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Abstract
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OBJECTIVES: Literature data on suicide (suicidal ideation and/or attempts) and Obsessive- Compulsive Disorder (OCD) are contradictory, with some Authors reporting rates for suicide attempts and suicide as low as 0.4% and 0.08%, respectively (Khan et al., 2002), and others referring a lifetime rate for suicide attempts of 11% and for suicidal ideation as high as 62% (Sørensen et al., 2004). One of the factors that might influence such discrepancies is co-morbidity, mainly with Mood Disorders (and specifically Major Depression). The aim of the present study was to determine the rate of suicide attempts and suicidal ideation in a sample of patients with OCD. Furthermore, we aimed to investigate the hypothesized correlation between suicidal ideation and co-morbidity with depressive disorders.
METHODS: Enrolled in the present study were 167 outpatients with a principal (DSM-IVTR) diagnosis of OCD; the rate of suicidal attempts and suicidal ideation during the week preceding the interview was assessed through the HAM-D (item 3). We then performed a comparison between subjects with (score > 0 on item 3 of the HAM-D) and without (score = 0) suicidal ideation on socio-demographic and clinical features of OCD (as assessed though the administration of a semistructured interview developed for OCD patients and previously used in other investigations, which comprises the Y-BOCS) and current Axis I co-morbidity as assessed with the SCID-I.
RESULTS: Table I shows socio-demographic and clinical characteristics of the whole sample. Up to the interview and during the preceding week none of the OCD subjects referred a suicide attempt, while 26.4% of the sample presented death or suicidal ideation as from a score > 0 on item 3 of the HAM-D. Table II presents results concerning the comparison of socio-demographic and clinical characteristics between patients with and without suicidal ideation: the presence of suicidal ideation was related to male sex, older age and lower educational level. Moreover subjects with suicidal ideation presented greater severity of the principal disorder as from greater scores on the Y-BOCS (total score and both obsession and compulsion sub-scores). Subjects with suicidal ideation had greater scores also at the HAM-D and HAM-A, suggesting greater axis I co-morbidity rates. The analysis of current comorbidity rates (Tab. III) showed greater rates for at least one disorder, at least one Mood Disorder and Major Depressive Episode in patients with suicidal ideation.
CONCLUSIONS: Results of the present study confirm previous findings of some Authors who found lower rates for suicide attempts in OCD patients and moreover, suggest that suicidal ideation at intake should be assessed routinely as it appears to be present in approximately 25% of subjects. The presence of suicidal ideation appears to be linked to a greater severity of OCD and to the concomitant presence of a Mood Disorder, particularly with Major Depressive Disorder. Other factors which might be unspecific and appear to be related to suicidal ideation are male sex, older age and a lower educational level.
Language: it |