What Are the Suicide Risks for People with Obsessive-Compulsive Disorder?

What you need to know

• About 1 in 8 people with obsessive-compulsive disorder (OCD) attempt suicide at some point in their life
• Around half of people with OCD experience suicidal thoughts during their lifetime
• Certain factors, like severe obsessions and substance use, increase suicide risk in OCD patients
• Doctors should regularly assess suicide risk in OCD patients and be aware of warning signs

Understanding OCD and Suicide Risk

Obsessive-compulsive disorder (OCD) is a common mental health condition that causes unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). OCD can significantly impact a person’s quality of life and daily functioning.

For many years, doctors and researchers thought OCD was not associated with an increased risk of suicide. However, recent studies have challenged this idea. This meta-analysis (a study that combines results from many individual studies) aimed to get a clearer picture of suicide risk in OCD patients.

Rates of Suicide Attempts and Suicidal Thoughts

The researchers analyzed data from 61 studies, including over 50,000 people with OCD. They found that:

• 13.5% of OCD patients had attempted suicide at some point in their life
• 27.3% of OCD patients currently had suicidal thoughts
• 47.3% of OCD patients had experienced suicidal thoughts at some point in their lifetime

These rates are much higher than those seen in the general population. For comparison, in large global surveys, only about 2% of people report suicidal thoughts in a given year.

Factors That Increase Suicide Risk

The study identified several factors associated with a higher risk of suicide attempts or thoughts in OCD patients:

• Severe obsessions: Patients with more intense and frequent obsessive thoughts had a higher risk of suicide attempts and suicidal thoughts.

• Substance use disorders: OCD patients who also struggled with drug or alcohol problems were at greater risk for suicide attempts.

• Depressive symptoms: More severe depression was linked to a higher risk of suicide attempts.

• Anxiety symptoms: Higher levels of anxiety were associated with more suicidal thoughts.

• Unemployment: OCD patients who were unemployed had higher rates of suicidal thoughts.

• Low education level: Less education was associated with more suicidal thoughts.

• Family history of suicide: Having a relative who died by suicide increased risk.

Interestingly, the severity of compulsions (the repetitive behaviors in OCD) was not associated with increased risk. In fact, more severe compulsions were linked to slightly lower rates of suicidal thoughts and attempts.

Protective Factors

The researchers also identified some factors that may help protect against suicide risk in OCD:

• Having a comorbid anxiety disorder: While anxiety symptoms increased risk, having a diagnosed anxiety disorder in addition to OCD was associated with lower risk.

• Certain types of obsessions: Patients whose main obsessions involved aggressive, sexual, or religious themes had lower rates of suicidal thoughts.

Implications for Treatment

These findings have important implications for how doctors assess and treat OCD patients:

1. Regular screening: Clinicians should regularly ask OCD patients about suicidal thoughts and past suicide attempts, as many patients may not bring this up on their own.

2. Assessing risk factors: Doctors should be aware of the factors that increase suicide risk, like severe obsessions and substance use, and monitor these closely.

3. Targeted interventions: Treatments that specifically address severe obsessions and depressive symptoms may help reduce suicide risk.

4. Substance use treatment: Addressing co-occurring substance use disorders is crucial for reducing suicide risk in OCD patients.

5. Social support: Helping patients with employment and education may indirectly reduce suicide risk.

Conclusions

• OCD is associated with a significantly elevated risk of suicide attempts and suicidal thoughts.
• Certain factors, like severe obsessions and substance use, further increase this risk.
• Regular assessment of suicide risk should be a standard part of OCD treatment.
• Targeted interventions addressing risk factors may help reduce suicide risk in OCD patients.

This research highlights the importance of taking suicide risk seriously in OCD patients. By understanding the risk factors and implementing appropriate screening and interventions, healthcare providers can work to reduce suicide risk and improve outcomes for people living with OCD.