Obsessive-compulsive symptoms may be unnoticed or unreported by patients because the focus of attention is on the primary diagnoses.
Obsessive-compulsive symptoms (OCS) predict both the presence and severity of anxiety and depressive disorders and may also affect the trajectory of these disorders, making OCS a potential course specifier signaling unfavorable outcomes, new research shows.
A team of researchers headed by Mieke Klein Hofmeijer-Sevink MD, PhD, of the Mental Health Care Institute GGZ Central, Amersfoort, The Netherlands, examined 2- and 4-year data collected in a prior longitudinal cohort study, the Netherlands Study of Anxiety and Depression (NESDA). The study consisted of 2981 adults (age 18 to 65) at baseline, including subjects with anxiety and depressive disorders and healthy controls.
For the current study, the researchers used the 2-year follow-up (wave 3) data as the baseline measurement and the 4-year data (wave 4) as 2-year follow-up. They analyzed data from healthy controls (n=469), participants with a remitted disorder (n=909), and participants with a current anxiety/or depressive disorder (n=747). Of these, 205 patients had a current depressive disorder, 270 had a current anxiety disorder, and 272 had a current comorbid anxiety and depressive disorder.
To assess OCs, the researchers used the Young Adult Self-Report Obsessive-Compulsive Scale (YASR-OCS) and to diagnose anxiety and depressive disorders they used the Composite International Diagnosis Interview (CIDI), version 2.1, using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria. The Beck Anxiety Inventory (BAI) was used to assess the severity of anxiety symptoms and the Inventory of Depressive Symptomatology (IDS) was used to determine the severity of depressive symptoms.
Based on a predefined threshold on the YASR-OCS, 76.4% of the sample (n=1624) did not have OCS (YASR-OCS ≤7), while OCS (YASR-OCS 7) were present in the remaining 23.6% (n=501).
Male sex, younger age, and fewer years of education were associated with OCS. Moreover, the presence of OCS was associated with higher levels of anxiety and depressive symptoms.
OCS were predominantly present in participants with current anxiety and/or depressive disorders (χ2: 473.74 (df 4), P .001), in contrast to being “hardly” or “infrequently” present in healthy controls and remitted patients, respectively.
In participants with a current disorder, the presence of OCS was associated with the severity of the disorder. Participants with OCS and a current depressive disorder had higher mean IDS scores than participants without OCS (IDS 26.4 [SD, 11.0] vs 20.3 [SD, 10.8]; F 15.07 [df 1], P .001).
Similarly, patients with OCS and a current anxiety disorder had higher mean BAI scores, as compared with those without OCS (BAI 14.5 [SD, 8.5] vs 11.8 [SD, 8.7]; F 5.95 [df 1], P =.02).
In participants with a comorbid anxiety and depressive disorder, IDS and BAI scores were both significantly higher in patients with OCS vs patients without OCS (IDS: 33.7 [SD, 11.5] vs 24.7 [SD, 10.7]; F 39.86 [df 1], P .001, and BAI: 20.3 [SD, 10.0] vs 13.4 [SD, 8.4]; F 31.22 [df 1], P .001).
At 2-year follow-up, 4.5% of healthy controls developed first onset anxiety and depressive disorders, which were associated with the presence of OCS. Of individuals who had a remitted disorder at baseline, relapse within 2 years occurred in 19.5% and was also significantly associated with OCS.
Persistence of the baseline disorder at 2-year follow-up was significantly associated with the presence of OCS above the cut-point in participants with a comorbid anxiety and depressive disorder (76.6%, χ2 15.06 (df 1), P .0001). However, persistence of a single baseline disorder (depression or anxiety) was not significantly associated with the presence of OCS.
OCS in healthy controls were associated with the development of anxiety or depressive disorders at the 2-year follow-up, while in participants with a remitted disorder, OCS were significantly associated with relapse. However, the association lost significance after adjusting for severity of anxiety and depressive symptoms.
“OCs frequently co-occur in populations with anxiety and depressive disorders as a primary diagnosis,” the researchers observed. However, although present, they “might be unnoticed or unreported by patients because the focus of attention is on the primary diagnoses.”
In light of the high relapse rate of participants (one-fifth of the sample), “identifying patients at high risk for relapse is of utmost importance,” the researchers emphasized, noting that “it seems important to treat these symptoms from the early treatment stages on.”
They suggested a transdiagnostic treatment form of cognitive behavioral therapy (CBT) that “targets more than one diagnosis by, for example, focusing on regulating emotions.”
Hofmeijer-Sevink MK, Batelaan NM, van Megen HJGM, et al. Presence and predictive value of obsessive-compulsive symptoms in anxiety and depressive disorders [published online January 1, 2017]. Can J Psychiatry. doi: 10.1177/0706743717711170.