Understanding depression and anxiety symptom interrelations in Indonesian OCD patients: A network approach

Obsessive-compulsive disorder (OCD) patients often experience co-occurring symptoms of depression and anxiety, underscoring the needs for targeted clinical interventions that address overlapping symptoms. Network analysis offers a method to examine the symptom interrelations and identify key symptoms for OCD patients interventions. This study collected self-report data on depression (PHQ-9) and anxiety (GAD-7) on OCD-diagnosed outpatients from a clinical psychology clinic in Jakarta, Indonesia (N = 232). The data were analyzed with several network analysis methods, including association networks, graphical LASSO, and directed acyclic graphs (DAGs), to visualize symptom interrelations. The findings indicated that while depression and anxiety symptoms in OCD are distinct, they are linked by “bridge” symptoms. Specifically, motor symptoms of depression and restlessness symptoms of anxiety were the key bridges, with worry and nervousness identified as highly central anxiety symptoms. In contrast, symptoms like appetite and suicidal symptoms of depression, along with irritability and fear in anxiety, were less connected within the network. Network analysis highlights that motoric symptoms may play a critical role in maintaining co-occurring anxiety and depression in OCD patients. Thus, interventions targeting motoric symptoms—such as intense exercise and behavioral activation—could be beneficial for managing these interconnected symptoms and improving patient outcomes.