OCD Patients Have Much Greater Risk of Suicide

MedicalResearch.com Interview with:

Lorena Fernández de la Cruz | Assistant Professor Department of Clinical Neuroscience | Karolinska Institutet Child and Adolescent Psychiatry Research Center Stockholm

Lorena Fernández de la Cruz

Lorena Fernández de la Cruz | Assistant Professor
Department of Clinical Neuroscience | Karolinska Institutet
Child and Adolescent Psychiatry Research Center

MedicalResearch.com: What is OCD?

Response: Obsessive-compulsive disorder (OCD) is one of the most common psychiatric disorders. OCD has a lifetime prevalence of about two per cent in the general population, generally runs a chronic course, and is often associated with a significantly reduced quality of life. Despite this, the risk of suicide in OCD has traditionally been considered low, probably due the particular personality profile of this patient group, typically described as “harm avoidant”. However, we have seen that the risk of suicide is higher than previously thought.

MedicalResearch.com: How common it is for patients with OCD to die by suicide?

Response: Patients with OCD are 10 times more likely to commit suicide and 5 times more likely to attempt suicide than people from the general population. Moreover, when adjusting for other psychiatric disorders, these risks are reduced, but remain substantial. In our study, as many as 43% of patients who died by suicide did not have other recorded psychiatric comorbidities. Clinicians should be aware that many patients with OCD may successfully complete suicide even in the absence of other psychiatric comorbidities.
These results mean that OCD should be added to the list of psychiatric disorders that are known to increase the risk of suicide in their own right. Actually, this high risk of suicidal behavior that we found in OCD is comparable to that in other mental disorders like schizophrenia, bipolar disorder, or attention-deficit hyperactivity disorder; and it is even higher than the risk found in disorders such as posttraumatic stress disorder or alcohol use disorders.

A previous suicide attempt was the strongest predictor of dying by suicide in individuals with OCD. These findings open an important opportunity to design preventing strategies that focus on this vulnerable subgroup of patients who have a history of suicide attempts. Additionally, some other mental disorders appearing together with OCD, such as personality disorders or substance use disorders, also seem to increase the risk of suicide.

MedicalResearch.com: Are there any characteristics that protect from suicide?

Response: In the OCD group, there were a few socio-economic factors that seemed to be protective. These are being a woman and a higher socioeconomic status. Having a comorbid anxiety disorder comorbid also seemed to be protective.

MedicalResearch.com: What can be done?

Response: Suicide risk needs to be carefully monitored in these patients, particularly in those who have previously attempted suicide. The identification and recognition of risk factors for suicidal behavior in OCD should guide the development of empirically-based preventive and intervention strategies aimed at reducing suicide rates in this group. Suicide prevention strategies, such as restricting access to means (e.g., lethal drugs), encouraging self-help, increasing the likelihood of intervention by a third party, or education of physicians, for example, have shown to be helpful in reducing the number of suicides. These strategies should be tailored to the needs of patients with OCD and implemented in their care plan with the aim to prevent fatal consequences in this group.

MedicalResearch.com: Why is the study novel?

Response: Both suicide and OCD are relatively rare outcomes and previous studies did not have enough power to address this question. Furthermore, because OCD is a chronic disorder, these patients may remain at risk of suicide for decades after the initial diagnosis. This means that studies with very long follow-up periods are needed to fully capture the risk. We studied one of the World’s largest cohorts of OCD patients and followed them up for 44 years. This allowed us to detect, for the first time, the likely true risk of suicide in this patient group. Unlike previously thought, OCD is a disorder that is associated with a very substantial risk of suicide.

Suicide in obsessive-compulsive disorder: a population-based study of 36,788 Swedish patients
L Fernández de la Cruz, M Rydell, B Runeson, D’Onofrio BM, G Brander, C Rück, Lichtenstein P, H Larsson, D Mataix-Cols.

Molecular Psychiatry, published online 19 July 2016, doi: 10.1038 / mp.2016.115.

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Last Updated on July 20, 2016 by Marie Benz MD FAAD