Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-02T19:15:38.530Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of suicide attempt and clinical characteristics of suicide attempters with obsessive-compulsive disorder: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS)

Published online by Cambridge University Press:  16 March 2017

Bernardo Dell’Osso ,
Beatrice Benatti ,
Chiara Arici ,
Carlotta Palazzo ,
A. Carlo Altamura ,
Eric Hollander ,
Naomi Fineberg ,
Dan J. Stein ,
Humberto Nicolini  and
Nuria Lanzagorta
...Show all authors
Bernardo Dell’Osso*
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, Milano, Italy Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
Beatrice Benatti
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, Milano, Italy
Chiara Arici
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, Milano, Italy
Carlotta Palazzo
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, Milano, Italy
A. Carlo Altamura
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, Milano, Italy
Eric Hollander
Affiliation:
Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York, USA
Naomi Fineberg
Affiliation:
Mental Health Unit, Hertfordshire Partnership Foundation Trust, Queen Elizabeth II Hospital, Welwyn Garden City, United Kingdom
Dan J. Stein
Affiliation:
MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Humberto Nicolini
Affiliation:
Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico Carracci Medical Group, Mexico City, Mexico
Nuria Lanzagorta
Affiliation:
Carracci Medical Group, Mexico City, Mexico
Donatella Marazziti
Affiliation:
Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotechnologie, Università di Pisa, Italy
Stefano Pallanti
Affiliation:
Department of Psychiatry, University of Florence, and Institute of Neurosciences, Florence, Italy
Michael van Ameringen
Affiliation:
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
Christine Lochner
Affiliation:
MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, South Africa
Oguz Karamustafalioglu
Affiliation:
Department of Psychiatry, Sisli Eftal Teaching and Research Hospital, Istanbul, Turkey
Luchezar Hranov
Affiliation:
University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry Sveti Naum, Sofia, Bulgaria
Martijn Figee
Affiliation:
Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Lynne Drummond
Affiliation:
National and Trustwide Services for OCD/BDD, SW London and St. George’s, National Health Service Trust, London, United Kingdom
Carolyn I. Rodriguez
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
John Grant
Affiliation:
Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Illinois, USA
Damiaan Denys
Affiliation:
Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Jose M. Menchon
Affiliation:
Psychiatry Unit at the Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
Joseph Zohar
Affiliation:
Tel Aviv University, Sackler School of Medicine, Israel Post-Trauma Center, Research Foundation by the Sheba Medical Center, Israel
*
*Address correspondence and reprint requests to: Bernardo Dell’Osso, Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico–Milano, Via Francesco Sforza 35, 20122 Milano, Italy. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Obsessive-compulsive disorder (OCD) is associated with variable risk of suicide and prevalence of suicide attempt (SA). The present study aimed to assess the prevalence of SA and associated sociodemographic and clinical features in a large international sample of OCD patients.

Methods

A total of 425 OCD outpatients, recruited through the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) network, were assessed and categorized in groups with or without a history of SA, and their sociodemographic and clinical features compared through Pearson’s chi-squared and t tests. Logistic regression was performed to assess the impact of the collected data on the SA variable.

Results

14.6% of our sample reported at least one SA during their lifetime. Patients with an SA had significantly higher rates of comorbid psychiatric disorders (60 vs. 17%, p<0.001; particularly tic disorder), medical disorders (51 vs. 15%, p<0.001), and previous hospitalizations (62 vs. 11%, p<0.001) than patients with no history of SA. With respect to geographical differences, European and South African patients showed significantly higher rates of SA history (40 and 39%, respectively) compared to North American and Middle-Eastern individuals (13 and 8%, respectively) (χ2=11.4, p<0.001). The logistic regression did not show any statistically significant predictor of SA among selected independent variables.

Conclusions

Our international study found a history of SA prevalence of ~15% in OCD patients, with higher rates of psychiatric and medical comorbidities and previous hospitalizations in patients with a previous SA. Along with potential geographical influences, the presence of the abovementioned features should recommend additional caution in the assessment of suicide risk in OCD patients.

