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

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.

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.

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).

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.