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Citation
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De Berardis D, Serroni N, Campanella D, Carano A, Caltabiano M, Pizzorno AM, Valchera A, Tancredi L, Sepede G, Gambi F, La Rovere R, Salerno RM, Moschetta FS, Ferro FM. Ital. J. Psychopathol. 2008; 14(2): 185-196. |
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Abstract
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OBJECTIVE: To our knowledge, there are very limited data on suicidal ideation in obsessive-compulsive disorder, despite it is a common psychiatric condition that often runs a chronic course with high rates of comorbidity and treatment nonresponse. Moreover, no studies have, to date, evaluated the role of alexithymia and insight in determining suicidal ideation among these patients. Therefore, the aim of our study was to evaluate suicidal ideation and the relationships with alexithymia and insight in a sample of adult outpatients with obsessive-compulsive disorder.
METHODS: A sample of 86 adult outpatients with DSM-IV diagnosis of obsessive-compulsive disorder (44 women and 42 men with a mean age of 36.2 ± 13.0 years), has been evaluated with a series of rating scales such as the Yale-Brown Obsessive Compulsive Scale, the Toronto Alexithymia Scale, the Scale for Suicide Ideation and the Montgomery-Åsberg Depression Rating Scale. The score of item #11 on the Yale-Brown Obsessive Compulsive Scale was considered as a measure of insight and scores of ≥ 3 were considered to mark the boundary between illness awareness and no awareness. Scores of ≥ 61 on the Toronto Alexithymia Scale were considered to be within the alexithymic range. As made in previous studies, scores > 5 on the SSI were used to define a person with current suicide risk.
RESULTS: There were no significant gender differences concerning demographic and clinical variables. 30 subjects (34.9%) were categorized as alexithymic and showed earlier onset, longer duration of illness and more likelihood to have a chronic course than nonalexithymics; they also scored higher on the Montgomery-Åsberg Depression Rating Scale and the Scale for Suicide Ideation (Table I). Alexithymics without insight (n = 21) scored higher on the Scale for Suicide Ideation than alexithymics with insight (n = 9), nonalexythimics without insight (n = 5) and nonalexithymics with insight (n = 51) (Fig. 1). Partial correlations between the Toronto Alexithymia Scale (and its subscales) and other dimensional variables, controlling for gender, age, illness duration and age at onset, showed that the Toronto Alexithymia Scale total score and Difficulty in Identifying Feelings/Difficulty in Describing Feelings subscales correlated with all study variables, whereas Externally Oriented Thinking correlated with the Yale-Brown Obsessive Compulsive Scale and its subscales (including item#11) but not with scores on the Scale for Suicide Ideation and on the Montgomery-Åsberg Depression Rating Scale (Table II).
RESULTS of a linear regression showed that chronic obsessive-compulsive disorder course together with Difficulty in Identifying Feelings dimension of Toronto Alexitohymia Scale and higher Montgomery-Åsberg Depression Rating Scale scores were significantly associated with higher scores on the Scale for Suicide Ideation (Table III).
CONCLUSIONS: Suicidal ideation is frequent among adult outpatients with obsessive-compulsive disorder and similar to that reported in affective disorders, schizophrenia and substance abuse. Alexithymia and depressive symptoms were highly correlated in obsessive-compulsive disorder patients and were significantly associated with higher suicide risk. The Difficulty in Identifying Feelings dimension of Toronto Alexithymia Scale appears to be significantly associated with presence of suicidal ideation as well as chronic course of the disorder. The Externally Oriented Thinking dimension of Toronto Alexithymia Scale appeared to be a variable fairly independent from depressive symptoms and suicidal ideation but was closely related to the severity of the disorder. Insight alone seems not to play a direct role in increasing suicide risk, but may have some relevance when associated with alexithymia. However, further longitudinal studies on larger samples are needed to definitely clarify this topic.
Language: it |