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Anthony P. S. Guerrero, MD; Earl S. Hishinuma, PhD; Naleen N. Andrade, MD; Cathy K. Bell, MD; David K. Kurahara, MD; Terry G. Lee, MD; Helen Turner, PhD; Jason Andrus, MD; Noelle Y. C. Yuen, MD; Alexander J. Stokes, MSc, HBO

Arch Pediatr Adolesc Med. 2003;157:665-670.

Background  A high prevalence rate of obsessive-compulsive disorder (OCD) among Hawaiian adolescents, particularly Native Hawaiians, has been reported. Because Native Hawaiian and other Polynesian youth are at an increased risk for rheumatic fever, caused by an autoimmune response to group A -hemolytic streptococci, we hypothesized that the genetic and environmental risk factors for streptococcal infections and their autoimmune sequelae potentially may be associated with the presence of OCD and may partially explain this high OCD prevalence.

Objective  To describe, among the adolescents in Hawaii diagnosed as having OCD through a previous study, OCD prevalence by ethnicity, household crowding and other measures of socioeconomic status, various measures of physical health and health-seeking behavior, and comorbid psychopathologic features.

Design  Six hundred nineteen adolescents from 5 high schools in the state of Hawaii were interviewed from April 15, 1993, to May 7, 1996. Interview instruments included the Diagnostic Interview Schedule for Children and other measurements of psychopathology. Obsessive-compulsive disorder diagnoses, based on current and past 6-month symptoms elicited via structured interview of the adolescents, were reported.

Results  Relative to other ethnicities, Native Hawaiians had a 2-fold higher risk (odds ratio = 2.03) for OCD. Degree of Polynesian ancestry correlated positively with OCD prevalence. Obsessive-compulsive disorder prevalence also correlated positively with crowding in the household; measures of physical illness; and measures of depression, anxiety, aggression, and illicit substance use.

Conclusions  The characteristics of OCD in this sample suggest the need to consider the possibility of a streptococcal origin and the need for further studies to clarify the genetic and environmental risk factors for OCD in Hawaiian and other Polynesian youth.

From The Native Hawaiian Mental Health Research Development Program of the Department of Psychiatry (Drs Guerrero, Hishinuma, Andrade, Bell, Lee, and Yuen), Department of Psychiatry, Division of Child and Adolescent Psychiatry (Drs Guerrero, Bell, Lee, Andrus, and Yuen), and the Department of Pediatrics (Drs Guerrero and Kurahara), University of Hawaii John A. Burns School of Medicine, and the Center for Biomedical Research, the Queen's Medical Center (Dr Turner and Mr Stokes), Honolulu.

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