Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-27T20:52:56.072Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  23 March 2020

L. Tibi ,
P. van Oppen ,
A.J.L.M. van Balkom ,
M. Eikelenboom ,
J. Rickelt ,
K.R.J. Schruers  and
G.E. Anholt
L. Tibi*
Affiliation:
Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
P. van Oppen
Affiliation:
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
A.J.L.M. van Balkom
Affiliation:
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
M. Eikelenboom
Affiliation:
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
J. Rickelt
Affiliation:
Department of Psychiatry & Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, the Netherlands
K.R.J. Schruers
Affiliation:
Department of Psychiatry & Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands Mondriaan Mental Health Center, Maastricht, the Netherlands Department of Health Psychology, University of Leuven, Belgium
G.E. Anholt
Affiliation:
Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
* Corresponding author. E-mail address:[email protected]
Get access

Abstract

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

Obsessive-compulsive disorderDepressionComorbidityLongitudinalModerators
Type
Original article
Information
European Psychiatry , Volume 44 , July 2017 , pp. 76 - 82
Copyright
Copyright © European Psychiatric Association 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ruscio, AMStein, DJChiu, WTKessler, RCThe epidemiology of obsessive-compulsive disorder in the national comorbidity survey replication. Mol Psychiatry 2010; 15(1): 53–63.CrossRefGoogle ScholarPubMed
Eisen, JLMancebo, MAPinto, AColes, MEPagano, MEStout, R, et al.Impact of obsessive-compulsive disorder on quality of life. Compr Psychiatry 2006; 47(4): 270–275.CrossRefGoogle ScholarPubMed
Subramaniam, MSoh, PVaingankar, JAPicco, LChong, SAQuality of life in obsessive-compulsive disorder: impact of the disorder and of treatment. CNS Drugs 2013; 27(5): 367–383.10.1007/s40263-013-0056-zCrossRefGoogle Scholar
Bartz, JAHollander, EIs obsessive-compulsive disorder an anxiety disorder?. Prog Neuro-Psychopharmacol Biol Psychiatry 2006; 30(3): 338–352.CrossRefGoogle ScholarPubMed
Saxena, SBrody, ALHo, MLAlborzian, SHo, MKMaidment, KM, et al.Cerebral metabolism in major depression and obsessive-compulsive disorder occurring separately and concurrently. Biol Psychiatry 2001; 50(3): 159–170.10.1016/S0006-3223(01)01123-4CrossRefGoogle ScholarPubMed
Taylor, SFLiberzon, INeural correlates of emotion regulation in psychopathology. Trends Cogn Sci 2007; 11(10): 413–418.10.1016/j.tics.2007.08.006CrossRefGoogle ScholarPubMed
Besiroglu, LUguz, FSaglam, MAgargun, MYCilli, ASFactors associated with major depressive disorder occurring after the onset of obsessive-compulsive disorder. J Affect Disord 2007; 102(1–3): 73–79.CrossRefGoogle ScholarPubMed
Storch, EAAbramowitz, JSKeeley, MCorrelates and mediators of functional disability in obsessive-compulsive disorder. Depress Anxiety 2009; 26(9): 806–813.10.1002/da.20481CrossRefGoogle ScholarPubMed
Yap, KMogan, CKyrios, MObsessive-compulsive disorder and comorbid depression: the role of OCD-related and non-specific factors. J Anxiety Disord 2012; 26(5): 565–573.CrossRefGoogle ScholarPubMed
Mathew, APettit, JLewinsohn, JSeeley, JRoberts, RCo-morbidity between major depressive disorder and anxiety disorders: shared etiology or direct causation?. Psychol Med 2011; 41(October (10)): 2023–2034.CrossRefGoogle ScholarPubMed
Bolhuis, KMcadams, TAMonzani, BGregory, AMMataix-Cols, DStringaris, A, et al.Aetiological overlap between obsessive-compulsive and depressive symptoms: a longitudinal twin study in adolescents and adults. Psychol Med 2014; 44(7): 1439–1449.CrossRefGoogle ScholarPubMed
