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Suicide Risk in Obsessive-Compulsive Disorder and Exploration of Risk Factors: A Systematic Review

[ Vol. 17 , Issue. 8 ]


Umberto Albert*, Diana De Ronchi, Giuseppe Maina and Maurizio Pompili   Pages 681 - 696 ( 16 )


Background: Historically, OCD has been considered to be associated with a relatively low risk of suicide. Recent studies, on the contrary, revealed a significant association between OCD and suicide attempts and ideation. A huge variation in prevalence rates, however, is reported.

Objective: To estimate prevalence rates of suicide attempts and suicidal ideation in individuals with OCD, and to identify predictors of suicide risk among subjects with OCD.

Methods: We systematically reviewed the literature on suicide risk (ideation and/or attempts) and OCD. We included studies with appropriate definition of OCD, cross-sectional or prospective design, separating clinical samples from epidemiological studies, that employed a quantitative measure of suicidality and/or reported an outcome measure of the association between suicidality and OCD or examined factors associated with suicidality.

Results: In clinical samples, the mean rate of lifetime suicide attempts is 14.2% (31 studies: range 6- 51.7%). Suicidal ideation is referred by 26.3-73.5% of individuals (17 studies, mean 44.1%); current suicidal ideation rate ranges between 6.4 and 75% (13 studies, mean 25.9). Epidemiological studies found that OCD increases significantly the odds of having a lifetime suicidal ideation as compared to the general population (OR: 1.9-10.3) and a history of lifetime suicide attempts (OR: 1.6- 9.9). Predictors of greater suicide risk are severity of OCD, the symptom dimension of unacceptable thoughts, comorbid Axis I disorders, severity of comorbid depressive and anxiety symptoms, past history of suicidality and some emotion-cognitive factors such as alexithymia and hopelessness.

Conclusion: Overall, suicidality appears a relevant phenomenon in OCD.


Obsessive-compulsive disorder, suicidal ideation, suicide attempts, deaths by suicide, prevalence rates, predictors, risk factors.


Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome

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