Obsessive-compulsive Disorder and Depression in University Students: Serial Meditation of (Intrusive and Deliberate) Rumination and Social Anxiety

Abstract

Background Early non-clinical obsessive-compulsive symptoms often disrupt young people’s social life in different ways and make the onset of clinical conditions more likely. Evidence shows frequent comorbidity between obsessive-compulsive symptoms and depression, suggesting that the former can start before depressive symptoms appear. However, the mechanisms that make this association more likely are unclear. This cross-sectional study examines whether (intrusive and deliberate) rumination and social anxiety play a serial mediating role between preclinical conditions in university students. Methods Two hundred and eighty-two university students responded to different scales that measure obsessive-compulsive symptoms, (intrusive and deliberate) rumination, social anxiety, and depression. Serial mediation analysis was computed using macro program PROCESS 4.2. Results Mediation analysis supported a direct positive association between obsessive-compulsive symptoms and depression, as well as multiple serial mediation of the three mediators analyzed. However, while greater intrusive rumination and social anxiety make depression more likely, deliberate rumination contributes to decreasing the risk of depression by reducing social anxiety. Conclusions Obsessive-compulsive symptoms, intrusive rumination, and social anxiety can increase the risk of depression, either separately or when combined. By contrast, deliberate rumination seems to be a protective factor as it is associated with less social anxiety. Deliberate rumination also plays a mediating role between intrusive rumination and social anxiety, which in turn makes depression less likely. Interventions based on training in deliberate rumination could attenuate the impact of obsessive-compulsive symptoms on social anxiety and depression.