Risk Factors for Depressive Status in Patients With Obsessive-Compulsive Disorder: A Case-Control Study

Abstract

Background: This study aimed to characterize clinical features of patients with obsessive-compulsive disorder(OCD) comorbid with depression, and to explore the relationship between OCD symptom severity and Hamilton Depression Rating Scale (HAMD) scores.

Methods: This retrospective study enrolled 202 patients with OCD treated at West China Hospital of Sichuan University between January 2021 and December 2025,none of whom had received anti-OCD or antidepressant pharmacotherapy during the 8 weeks prior to enrolment.Of these participants, 96 patients presented comorbid depression (depression group, HAMD-17 ≥ 8), and 106 patients had no comorbid depression (non-depression group,HAMD-17 < 8). Least Absolute Shrinkage and Selection Operator(LASSO) regression was used to identify independent variables associated with comorbid depression for constructing a Logistic regression model. Pearson correlation analysis was performed to assess the relationship between Yale–Brown Obsessive-Compulsive Scale (Y-BOCS) total score, obsession score and compulsion score with HAMD-17 scores in the depression group.

Results: The depression group showed a significantly longer disease course (98.62±9.00 months vs. 93.02 ± 8.96 months, t = 4.427, p < 0.001) and a lower proportion of first-time consultations (32.29% vs. 49.06%, χ2 = 5.849, p = 0.016). Comorbid anxiety (28.12% vs. 8.49%, χ2 =13.260, p <0.001) and family history of psychosis (23.96% vs. 5.66%, χ2 = 13.718, p < 0.001) were more frequent in the depression group. LASSO regression (1SE lambda= 0.017) selected six variables for the logistic model: comorbid anxiety, family history of psychosis, medical payment type, OCD severity (moderate-severe vs. mild), obsession severity and compulsion severity. Multivariate logistic regression analysis identified comorbid anxiety (OR=3.418, 95%CI:1.202–9.715), family history of psychosis (OR = 2.649, 95% CI: 1.050–6.680), OCD severity (OR= 1.618, 95% CI: 1.035–2.529), obsession severity (OR =1.826, 95%CI:1.059–3.148), and compulsion severity (OR= 2.980, 95% CI: 1.361–6.527) as independent risk factors for comorbid depression (all p < 0.05). Pearson correlation analysis revealed that Y-BOCS total score, obsession score, and compulsion score were all significantly positively correlated with HAMD score (r = 0.577, r = 0.649, r = 0.721, respectively; all p < 0.05).

Conclusions: Comorbid anxiety, a family history of psychosis, and greater severity of OCD may significantly increase the risk of comorbid depression in patients with OCD. The severity of obsessive-compulsive symptoms demonstrates a moderate to strong positive correlation with depression severity.