Milanfranchi, AMarazziti, DPfanner, CPresta, SLensi, PRavagli, S, et al.Comorbidity in obsessive-compulsive disorder: focus on depression. Eur Psychiatry 1995; 10(8): 379–382.10.1016/0924-9338(96)80341-5CrossRefGoogle ScholarPubMed
Huppert, JDSimpson, HBNissenson, KJLiebowitz, MRFoa, EBQuality of life and functional impairment in obsessive-compulsive disorder: a comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depress Anxiety 2009; 26(1): 39–45.CrossRefGoogle Scholar
Zitterl, WDemal, UAigner, MLenz, GUrban, CZapotoczky, HG, et al.Naturalistic course of obsessive compulsive disorder and comorbid depression. Longitudinal results of a prospective follow-up study of 74 actively treated patients. Psychopathology 2000; 33(2): 75–80.CrossRefGoogle ScholarPubMed
Anholt, GEAderka, IMVan Balkom, A.J.L.M.Smit, JHHermesh, HDe Haan, E, et al.The impact of depression on the treatment of obsessive-compulsive disorder: results from a 5-year follow-up. J Affect Disord 2011; 135(1–3): 201–207.10.1016/j.jad.2011.07.018CrossRefGoogle Scholar
Meyer, JMMcNamara, JPHReid, AMStorch, EAGeffken, GRMason, DM, et al.Prospective relationship between obsessive-compulsive and depressive symptoms during multimodal treatment in pediatric obsessive-compulsive disorder. Child Psychiatry Hum Dev 2014; 45(2): 163–172.CrossRefGoogle ScholarPubMed
Zandberg, LJZang, YMcLean, CPYeh, RSimpson, HBFoa, EBChange in obsessive-compulsive symptoms mediates subsequent change in depressive symptoms during exposure and response prevention. Behav Res Ther 2015; 68: 76–81.CrossRefGoogle ScholarPubMed
Nestadt, GAddington, ASamuels, JLiang, KYBienvenu, OJRiddle, M, et al.The identification of OCD-related subgroups based on comorbidity. Biol Psychiatry 2003; 53(10): 914–920.CrossRefGoogle ScholarPubMed
Rickelt, JViechtbauer, WLieverse, ROverbeek, Tvan Balkom, AJvan Oppen, P, et al.The relation between depressive and obsessive-compulsive symptoms in obsessive-compulsive disorder: results from a large, naturalistic follow-up study. J Affect Disord 2016; 203(October): 241–247.CrossRefGoogle ScholarPubMed
Cheung, GLau, RTesting mediation and suppression effects of latent variables: bootstrapping with structural equation models. Organ Res Methods 2008; 11: 296–325.10.1177/1094428107300343CrossRefGoogle Scholar
Rachman, SObsessions, responsibility and guilt. Behav Res Ther 1993; 31(2): 149–154.CrossRefGoogle ScholarPubMed
Abramowitz, JSStorch, EAKeeley, MCordell, EObsessive-compulsive disorder with comorbid major depression: what is the role of cognitive factors?. Behav Res Ther 2007; 45(10): 2257–2267.CrossRefGoogle ScholarPubMed
Visser, HAVan Oppen, PVan Megen, HJEikelenboom, MVan Balkom, AJObsessive-compulsive disorder; chronic versus non-chronic symptoms. J Affect Disord 2014; 152–154(1): 169–174.10.1016/j.jad.2013.09.004CrossRefGoogle ScholarPubMed
Hames, JLHagan, CRJoiner, TEInterpersonal processes in depression. Annu Rev Clin Psychol 2013; 9: 355–377.CrossRefGoogle ScholarPubMed
Renshaw, KDSteketee, GRodrigues, CSCaska, CMObsessive-compulsive disorder. In: Beck, JG editors. Interpersonal processes in the anxiety disorders: implications for understanding psychopathology and treatment. Washington, DC, US: American Psychological Association; 2010. p. 153–177.10.1037/12084-006CrossRefGoogle Scholar
Renshaw, KDSteketee, GChambless, DLInvolving family members in the treatment of OCD. Cogn Behav Ther 2005; 34(3): 164–175.CrossRefGoogle ScholarPubMed
Starr, LRDavila, JCognitive and interpersonal moderators of daily co-occurrence of anxious and depressed moods in generalized anxiety disorder. Cogn Ther Res 2012; 36(6): 655–669.10.1007/s10608-011-9434-3CrossRefGoogle ScholarPubMed