Keywords

Obsessive-compulsive disordersuicide attemptprevalencecomorbidityhospitalization
Type
Original Research
Information
CNS Spectrums , Volume 23 , Issue 1 , February 2018 , pp. 59 - 66
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This research was supported by the European College of Neuropsychopharmacology (ECNP) Research Networks Initiative.

References

1. Grabe, HJ, Ruhrmann, S, Ettelt, S, et al. Familiality of obsessive-compulsive disorder in nonclinical and clinical subjects. Am J Psychiatry. 2006; 163(11): 1986–1992. http://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.2006.163.11.1986. Accessed February 6, 2017.CrossRefGoogle ScholarPubMed
2. Fontenelle, LF, Mendlowicz, MV, Versiani, M. The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006; 30(3): 327–337. Epub ahead of print Jan 18.Google Scholar
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
4. Kamath, P, Reddy, YC, Kandavel, T. Suicidal behavior in obsessive-compulsive disorder. J Clin Psychiatry. 2007; 68(11): 1741–1750.CrossRefGoogle ScholarPubMed
5. Angelakis, I, Gooding, P, Tarrier, N, Panagioti, M. Suicidality in obsessive-compulsive disorder (OCD): a systematic review and meta-analysis. Clin Psychol Rev. 2015; 39: 1–15. Epub ahead of print Mar 25.Google Scholar
6. Fernández de la Cruz, L, Rydell, M, Runeson, B, et al. Suicide in obsessive-compulsive disorder: a population-based study of 36,788 Swedish patients. Mol Psychiatry. 2016; 22: 1–7. http://www.nature.com/mp/journal/vaop/ncurrent/pdf/mp2016115a.pdf. Accessed February 7, 2017.Google Scholar
7. Velloso, P, Piccinato, C, Ferrao, Y, et al. The suicidality continuum in a large sample of obsessive-compulsive disorder ( OCD ) patients. Eur Psychiatry. 2016; 38: 1–7. Epub ahead of print Sep 6.Google Scholar
8. Marusic, A. History and geography of suicide: could genetic risk factors account for the variation in suicide rates? Am J Med Genet C Semin Med Genet. 2005; 133C(1): 43–47.CrossRefGoogle ScholarPubMed
9. Burvill, PW 1998. Migrant suicide rates in Australia and in country of birth. Psychol Med. 28(1): 201–208.Google Scholar
10. Dell’Osso, B, Nicolini, H, Lanzagorta, N, et al. Cigarette smoking in patients with obsessive compulsive disorder: A report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS). CNS Spectr. 2015; 20(5): 469–473. Epub ahead of print Sep 9.Google Scholar
11. Balci, V, Sevincok, L. Suicidal ideation in patients with obsessive-compulsive disorder. Psychiatry Res. 2010; 175(1–2): 104–108. Epub ahead of print Nov 17, 2009.Google Scholar
12. Dhyani, M, Trivedi, JK, Nischal, A, Sinha, PK, Verma, S. Suicidal behaviour of Indian patients with obsessive compulsive disorder. Indian J Psychiatry. 2013; 55(2): 161–166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3696240/. Accessed February 7, 2017.Google Scholar
13. Gupta, G, Avasthi, A, Grover, S, Singh, SM. Factors associated with suicidal ideations and suicidal attempts in patients with obsessive compulsive disorder. Asian J Psychiatr. 2014; 12: 140–146.Google Scholar
14. De Berardis, D, Serroni, N, Campanella, D, et al. Alexithymia, responsibility attitudes and suicide ideation among outpatients with obsessive-compulsive disorder: an exploratory study. Compr Psychiatry. 2015; 58: 82–87.CrossRefGoogle ScholarPubMed
15. De Berardis, D, Campanella, D, Gambi, F, et al. Insight and alexithymia in adult outpatients with obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci. 2005; 255(5): 350–358. Epub ahead of print Feb 21.CrossRefGoogle ScholarPubMed
16. Carpenter, L, Chung, MC. Childhood trauma in obsessive compulsive disorder: the roles of alexithymia and attachment. Psychol Psychother. 2011; 84(4): 367–388. Epub ahead of print Feb 25.CrossRefGoogle ScholarPubMed
