Tibi L, van Oppen P, van Balkom A J L M, Eikelenboom M, Rickelt J, Schruers K R J, Anholt G E
Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands.
Eur Psychiatry. 2017 Jul;44:76-82. doi: 10.1016/j.eurpsy.2017.03.009. Epub 2017 Apr 7.
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.
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.
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.
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.
抑郁症是强迫症（OCD）中最常见的共病情况。然而，强迫症中抑郁共病的机制尚不清楚。我们在一个大型的强迫症患者前瞻性临床样本中，评估了强迫症与抑郁症关联随时间变化的方向性和调节因素。
数据来自参与荷兰强迫症协会（NOCDA）研究的382名强迫症患者。采用交叉滞后结构方程模型分析来评估强迫症与抑郁症状之间的时间关联。在基线、两年和四年随访时进行评估。对强迫症与抑郁症状之间前瞻性关联的认知和人际调节因素进行了测试。
交叉滞后分析表明，强迫症在两年随访时可预测抑郁症状，反之则不然。这种关系在四年随访时消失。安全依恋风格调节了强迫症与抑郁症之间的前瞻性关联。
强迫症中的抑郁共病可能是致残性强迫症症状的一种功能性后果。强迫症和抑郁症状在两年和四年随访之间都表现出很强的稳定性效应，这可能解释了在此期间它们之间缺乏关联的原因。在强迫症患者中，安全依恋是预防未来抑郁症状的一种缓冲。
