-1.479) were at higher risk compared to their demographic counterparts. Regarding academic performance, students with poor (OR, 2.343; 95%CI, 1.641-3.347; p < 0.001) or moderate (OR, 1.430; 95%CI, 1.196-1.711; p < 0.001) academic performance had higher risks of OCS than those with good performance. Participants with stronger OCS (OR, 5.115; 95%CI, 3.438-7.609; p < 0.001) were statistically and positively associated with the higher severity of psychological strain. View this table: View inline View popup Download powerpoint Table 4. Logistic regression analysis of factors associated with psychological strain (N=3322) Discussion This study explored the prevalence of OCS in a representative sample of university students, addressing the gap of a lack of epidemiological studies in the post-pandemic era. In the present study, the probable prevalence of OCS was 6.5%. This finding was similar with studies done in Turkish 4.2% ( Yoldascan et al., 2009 ), Saudi Arabia 5.1% ( Sultan et al., 2021 ), India 8.5% ( Jaisoorya et al., 2017 ), but lower than that reported in Iran 32.4% ( Assareh et al., 2016 ) or America 35.7% ( Huz et al., 2016 ). The possible discrepancy may be due to the different assessment criteria for obsessive-compulsive symptoms. The utilized criteria in Iranian research focused on subclinical symptoms, and the study conducted in America classified participants as having OCS based on the presence of at least one self-reported obsessive-compulsive symptom. A meta-analytic review indicated that women are typically at greater risk of experiencing OCS than men ( Fawcett et al., 2020 ). Consistent with previous studies, our results found that female students had a higher prevalence of OCS. Moreover, we found that the major (medical vs. non-medical) was related to obsessive-compulsive symptoms among university student samples. However, logistic regression revealed that medical students had a lower risk of OCS compared to non-medical students (OR, 0.680; 95%CI, 0.496-0.932), which is inconsistent with previous studies that found medical students were more prone to have obsessive-compulsive symptoms ( Torres et al., 2016 ; Harries et al., 2017 ). The possible explanation may be that the non-medical students’ limited knowledge of OCD led to misinterpretation of obsessive-compulsive symptoms, potentially resulted in inflated self-reported symptom scores. As expected, a significant positive correlation was observed in this study between the family history of OCD and severity of OCS (total Y-BOCS score). A recent meta-analysis reported that OCD is a prevalent and highly familial disorder, which has a phenotypic heritability of around 50% among the relatives of children and adolescent probands ( Blanco-Vieira et al., 2023 ). A review concluded that OCD has a significant hereditable component, with relatives of OCD cases being 4 times more likely to develop the disorder than the general population ( Bloch and Pittenger, 2010 ). Psychological strain can significantly predict suicidal ideation among Chinese and American college students (J. Zhang et al., 2017 ). In addition to the well-documented association between psychological strain and suicidal behaviors ( Song et al., 2019 ; Tang et al., 2018 ; Wang et al., 2021 ), it is also reported that psychological strain was significantly related to depression ( Zhang and Lv, 2014 ). These findings indicated that psychological strain is one of the significant contributing factors to the development of mental disorders. The severity of OCS was associated with coping strain in our study. More severe obsessive-compulsive symptoms were associated with higher level of coping strain scores. Severe and intense coping strain can cause mental disorders ( Zhang et al., 2014 ), which may further exacerbate preexisting OCS. Notably, more severe obsessive-compulsive symptoms were associated with higher coping strain scores as well. Within non-clinical populations, subclinical OCS often received limited clinical attentions. The absence of professional guidance left individuals without the ability to control their