17. De Berardis, D, Serroni, N, Campanella, D, et al. Suicide risk among patients with obsessive-compulsive disorder: the role of alexithymia and insight. Ital J Psychopathology. 2008; 14(2): 185–196. http://www.jpsychopathol.it/wp-content/uploads/2015/08/Deberardis1.pdf. Accessed February 7, 2017.Google Scholar
18. Pompili, M. Exploring the phenomenology of suicide. Suicide Life Threat Behav. 2010; 40(3): 234–244.Google Scholar
19. Papakostas, GI, Ongür, D, Iosifescu, DV, Mischoulon, D, Fava, M. Cholesterol in mood and anxiety disorders: review of the literature and new hypotheses. Eur Neuropsychopharmacol. 2004; 14(2): 135–142.Google Scholar
20. De Berardis, D, Serroni, N, Marini, S, et al. Alexithymia, suicidal ideation, and serum lipid levels among drug-naïve outpatients with obsessive-compulsive disorder. Rev Bras Psiquiatr. 2014; 36(2): 125–130. Epub ahead of print Jan 17. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000200125&lng=en&nrm=iso&tlng=en. Accessed February 7, 2017.Google Scholar
21. Dell’Osso, B, Benatti, B, Hollander, E, et al. Childhood, adolescent and adult age at onset and related clinical correlates in obsessive-compulsive disorder: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Int J Psychiatry Clin Pract. 2016; 20(4): 210–217. Epub ahead of print Jul 19.CrossRefGoogle ScholarPubMed
22. Menchón, JM, van Ameringen, M, Dell’Osso, B, et al. Standards of care for obsessive-compulsive disorder centres. Int J Psychiatry Clin Pract. 2016; 20(3): 204–208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950405/. Accessed February 7, 2017.Google Scholar
23. Gibbon, M, Spitzer, RL, Williams, JBW, et al. Structured Clinical Interview for DSM–IV Axis II Personality Disorders (SCID–II). Washington, DC: American Psychiatric Press; 1997.Google Scholar
24. First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM–IV–TR Axis I Disorders, Research Version, Patient Edition (SCID–I/P). New York: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
25. First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM–-IV–TR Axis I Disorders, Research Version, Non-Patient Edition (SCID–I/NP). New York: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
26. Goodman, WK, Price, LH, Rasmussen, SA, et al. The Yale–Brown Obsessive Compulsive Scale, I: development, use and reliability. Arch Gen Psychiatry. 1989; 46(11): 1006–1011.Google Scholar
27. Nock, MK, Borges, G, Bromet, EJ, Cha, CB, Kessler, RC, Lee, S. Suicide and suicidal behavior. Epidemiol Rev. 2008; 30: 133–154. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576496/. Accessed February 7, 2017.Google Scholar
28. Hollander, E, Greenwald, S, Neville, D, Johnson, J, Hornig, CD, Weissman, MM. Uncomplicated and comorbid obsessive-compulsive disorder in an epidemiologic sample. Depress Anxiety. 1996–7; 4(3): 111–119.Google Scholar
29. Hollander, E, Stein, DJ, Kwon, J, Rowland, C. Psychosocial function and economic costs of obsessive-compulsive disorder. CNS Spectr. 1997; 2(10): 16–25. Epub Nov 1, 2014.CrossRefGoogle Scholar
30. Torres, AR, de Abreu Ramos-Cerqueira, AT, Torresan, RC, et al. Prevalence and associated factors for suicidal ideation and behaviors in obsessive-compulsive disorder. CNS Spectr. 2007; 12(10): 771–778.CrossRefGoogle ScholarPubMed
31. Torres, AR, Ramos-Cerqueira, AT, Ferrão, YA, Fontenelle, LF, do Rosário, MC, Miguel, EC. Suicidality in obsessive-compulsive disorder: prevalence and relation to symptom dimensions and comorbid conditions. J Clin Psychiatry. 2011; 72(1): 17–26. quiz 119–20.CrossRefGoogle ScholarPubMed
32. Alonso, P, Segalàs, C, Real, E, et al. Suicide in patients treated for obsessive-compulsive disorder: a prospective follow-up follow-up study. J Affect Disord. 2010; 124(3): 300–308. Epub ahead of print Jan 13.Google Scholar
