We wish to acknowledge and thank the study participants, as well as funding support from the Ministry of Science and Innovation, State Research Agency of Spain.
The authors declare that they have no conflicts of interest.
Ethical approval
This study was approved by the Human Research Ethics Committee of the Universitat de València (2534203).
Consent to participate
Informed consent to participate in the study was obtained from all participants.
Consent to publication
Not applicable.
Availability of data and materials
The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.
Funding
This study was supported by the Ministry of Science and Innovation, State Research Agency of Spain 10.13039/501100011033, by the European Union European Regional Development Fund A way of making Europe under grants [number PID2021-124409OB-I00], and by the Ministry of Education and Sports—Beca de Colaboración [Code: 998142]. None of the funders had any role in the design, preparation, review or approval of the manuscript or in the decision to submit the manuscript for publication.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing; 2022. [DOI]
Coluccia A, Ferretti F, Fagiolini A, Pozza A. Quality of life in children and adolescents with obsessive-compulsive disorder: a systematic review and meta-analysis.Neuropsychiatr Dis Treat. 2017;13:597–608. [DOI] [PubMed] [PMC]
Coluccia A, Fagiolini A, Ferretti F, Pozza A, Costoloni G, Bolognesi S, et al. Adult obsessive-compulsive disorder and quality of life outcomes: A systematic review and meta-analysis.Asian J Psychiatr. 2016;22:41–52. [DOI] [PubMed]
Hollander E, Stein DJ, Kwon JH, Rowland C, Wong CM, Broatch J, et al. Psychosocial Function and Economic Costs of Obsessive-Compulsive Disorder.CNS Spectr. 1998;3:48–58. [DOI]
Leininger M, Dyches TT, Prater MA, Heath MA. Teaching Students With Obsessive-Compulsive Disorder.Interv Sch Clin. 2010;45:221–31. [DOI]
Vallani T, Best JR, Selles RR, Negreiros J, Hansen URM, Naqqash Z, et al. School and parent perspectives on symptomatology in pediatric obsessive-compulsive disorder (OCD).J Obsessive Compuls Relat Disord. 2022;33:100731. [DOI]
Piacentini J, Bergman RL, Keller M, McCracken J. Functional impairment in children and adolescents with obsessive-compulsive disorder.J Child Adolesc Psychopharmacol. 2003;13:S61–9. [DOI] [PubMed]
Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication.Mol Psychiatry. 2010;15:53–63. [DOI] [PubMed] [PMC]
García-Soriano G, Roncero M. What do Spanish adolescents think about obsessive-compulsive disorder? Mental health literacy and stigma associated with symmetry/order and aggression-related symptoms.Psychiatry Res. 2017;250:193–9. [DOI] [PubMed]
Stengler K, Olbrich S, Heider D, Dietrich S, Riedel-Heller S, Jahn I. Mental health treatment seeking among patients with OCD: impact of age of onset.Soc Psychiatry Psychiatr Epidemiol. 2013;48:813–9. [DOI] [PubMed]
Hezel DM, Rose SV, Simpson HB. Delay to diagnosis in OCD.J Obsessive Compuls Relat Disord. 2022;32:100709. [DOI]
García-Soriano G, Rufer M, Delsignore A, Weidt S. Factors associated with non-treatment or delayed treatment seeking in OCD sufferers: a review of the literature.Psychiatry Res. 2014;220:1–10. [DOI] [PubMed]
Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis.Lancet Psychiatry. 2016;3:730–9. [DOI] [PubMed] [PMC]
Perris F, Sampogna G, Giallonardo V, Agnese S, Palummo C, Luciano M, et al. Duration of untreated illness predicts 3-year outcome in patients with obsessive-compulsive disorder: A real-world, naturalistic, follow-up study.Psychiatry Res. 2021;299:113872. [DOI] [PubMed]
Ziegler S, Bednasch K, Baldofski S, Rummel-Kluge C. Long durations from symptom onset to diagnosis and from diagnosis to treatment in obsessive-compulsive disorder: A retrospective self-report study.PLoS One. 2021;16:e0261169. [DOI] [PubMed] [PMC]
Kutcher S, Bagnell A, Wei Y. Mental health literacy in secondary schools: a Canadian approach.Child Adolesc Psychiatr Clin N Am. 2015;24:233–44. [DOI] [PubMed]
Christou GA. Exploring elementary educators’ mental health literacy and decision-making using a mixed-method approach and attribution theory [dissertation]. Kingston: Queen’s University; 2021.