Starr, LRHammen, CConnolly, NPBrennan, PADoes relational dysfunction mediate the association between anxiety disorders and later depression? Testing an interpersonal model of comorbidity. Depress Anxiety 2014; 31(1): 77–86.CrossRefGoogle ScholarPubMed
Jinyao, YXiongzhao, ZAuerbach, RPGardiner, CKLin, CYuping, W, et al.Insecure attachment as a predictor of depressive and anxious symptomology. Depress Anxiety 2012; 29(9): 789–796.CrossRefGoogle ScholarPubMed
Rudden, MBusch, FNMilrod, BSinger, MAronson, ARoiphe, J, et al.Panic disorder and depression: a psychodynamic exploration of comorbidity a. Int J Psychoanal 2003; 84: 997–1015.CrossRefGoogle Scholar
Panksepp, JWatt, DPanksepp, JWatt, DWhy does depression hurt? Ancestral primary-process separation-distress (PANIC/GRIEF) and diminished brain reward (SEEKING) processes in the genesis of depressive affect. Psychiatry 2011; 74(1): 5–13.10.1521/psyc.2011.74.1.5CrossRefGoogle ScholarPubMed
Schuurmans, JVan Balkom, A.J.L.M.Van Megen, HJMSmit, JHEikelenboom, MCath, DC, et al.The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study: design and rationale of a longitudinal naturalistic study of the course of OCD and clinical characteristics of the sample at baseline. Int J Methods Psychiatr Res 2012; 21(4): 273–285.CrossRefGoogle ScholarPubMed
First, MSpitzer, RGibbon, MWilliams, JBStructured Clinical Interview for DSM-IV Axis I Disorders Patient Edition (SCID-I/P version 2.0) Lisse, the Netherlands: Swets & Zeitlinger BV; 1999Google Scholar
Shahar, GDavidson, LDepressive symptoms erode self-esteem in severe mental illness: a three-wave, cross-lagged study. J Consult Clin Psychol 2003; 71(5): 890–900.10.1037/0022-006X.71.5.890CrossRefGoogle ScholarPubMed
Goodman, WKPrice, LHRasmussen, SAMazure, CFleischmann, RLHill, CL, et al.The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46: 1006–1011.10.1001/archpsyc.1989.01810110048007CrossRefGoogle ScholarPubMed
Goodman, WKPrice, LHRasmussen, SAMazure, CFleischmann, RLHill, CL, et al.The Yale-Brown Obsessive Compulsive Scale: II. Validity. Arch Gen Psychiatry 1989; 46: 1012–1016.CrossRefGoogle ScholarPubMed
Sanavio, EObsessions and compulsions: the Padua Inventory. Behav Res Ther 1988; 26(2): 169–177.10.1016/0005-7967(88)90116-7CrossRefGoogle ScholarPubMed
Anholt, GEvan Oppen, PEmmelkamp, PMGCath, DCSmit, JHvan Dyck, R, et al.Measuring obsessive-compulsive symptoms: Padua Inventory-Revised vs. Yale-Brown Obsessive Compulsive Scale. J Anxiety Disord 2009; 23(6): 830–835.10.1016/j.janxdis.2009.04.004CrossRefGoogle ScholarPubMed
Beck, AWard, CMendelson, MMock, JErbaugh, JAn inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–571.CrossRefGoogle ScholarPubMed
Montgomery, S.M.Å.A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382–389.10.1192/bjp.134.4.382CrossRefGoogle ScholarPubMed
Obsessive Compulsive Cognitions Working Group. Development and initial validation of the Obsessive Beliefs Questionnaire and Interpretations of Intrusions Inventory. Behav Res Ther 2001; 39: 987–1006.10.1016/S0005-7967(00)00085-1CrossRefGoogle Scholar
Cole, JKazarian, SThe level of expressed emotion scale: a new measure of expressed emotion. J Clin Psychol 1988; 44: 392–397.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Hale, WWRaaijmakers, QAWGerlsma, CMeeus, WDoes the level of expressed emotion (LEE) questionnaire have the same factor structure for adolescents as it has for adults?. Soc Psychiatry Psychiatr Epidemiol 2007; 42(3): 215–220.CrossRefGoogle Scholar
Brown, SDBrady, TLent, RWWolfert, JHall, SPerceived social support among college students: three studies of the psychometric characteristics and counseling uses of the Social Support Inventory. J Couns Psychol 1987; 34(3): 337–354.CrossRefGoogle Scholar
Bartholomew, KHorowitz, LMAttachment styles among young adults. J Pers Soc Psychol 1991; 61(2): 226–244.CrossRefGoogle ScholarPubMed