symptoms, which is one of the reasons why the obsessive-compulsive symptoms worsen. The coping strain intensifies when limited self-control capacity that generates strong discomfort during the emergence of obsessions or compulsions clash with motivated attempts to suppress obsessive-compulsive symptoms. And these make the strong relationship between psychological strain and obsessive-compulsive symptoms more plausible. Implications for Practice This study reported the prevalence of obsessive-compulsive symptoms (OCS) in Chinese university students and the association between psychological strain and obsessive-compulsive symptoms. The figure of 6.5% indicated that OCS is common in this population. The association between OCS and coping strain probably drives individuals toward extreme solution, such that even subclinical OCS may exacerbate psychological strain. Conversely, strong psychological strain may itself trigger OCS through inward frustration-aggression pathways. This vicious cycle suggests that the presence of OCS in university students may be a marker of experiencing psychological strain, which, could potentially escalate into serious mental disorders or suicide ( Zhang et al., 2014 ). Universities and society should not overlook OCS, and mental health service providers should support university students in recognizing and managing OCS to help unlashing psychological strain for promoting overall mental health. Limitations First, the self-reported data collection may involve information bias despite it being commonly used in the epidemiological study and multivariable regression model used. Second, psychological strain is predominantly investigated within the strain theory of suicide, with relatively scarce research exploring its association to other mental disorders. Consequently, our interpretations of the underlying mechanisms are likely to be less comprehensive. Third, most participants in this study were medical students, with fewer from other majors, which may limit the generalizability of the findings to university students in a specific major. Conclusions Obsessive-compulsive symptoms (OCS) is a common mental condition among Chinese university students, with a prevalence of 6.5%. OCS is more frequent in university students reporting a family history of obsessive-compulsive disorder (OCD). A significant association exists between OCS and psychological strain, suggesting these constructs may mutually reinforce and maintain each other through a vicious cycle. Data statement The datasets generated and/or analyzed during the current study are not publicly available due to institutional restrictions, but are available from the corresponding author upon reasonable request ( wzhzh_lion{at}126.com ). Funding sources This work was supported by the Funds for Social Development of Dongguan City [Grant number: 20221800902552]. Acknowledgments The authors sincerely thank all study participants and research staff who have contributed to this work. References ↵ Assareh M , Rakhshani T , Kashfi M , Ayazi M , 2016 . Status of obsessive compulsive disorder among Iranian college students in Kermanshah, Iran . J Hum Environ Health Promotion . 1 ( 4 ): 213 – 9 . https://jhehp.zums.ac.ir/article-1-63-en.html OpenUrl ↵ Blanco-Vieira T , Radua J , Marcelino L , Bloch M , Mataix Cols D , do Rosário MC , 2023 . The genetic epidemiology of obsessive-compulsive disorder: a systematic review and meta-analysis . Transl Psychiatry . 13 ( 1 ): 230 . doi: 10.1038/s41398-023-02433-2 OpenUrl CrossRef PubMed ↵ Bloch MH , Pittenger C , 2010 . The Genetics of Obsessive-Compulsive Disorder. Curr . Psychiatry Rev . 6 , 91 – 103 . doi: 10.2174/157340010791196439 OpenUrl CrossRef PubMed ↵ Bobes J , González MP , Bascarán MT , Arango C , Sáiz PA , Bousoño M , 2001 . Quality of life and disability in patients with obsessive-compulsive disorder . European Psychiatry . 