Suicide in patients treated for obsessive-compulsive disorder: A follow-up study

Background: To describe the occurrence of persistent suicidal ideation and suicide attempts in a sample of obsessive-compulsive patients followed-up prospectively during 1 to 6 years, and to determine the existence of predictors of suicide behavior. Method: Two hundred and eighteen outpatients with DSM-IV OCD, recruited from a specialized OCD Unit in Barcelona, Spain, between February 1998 and December 2007, were included in the study. Suicide ideation was assessed by item 3 of the Hamilton Depression Rating Scale. Suicide attempts were evaluated by the Beck Suicide Intent Scale. Patients with and without persistent suicidal thoughts and suicide attempters and non-attempters were compared on sociodemographic and clinical variables. A Cox proportional hazards regression analysis was used to estimate potential predictors of suicide. Results: Patients completed a mean follow-up period of treatment of 4.1 years (SD: 1.7; range: 1-6 years). During this period, eighteen patients (8.2%) reported persistent suicidal ideation, two patients (0.91%) committed suicide and 11 (5.0%) attempted suicide. Being unmarried, presenting higher basal scores in the HDRS, current or previous history of affective disorders and symmetry/ordering obsessions were independently associated with suicidal behaviors. Limitations: Patients were recruited from a specialized OCD clinic and received exhaustive treatment. Influence of variables including social support, life events, hopelessness and substance abuse/dependence was not assessed. Conclusions: Suicide behavior is not a highly common phenomenon in OCD, but it should not be disregarded, especially in unmarried patients, with comorbid depression and symmetry/ ordering obsessions and compulsions, who appear to be at a greater risk for suicide acts. (C) 2009 Elsevier B.V. All rights reserved.