33. Goldsmith, SK, Pellmar, TC, Kleinman, AM, Bunney, WE. eds. Reducing Suicide: A National Imperative. Washington, DC: National Academies Press; 2002.Google Scholar
34. Klonsky, ED, May, AM, Saffer, BY. Suicide, suicide attempts, and suicidal ideation. Annu Rev Clin Psychol. 2016; 12: 307–330.Google Scholar
35. Lochner, C, Fineberg, NA, Zohar, J, et al. Comorbidity in obsessive-compulsive disorder (OCD): a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Compr Psychiatry. 2014; 55(7): 1513–1519. Epub ahead of print Jun 9.Google Scholar
36. Viswanath, B, Narayanaswamy, JC, Rajkumar, RP, et al. Impact of depressive and anxiety disorder comorbidity on the clinical expression of obsessive-compulsive disorder. Compr Psychiatry. 2012; 53(6): 775–782.Google Scholar
37. Brezo, J, Paris, J, Turecki, G. Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatr Scand. 2006; 113(3): 183–206.CrossRefGoogle ScholarPubMed
38. Rosario-Campos, MC, Leckman, JF, Mercadante, MT, et al. Adults with early-onset obsessive-compulsive disorder. Am J Psychiatry. 2001; 158(11): 1899–1903. http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.158.11.1899. Accessed February 7, 2017.Google Scholar
39. Storch, EA, Hanks, CE, Mink, JW, et al. Suicidal thoughts and behaviors in children and adolescents with chronic tic disorders. Depress Anxiety. 2015; 32(10): 744–753. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547888/. Accessed February 7, 2017.Google Scholar
40. Dávila, G, Berthier, ML, Kulisevsky, J, Jurado Chacón, S. Suicide and attempted suicide in Tourette’s syndrome. J Clin Psychiatry. 2010; 71(10): 1401–1402. http://www.psychiatrist.com/JCP/article/Pages/2010/v71n10/v71n1019.aspx. Accessed February 7, 2017.Google Scholar
41. Sanna, L, Stuart, AL, Pasco, JA, et al. Suicidal ideation and physical illness: does the link lie with depression? J Affect Disord. 2014: 152–154; 422–6. Epub ahead of print Oct 10, 2013.Google ScholarPubMed
42. Lee, SH, Tsai, YF, Chen, CY, Huang, LB. Triggers of suicide ideation and protective factors of actually executing suicide among first onset cases in older psychiatric outpatients: a qualitative study. BMC Psychiatry. 2014; 14: 269. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237773/. Accessed February 7, 2017.Google Scholar
43. Ruscio, A, Stein, D, Chiu, W, Kessler, RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2008; 15(1): 53–63. Epub ahead of print Aug 26, 2008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797569/. Accessed February 7, 2017.CrossRefGoogle ScholarPubMed
44. Brakoulias, V, Sara, G. Hospital admissions for obsessive-compulsive disorder in NSW, 1997 to 2010. Australas Psychiatry. 2011; 19(5): 502–506. http://journals.sagepub.com/doi/pdf/10.3109/10398562.2011.631543. Accessed February 7, 2017.Google Scholar
45. National Institute for Health and Clinical Excellence. Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. London: NIHCE; 2005.Google Scholar
46. Geller, DA, March, J. Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 2012; 51(1): 98–113. http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf. Accessed February 7, 2017.Google Scholar
47. Albert, U, Barbaro, F, Aguglia, A, Maina, G, Bogetto, F. Combined treatments in obsessive-compulsive disorder: current knowledge and future prospects [in Italian]. Riv Psichiatr. 2012; 47(4): 255–268. http://www.rivistadipsichiatria.it/articoli.php?archivio=yes&vol_id=1139&id=12553. Accessed February 7, 2017.Google Scholar
48. Dell’Osso, B, Benatti, B, Buoli, M, et al. The influence of age at onset and duration of illness on long-term outcome in patients with obsessive-compulsive disorder: a report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS). Eur Neuropsychopharmacol. 2013; 23(8): 865–871. Epub ahead of print Jun 21.Google Scholar