16 ( 4 ): 239 – 245 . doi: 10.1016/s0924-9338(01)00571-5 OpenUrl CrossRef PubMed Web of Science ↵ Brakoulias V , Starcevic V , Belloch A , Brown C , Ferrao YA , Fontenelle LF , Lochner C , Marazziti D , Matsunaga H , Miguel EC , Reddy YCJ , do Rosario MC , Shavitt RG , Shyam Sundar A , Stein DJ , Torres AR , Viswasam K , 2017 . Comorbidity, age of onset and suicidality in obsessive-compulsive disorder (OCD): An international collaboration . Compr Psychiatry . 76 : 79 – 86 . doi: 10.1016/j.comppsych.2017.04.002 OpenUrl CrossRef PubMed ↵ Brock H , Rizvi A , Hany M , 2025 . Obsessive-Compulsive Disorder . StatPearls [Internet] . ↵ Chaturvedi K , Vishwakarma DK , Singh N , 2021 . COVID-19 and its impact on education, social life and mental health of students: A survey . Children and youth services review . 121 , 105866 . doi: 10.1016/j.childyouth.2020.105866 OpenUrl CrossRef PubMed ↵ Fawcett EJ , Power H , Fawcett JM , 2020 . Women Are at Greater Risk of OCD Than Men: A Meta-Analytic Review of OCD Prevalence Worldwide . J Clin Psychiatry . 81 ( 4 ): 19r13085 . doi: 10.4088/JCP.19r13085 OpenUrl CrossRef PubMed ↵ Goodman WK , Price LH , Rasmussen SA , Mazure C , Fleischmann RL , Hill CL , Heninger GR , Charney DS , 1989 . The Yale-Brown Obsessive Compulsive Scale. I. Development, Use, and Reliability . Archives of general psychiatry . 46 ( 11 ), 1006 – 1011 . doi: 10.1001/archpsyc.1989.01810110048007 OpenUrl CrossRef PubMed Web of Science ↵ Harries MD , Kim SW , Grant JE , 2017 . A Comparative Study of Obsessionality in Medical Students, Law Students, and Controls . The Psychiatric quarterly . 88 ( 3 ), 603 – 610 . doi: 10.1007/s11126-016-9481-8 OpenUrl CrossRef PubMed ↵ Hollander E , Stein DJ , Kwon JH , Rowland C , Wong CM , Broatch J , Himelein C , 1998 . Psychosocial Function and Economic Costs of Obsessive-Compulsive Disorder . CNS Spectrums . 3 ( S1 ), 48 – 58 . doi: 10.1017/S1092852900007239 OpenUrl CrossRef ↵ Hu P , Liang P , Liu X , Ouyang Y , Wang J , 2023 . Parenting styles and obsessive-compulsive symptoms in college students: the mediating role of perfectionism . Front Psychiatry . 7 ; 14 : 1126689 . doi: 10.3389/fpsyt.2023.1126689 OpenUrl CrossRef ↵ Huang Y , Wang Y , Wang H , Liu Z , Yu X , Yan J , Yu Y , Kou C , Xu X , Lu J , Wang Z , He S , Xu Y , He Y , Li T , Guo W , Tian H , Xu G , Xu X , Ma Y , Wang L , Wang L , Yan Y , Wang B , Xiao S , Zhou L , Li L , Tan L , Zhang T , Ma C , Li Q , Ding H , Geng H , Jia F , Shi J , Wang S , Zhang N , Du X , Du X , Wu Y , 2019 . Prevalence of mental disorders in China: a cross-sectional epidemiological study . Lancet Psychiatry . 6 ( 3 ): 211 – 224 . doi: 10.1016/S2215-0366(18)30511-X . OpenUrl CrossRef PubMed ↵ Huz I , Nyer M , Dickson C , Farabaugh A , Alpert J , Fava M , Baer L , 2016 . Obsessive-Compulsive Symptoms as a Risk Factor for Suicidality in U.S. College Students . The Journal of adolescent health: official publication of the Society for Adolescent Medicine . 58 ( 4 ), 481 – 484 . doi: 10.1016/j.jadohealth.2015.11.011 OpenUrl CrossRef PubMed ↵ Jaisoorya TS , Janardhan Reddy YC , Nair BS , Rani A , Menon PG , Revamma M , Jeevan CR , Radhakrishnan KS , Jose V , Thennarasu K , 2017 . Prevalence and correlates of obsessive-compulsive disorder and subthreshold obsessive-compulsive disorder among college students in Kerala, India . Indian J Psychiatry . 59 ( 1 ): 56 – 62 . doi: 10.4103/0019-5545.204438 OpenUrl CrossRef PubMed ↵ Liu W , Li J , Huang Y , Yu B , Qin R , Cao X , 2020 . The relationship between left-behind experience and obsessive-compulsive symptoms in college students in China: the mediation effect of self-esteem . Psychology, Health & Medicine . 26 ( 5 ), 644 – 655 . doi: 10.1080/13548506.2020.1748667 OpenUrl CrossRef PubMed ↵ Liu Y , Wu S , Li Y , Shao F , Su JK , Liu XF , 2018 . A survey of mental symptoms of Chinese population based on SCL-90 . Chin Ment Health J . 32 : 437 – 41 . (in Chinese). OpenUrl ↵ Oswalt SB , Lederer AM , Chestnut-Steich K , Day C , Halbritter A , Ortiz D , 2020 . Trends in college students’ mental health diagnoses and utilization of services, 2009–2015 . J Am Coll Health . 68 ( 1 ): 41 – 51 . doi: 10.1080/07448481.2018.1515748 OpenUrl CrossRef PubMed ↵ Rachman S , de Silva P , 1978 . Abnormal and normal obsessions . Behaviour research and therapy . 