<abstract xmlns="http://www.w3.org/1999/xhtml"><p>Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders.</p><sec id="j_gp-2018-0009_s_005_w2aab3b7b8b1b6b1aab1c14b2Aa"><h3>Methods</h3><p>We conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD.</p></sec><sec id="j_gp-2018-0009_s_006_w2aab3b7b8b1b6b1aab1c14b3Aa"><h3>Results</h3><p>404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide.</p></sec><sec id="j_gp-2018-0009_s_007_w2aab3b7b8b1b6b1aab1c14b4Aa"><h3>Conclusions</h3><p>Even though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.</p></sec></abstract>

Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders.MethodsWe conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD.Results404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide.ConclusionsEven though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.

Increased Risk of Attempted and Completed Suicide in Obsessive Compulsive Disorder: A Systematic Review of Follow-up Studies

Global Psychiatry

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Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders,...

Authors (year)	Country	Study focus	Study type	Subjects	Gender	(mean) Age	Assessment of OCD
Alonso et al. 2010	Spain	Suicide attempts in subjects with OCD	Prospective cohort over 1-6 years (mean 4.1 years)	218 subjects with OCD from specialized clinic	57% male	31 years	Diagnostic and Statistical Manual of Mental Disorders, version IV (DSM-IV)
Angst et al. 2005, re-reported by Fineberg et al. 2013	Switzerland	Suicide attempts in OCD versus the remaining general population	Prospective cohort with a 20 year follow-up	32 cases with OCD/ 79 subjects with Obsessive compulsive syndrome (OCS), 142 control subjects from general population	37% vs. 54% vs. 57% male	20 years at intake	DSM-IV for OCD, Obsessive Compulsive Syndrome (OCS) indicating the same symptoms but less subjective distress.
Bolton et al. 2008	Canada	Suicide attempts in OCD	prospective cohort of 1920 subjects, Baltimore Epidemiological Catchment Area survey 13 year follow up	48 subjects with OCD without any of suicide history attempts, 1229 subjects without any anxiety disorder	37% male	Not given	DSM-III diagnosis after structured interview
Fernandez de la Cruz et al. 2017	Sweden	Suicide attempts in OCD versus general population	Cohort study using register data (National Patient register) follow-up up to 44 years	36788 patients with OCD and 387880 matched controls	43% male	43 years (age at death by suicide), 30 age at first suicide attempt	International Classification of Diseases (8th to 10th revision)
Rueck et al. 2017	Sweden	Suicide in OCD subjects treated with capsulotomy	Prospective cohort study using register data wih a follow up of up to 43 years	70 patients with capsulotomy	53% male	68 years old at the age of death	International Classification of Diseases (8th to 10th revision)
Sareen et al. 2005. update reported ten Have et al. 2009	Netherlands	Suicide attempts in general population including OCD subjects	Prospective cohort with 3 year follow up	4670 subjects with completed follow up	Not given	Not given	Composite International Diagnostic Interview providing DSM-III revised diagnosis

Increased Risk of Attempted and Completed Suicide in Obsessive Compulsive Disorder: A Systematic Review of Follow-up Studies

Published Online: Oct 22, 2018

Page range: 61 - 70

Received: Dec 30, 2017

Accepted: Sep 05, 2018

DOI: https://doi.org/10.2478/gp-2018-0009

Keywords
Obsessive-compulsive disorder, OCD, suicide, completed suicide, suicide attempt, suicidal behaviour, follow-up, incidence, epidemiology

© 2018 Reinhard Heun, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Follow-up studies assessing risk of suicide attempts and completed suicide in subjects with OCD and controls

Increased Risk of Attempted and Completed Suicide in Obsessive Compulsive Disorder: A Systematic Review of Follow-up Studies

Published Online: Oct 22, 2018

Page range: 61 - 70

Received: Dec 30, 2017

Accepted: Sep 05, 2018

DOI: https://doi.org/10.2478/gp-2018-0009

KeywordsObsessive-compulsive disorder, OCD, suicide, completed suicide, suicide attempt, suicidal behaviour, follow-up, incidence, epidemiology

© 2018 Reinhard Heun, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Follow-up studies assessing risk of suicide attempts and completed suicide in subjects with OCD and controls

Keywords
Obsessive-compulsive disorder, OCD, suicide, completed suicide, suicide attempt, suicidal behaviour, follow-up, incidence, epidemiology