The long-term association of OCD and depression and its moderators: A four-year follow up study in a large clinical sample

Eur Psychiatry. 2017 Jul;44:76-82. doi: 10.1016/j.eurpsy.2017.03.009. Epub 2017 Apr 7.


Background: Depression is the most common comorbidity in obsessive-compulsive disorder (OCD). However, the mechanisms of depressive comorbidity in OCD are poorly understood. We assessed the directionality and moderators of the OCD-depression association over time in a large, prospective clinical sample of OCD patients.

Methods: Data were drawn from 382 OCD patients participating at the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) study. Cross-lagged, structural equation modeling analyses were used to assess the temporal association between OCD and depressive symptoms. Assessments were conducted at baseline, two-year and four-year follow up. Cognitive and interpersonal moderators of the prospective association between OCD and depressive symptoms were tested.

Results: Cross-lagged analyses demonstrated that OCD predicts depressive symptoms at two-year follow up and not vice a versa. This relationship disappeared at four-year follow up. Secure attachment style moderated the prospective association between OCD and depression.

Conclusions: Depressive comorbidity in OCD might constitute a functional consequence of the incapacitating OCD symptoms. Both OCD and depression symptoms demonstrated strong stability effects between two-year and four-year follow up, which may explain the lack of association between them in that period. Among OCD patients, secure attachment represents a buffer against future depressive symptoms.

Keywords: Comorbidity; Depression; Longitudinal; Moderators; Obsessive-compulsive disorder.

MeSH terms

  • Adult
  • Comorbidity
  • Depression / complications*
  • Depression / psychology*
  • Depressive Disorder / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Obsessive-Compulsive Disorder / complications*
  • Obsessive-Compulsive Disorder / psychology*
  • Prospective Studies
  • Severity of Illness Index*