Multiple forms of discrimination and obsessive-compulsive disorder: a prospective cohort study

TL;DR

Experiencing multiple forms of discrimination in early adolescence is linked to a higher risk of developing obsessive-compulsive disorder later.

Contribution

This study is the first to prospectively examine the relationship between various forms of discrimination and OCD in U.S. early adolescents.

Findings

Multi-discrimination is associated with a 67% increased risk of probable OCD in early adolescents.

Racial, sexual orientation, and weight discrimination each significantly predict OCD risk.

Country of origin discrimination was not significantly linked to OCD risk.

Abstract

Discrimination increases the risk for adverse mental health in minority populations, with studies showing elevated rates of obsessive-compulsive disorder (OCD) in Black adults facing racial discrimination. Yet, there is a lack of longitudinal research on the different forms of discrimination in relation to OCD risk in early adolescence. The objective of this study was to examine the prospective associations between multiple forms of discrimination and OCD in a national sample of U.S. early adolescents.

We examined prospective cohort data from Year 2 (2018–2020, ages 10–13) and Year 3 (2019–2021) of the Adolescent Brain Cognitive Development Study (N = 7,983). Multiple logistic regression models were used to analyze associations between Year 2 past 12-month experiences of discrimination (based on race and ethnicity, country of origin, sexual orientation, weight, and combined multi-discrimination) and Year 3 probable OCD (Child Behavior Checklist; based on dichotomized t-score indicating high risk), adjusting for theoretically relevant covariates including age, sex, sexual orientation, race and ethnicity, country of origin, household income, parent education, depression, body mass index category, study site, and Year 2 probable OCD.

Adjusting for all covariates, multi-discrimination (OR = 1.67; 95% CI 1.23, 2.27), racial discrimination (OR = 2.77; 95% CI 1.32, 5.80), sexual orientation discrimination (OR = 2.51; 95% CI 1.11, 5.64), and weight discrimination (OR = 2.51; 95% CI 1.13, 5.59) at Year 2 were prospectively associated with developing probable OCD at Year 3. There were no significant findings for discrimination based on country of origin.

Early adolescents who have experienced several forms of discrimination have higher odds of developing probable OCD, suggesting the utility of screening for OCD in even younger adolescents who have encountered discrimination. Educators can play a role in guiding adolescents experiencing discrimination to appropriate resources for accessing mental healthcare.

The online version contains supplementary material available at 10.1186/s13034-025-00864-x.