Yamaguchi S, Foo JC, Nishida A, Ogawa S, Togo F, Sasaki T. Mental health literacy programs for school teachers: A systematic review and narrative synthesis.Early Interv Psychiatry. 2020;14:14–25. [DOI] [PubMed]
Chaves A, Arnáez S, Roncero M, García-Soriano G. Teachers’ Knowledge and Stigmatizing Attitudes Associated With Obsessive-Compulsive Disorder: Effectiveness of a Brief Educational Intervention.Front Psychiatry. 2021;12:677567. [DOI] [PubMed] [PMC]
Nalipay MJN, Simon PD. Teachers are frontliners too: Promoting mental health literacy among teachers in low-and middle-income countries.Asian J Psychiatr. 2023;81:103407. [DOI] [PubMed]
Brakoulias V, Perkes IE, Tsalamanios E. A call for prevention and early intervention in obsessive-compulsive disorder.Early Interv Psychiatry. 2018;12:572–7. [DOI] [PubMed]
Jorm AF, Kitchener BA, Sawyer MG, Scales H, Cvetkovski S. Mental health first aid training for high school teachers: a cluster randomized trial.BMC Psychiatry. 2010;10:51. [DOI] [PubMed] [PMC]
White SW, Sukhodolsky DG, Rains AL, Foster D, McGuire JF, Scahill L. Elementary School Teachers’ Knowledge of Tourette Syndrome, Obsessive-Compulsive Disorder, & Attention-Deficit/Hyperactivity Disorder: Effects of Teacher Training.J Dev Phys Disabil. 2011;23:5–14. [DOI]
Jassi AD, Kolvenbach S, Heyman I, Macleod T, Rose J, Diamond H. Increasing knowledge about obsessive compulsive disorder and support for parents and schools: Evaluation of initiatives.Health Educ J. 2016;75:600–9. [DOI]
García-Soriano G, Arnáez S, Chaves A, Del Valle G, Roncero M, Moritz S. Can an app increase health literacy and reduce the stigma associated with obsessive-compulsive disorder? A crossover randomized controlled trial.J Affect Disord. 2024;350:636–47. [DOI] [PubMed]
Chaves A, Arnáez S, García-Soriano G. The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study.JMIR Mhealth Uhealth. 2024;12:e48027. [DOI] [PubMed] [PMC]
Arnáez S, Roncero M, López-Santiago J, Del Valle G, Cabedo E, Bottesi G, et al. Fighting against self-stigma in adults with self-reported diagnosis of OCD: A single-arm pilot study using a mobile app-based intervention.Br J Clin Psychol. 2025;64:788–805. [DOI] [PubMed] [PMC]
Fineberg NA, Dell’Osso B, Albert U, Maina G, Geller D, Carmi L, et al. Early intervention for obsessive compulsive disorder: An expert consensus statement.Eur Neuropsychopharmacol. 2019;29:549–65. [DOI] [PubMed]
Chaves A, Arnáez S, Roncero M, García-Soriano G. Assessment of Public Stigma, Mental Health Literacy, and Help-Seeking Intentions Based on Different Dimensions of Obsessive-Compulsive Content: A Study of the Spanish Mental Health-Naïve Population.Brain Behav. 2024;14:e70159. [DOI] [PubMed] [PMC]
Chaves A, Arnáez S, Castilla D, Roncero M, García-Soriano G. Enhancing mental health literacy in obsessive-compulsive disorder and reducing stigma via smartphone: A randomized controlled trial protocol.Internet Interv. 2022;29:100560. [DOI] [PubMed] [PMC]
Corrigan PW, Powell KJ, Michaels PJ. Brief battery for measurement of stigmatizing versus affirming attitudes about mental illness.Psychiatry Res. 2014;215:466–70. [DOI] [PubMed]
Muñoz M, Guillén AI, Pérez-Santos E, Corrigan PW. A structural equation modeling study of the Spanish Mental Illness Stigma Attribution Questionnaire (AQ-27-E).Am J Orthopsychiatry. 2015;85:243–9. [DOI] [PubMed]
Corrigan P, Markowitz FE, Watson A, Rowan D, Kubiak MA. An attribution model of public discrimination towards persons with mental illness.J Health Soc Behav. 2003;44:162–79. [DOI] [PubMed]
Link BG, Cullen FT, Frank J, Wozniak JF. The Social Rejection of Former Mental Patients: Understanding Why Labels Matter.Am J Sociol. 1987;92:1461–500. [DOI]
Wilson CJ, Deane FP, Ciarrochi J, Rickwood D. Measuring Help-Seeking Intentions: Properties of the General Help-Seeking Questionnaire.Can J Couns Psychother. 2025;39:15–28.
Pacheco del Castillo LA. Dominican college students’ experiences of distress, help-seeking and stigma [dissertation]. Michigan: Western Michigan University; 2017.