Ravitz, PMaunder, RHunter, JSthankiya, BLancee, WAdult attachment measures: a 25-year review. J Psychosom Res 2010; 69(4): 419–432.CrossRefGoogle ScholarPubMed
Dozois, DJADobson, KSAhnberg, JLA psychometric evaluation of the Beck Depression Inventory-II. Psychol Assess 1998; 10(2): 83–89.CrossRefGoogle Scholar
Hu, LBentler, PCutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model A Multidiscip J 1999; 6(1): 1–55.CrossRefGoogle Scholar
Hayes, AFIntroduction to mediation, moderation, and conditional process analysis: a regression-based approach. Guilford Press; 2013.Google Scholar
Holmbeck, GToward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child-clinical and pediatric psychology literatures. J Consult Clin Psychol 1997; 65: 599–610.10.1037/0022-006X.65.4.599CrossRefGoogle Scholar
Anderson, JCGerbing, DWStructural equation modeling in practice: a review and recommended two-step approach. Psychol Bull 1988; 103(3): 411–423.CrossRefGoogle Scholar
Wittchen, HUBeesdo, KBittner, AGoodwin, RDDepressive episodes – evidence for a causal role of primary anxiety disorders?. Eur Psychiatry 2003; 18(8): 384–393.10.1016/j.eurpsy.2003.10.001CrossRefGoogle ScholarPubMed
Mikulincer, MOrbach, IAttachment styles and repressive defensiveness: the accessibility and architecture of affective memories. J Pers Soc Psychol 1995; 68(5): 917–925.10.1037/0022-3514.68.5.917CrossRefGoogle ScholarPubMed
Doron, GKyrios, MObsessive compulsive disorder: a review of possible specific internal representations within a broader cognitive theory. Clin Psychol Rev 2005; 25(4): 415–432.10.1016/j.cpr.2005.02.002CrossRefGoogle ScholarPubMed
Doron, GMoulding, RNedeljkovic, MKyrios, MMikulincer, MSar-El, DAdult attachment insecurities are associated with obsessive compulsive disorder. Psychol Psychother 2012; 85(2): 163–178.CrossRefGoogle ScholarPubMed
Haaland, ATVogel, PALaunes, GHaaland, V.Ø.Hansen, BSolem, S, et al.The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behav Res Ther 2011; 49(11): 781–788.10.1016/j.brat.2011.08.007CrossRefGoogle ScholarPubMed
Cherian, AVPandian, DBada Math, SKandavel, TJanardhan Reddy, YCFamily accommodation of obsessional symptoms and naturalistic outcome of obsessive-compulsive disorder. Psychiatry Res 2014; 215(2): 372–378.CrossRefGoogle ScholarPubMed
Goldberg, XSoriano-Mas, CAlonso, PSegalàs, CReal, ELópez-Solà, C, et al.Predictive value of familiality, stressful life events and gender on the course of obsessive-compulsive disorder. J Affect Disord 2015; 185: 129–134.CrossRefGoogle ScholarPubMed
Gillath, OBunge, SAShaver, PRWendelken, CMikulincer, MAttachment-style differences in the ability to suppress negative thoughts: exploring the neural correlates. Neuroimage 2005; 28(4): 835–847.CrossRefGoogle ScholarPubMed
Doron, GKyrios, MMoulding, RSensitive domains of self-concept in obsessive-compulsive disorder (OCD): further evidence for a multidimensional model of OCD. J Anxiety Disord 2007; 21(3): 433–444.CrossRefGoogle ScholarPubMed
Hammen, CGeneration of stress in the course of unipolar depression. J Abnorm Psychol 1991; 100(4): 555–561.CrossRefGoogle ScholarPubMed
Rachman, SA cognitive theory of obsessions. Behav Res Ther 1997; 35(9): 793–802.CrossRefGoogle ScholarPubMed
Emmelkamp, PMGKloek, JBlaauw, EObsessive-compulsive disorders. In: Wilson, P, editors. Principles and practice of relapse prevention. Gilford: New York; 1992. p. 213–230.Google Scholar
Thiel, NJacob, GATuschen-Caffier, BHerbst, NKülz, AKHertenstein, E, et al.Schema therapy augmented exposure and response prevention in patients with obsessive-compulsive disorder: feasibility and efficacy of a pilot study. J Behav Ther Exp Psychiatry 2016; 52: 59–67.10.1016/j.jbtep.2016.03.006CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.