16 ( 4 ), 233 – 248 . doi: 10.1016/0005-7967(78)90022-0 OpenUrl CrossRef PubMed Web of Science ↵ Sharma E , Sharma LP , Balachander S , Lin B , Manohar H , Khanna P , Lu C , Garg K , Thomas TL , Au ACL , Selles RR , Højgaard DRMA , Skarphedinsson G , Stewart SE , 2021 . Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis . Frontiers in psychiatry . 12 , 703701 . doi: 10.3389/fpsyt.2021.703701 OpenUrl CrossRef PubMed ↵ Song Y , Bai W , Wang M , Liu X , Zhang L , Yu W , Li Y , Hua W , Lew B , Talib MA , Kou C , 2019 . The association between psychological strain and suicidal behaviors among college students: A mental health survey in Jilin Province, Northeast China . J Affect Disord . 259 : 195 – 200 . doi: 10.1016/j.jad.2019.08.042 OpenUrl CrossRef PubMed ↵ Sultan S , Fallata EO , Bashar MA , Olaqi EE , Alsharif GH , BinSaleh RA , Fakieh RA , 2021 . Prevalence, sociodemographic and academic correlates of obsessive-compulsive disorder in the students of College of Applied Medical Sciences, Umm Al-Qura University . Journal of Obsessive-Compulsive and Related Disorders . 28 , Article 100604 . doi: 10.1016/j.jocrd.2020.100604 OpenUrl CrossRef ↵ Tang F , Byrne M , Qin P , 2018 . Psychological distress and risk for suicidal behavior among university students in contemporary China . J Affect Disord . 228 : 101 – 108 . doi: 10.1016/j.jad.2017.12.005 OpenUrl CrossRef PubMed ↵ Torres AR , Cruz BL , Vicentini HC , Lima MCP , Ramos Cerqueira ATA , 2016 . Obsessive-Compulsive symptoms in medical students: prevalence, severity, and correlates . Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry . 40 ( 1 ): 46 – 54 . doi: 10.1007/s40596-015-0357-2 OpenUrl CrossRef ↵ Wang L , Wang Z , Jia C , Sun X , He Z , 2021 . Psychological Strain and Suicidal Behaviors Among Medical Students in Northwest, China: The Mediating Effect of Psychological Distress and Hopelessness . J Nerv Ment Dis . 209 ( 10 ): 753 – 758 . doi: 10.1097/NMD.0000000000001375 OpenUrl CrossRef PubMed ↵ Yoldascan E , Ozenli Y , Kutlu O , Topal K , Bozkurt AI , 2009 . Prevalence of obsessive-compulsive disorder in Turkish university students and assessment of associated factors . BMC Psychiatry . 9 : 1 – 8 . doi: 10.1186/1471-244X-9-40 OpenUrl CrossRef PubMed ↵ Zhang C C , Gong H , Zhang Y , Jin H , Yang Y , Li B , Li Y , Luo X , Liu W , Fang F , Li B , Sun B , Fletcher T , La Buissonnière Ariza V , Goodman WK , Storch EA , 2019 . Development and psychometric evaluation of the Mandarin Chinese version of the Yale-Brown Obsessive-Compulsive Scale - Second Edition . Brazilian Journal of Psychiatry . 41 ( 6 ), 494 - 498 . doi: 10.1590/1516-4446-2018-0126 OpenUrl CrossRef PubMed ↵ Zhang J , Liu Y , Sun L , 2017 . Psychological strain and suicidal ideation: A comparison between Chinese and US college students . Psychiatry research . 255 , 256 – 262 . doi: 10.1016/j.psychres.2017.05.046 OpenUrl CrossRef PubMed ↵ Zhang J , Lu J , Zhao S , Lamis DA , Li N , Kong Y , Jia C , Zhou L , Ma Z , 2014 . Developing the Psychological Strain Scales (PSS): Reliability, Validity, and Preliminary Hypothesis Tests . Soc Indic Res . 115 ( 1 ): 337 – 361 . doi: 10.1007/s11205-012-0222-6 OpenUrl CrossRef PubMed ↵ Zhang J , Lv JC , 2014 . Psychological strains and depression in Chinese rural populations . Psychol Health Med . 19 : 365 – 373 . doi: 10.1080/13548506.2013.808752 OpenUrl CrossRef PubMed Web of Science ↵ Zhang J , Wang W , Huen JMY , Lyu J , Lew B , 2020 . Towards Higher Psychometric Properties: Testing the Psychological Strain Scales with Larger Samples . Arch Suicide Res . 26 ( 2 ): 912 – 927 . doi: 10.1080/13811118.2020.1847707 OpenUrl CrossRef PubMed ↵ Zhang X , Zhang J , Procter N , Chen X , Su Y , Lou F , Cao F , 2017 . Suicidal Ideation and Psychological Strain Among Patients Diagnosed With Stomach Cancer: The Mediation of Psychopathological Factors . The Journal of nervous and mental disease . 205 ( 7 ), 550 – 557 . doi: 10.1097/NMD.0000000000000679 OpenUrl CrossRef PubMed View the discussion thread. Back to top Previous Next Posted August 02, 2025. 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