Abramovitch A, Abramowitz JS, McKay D. The OCI-4: An ultra-brief screening scale for obsessive-compulsive disorder.J Anxiety Disord. 2021;78:102354. [DOI] [PubMed]
Foa EB, Huppert JD, Leiberg S, Langner R, Kichic R, Hajcak G, et al. The Obsessive-Compulsive Inventory: development and validation of a short version.Psychol Assess. 2002;14:485–96. [DOI] [PubMed]
Fullana MA, Tortella-Feliu M, Caseras X, Andión O, Torrubia R, Mataix-Cols D. Psychometric properties of the Spanish version of the Obsessive-Compulsive Inventory--revised in a non-clinical sample.J Anxiety Disord. 2005;19:893–903. [DOI] [PubMed]
Gao M, Kortum P, Oswald F. Psychometric Evaluation of the USE (Usefulness, Satisfaction, and Ease of use) Questionnaire for Reliability and Validity. In: Proceedings of the Human Factors and Ergonomics Society Annual Meeting; Washington: Human Factors and Ergonomics Society; 2018. pp. 1414–8. [DOI]
Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale.J Usability Stud. 2009;4:114–23.
Castilla D, Jaen I, Suso-Ribera C, Garcia-Soriano G, Zaragoza I, Breton-Lopez J, et al. Psychometric Properties of the Spanish Full and Short Forms of the System Usability Scale (SUS): Detecting the Effect of Negatively Worded Items.Int J Hum Comput Interact. 2023;40:4145–51. [DOI]
Davis FD. Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information.MIS Q. 1989;13:319–40. [DOI]
Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis.Clin Psychol Rev. 2012;32:329–42. [DOI] [PubMed]
Fleming TM, de Beurs D, Khazaal Y, Gaggioli A, Riva G, Botella C, et al. Maximizing the Impact of e-Therapy and Serious Gaming: Time for a Paradigm Shift.Front Psychiatry. 2016;7:65. [DOI] [PubMed] [PMC]
Eysenbach G. The law of attrition.J Med Internet Res. 2005;7:e11. [DOI] [PubMed] [PMC]
Fuhr K, Schröder J, Berger T, Moritz S, Meyer B, Lutz W, et al. The association between adherence and outcome in an Internet intervention for depression.J Affect Disord. 2018;229:443–9. [DOI] [PubMed]
Price M, Gros DF, McCauley JL, Gros KS, Ruggiero KJ. Nonuse and dropout attrition for a web-based mental health intervention delivered in a post-disaster context.Psychiatry. 2012;75:267–84. [DOI] [PubMed] [PMC]
Litvin S, Saunders R, Maier MA, Lüttke S. Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial.PLoS One. 2020;15:e0237220. [DOI] [PubMed] [PMC]
Torous J, Lipschitz J, Ng M, Firth J. Dropout rates in clinical trials of smartphone apps for depressive symptoms: A systematic review and meta-analysis.J Affect Disord. 2020;263:413–9. [DOI] [PubMed]
Thornicroft G, Sunkel C, Alikhon Aliev A, Baker S, Brohan E, el Chammay R, et al. The Lancet Commission on ending stigma and discrimination in mental health.Lancet. 2022;400:1438–80. [DOI] [PubMed]
Cangas AJ, Navarro N, Parra JMA, Ojeda JJ, Cangas D, Piedra JA, et al. Stigma-Stop: A Serious Game against the Stigma toward Mental Health in Educational Settings.Front Psychol. 2017;8:1385. [DOI] [PubMed] [PMC]
Fernández-Álvarez J, Díaz-García A, González-Robles A, Baños R, García-Palacios A, Botella C. Dropping out of a transdiagnostic online intervention: A qualitative analysis of client’s experiences.Internet Interv. 2017;10:29–38. [DOI] [PubMed] [PMC]
Linardon J, King T, Shatte A, Fuller-Tyszkiewicz M. Usability Evaluation of a Cognitive-Behavioral App-Based Intervention for Binge Eating and Related Psychopathology: A Qualitative Study.Behav Modif. 2022;46:1002–20. [DOI] [PubMed]
Yim SH, Bailey E, Gordon G, Grant N, Musiat P, Schmidt U. Exploring Participants’ Experiences of a Web-Based Program for Bulimia and Binge Eating Disorder: Qualitative Study.J Med Internet Res. 2020;22:e17880. [DOI] [PubMed] [PMC]
Chandra A, Minkovitz CS. Stigma starts early: gender differences in teen willingness to use mental health services.J Adolesc Health. 2006;38:754.e1–8. [DOI] [PubMed]
Wendt D, Shafer K. Gender and Attitudes about Mental Health Help Seeking: Results from National Data.Health Soc Work. 2016;41:e20–8. [DOI]
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010.Lancet. 2013;382:1575–86. [DOI] [PubMed]
