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Suicidality in Obsessive-Compulsive Disorder: Prevalence and Relation to Symptom Dimensions and Comorbid Conditions

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Abstract

Suicidal thoughts and behaviors, also known as suicidality, are a fairly neglected area of study in patients with obsessive-compulsive disorder (OCD). To evaluate several aspects of suicidality in a large multicenter sample of OCD patients and to compare those with and without suicidal ideation, plans, and attempts according to demographic and clinical variables, including symptom dimensions and comorbid disorders. This cross-sectional study included 582 outpatients with primary OCD (DSM-IV) recruited between August 2003 and March 2008 from 7 centers of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. The following assessment instruments were used: the Yale-Brown Obsessive Compulsive Scale, the Dimensional Yale-Brown Obsessive Compulsive Scale, the Beck Depression and Anxiety Inventories, the Structured Clinical Interview for DSM-IV Axis I Disorders, and 6 specific questions to investigate suicidality. After univariate analyses, logistic regression analyses were performed to adjust the associations between the dependent and explanatory variables for possible confounders. Thirty-six percent of the patients reported lifetime suicidal thoughts, 20% had made suicidal plans, 11% had already attempted suicide, and 10% presented current suicidal thoughts. In the logistic regression, only lifetime major depressive disorder and posttraumatic stress disorder (PTSD) remained independently associated with all aspects of suicidal behaviors. The sexual/religious dimension and comorbid substance use disorders remained associated with suicidal thoughts and plans, while impulse-control disorders were associated with current suicidal thoughts and with suicide plans and attempts. The risk of suicidal behaviors must be carefully investigated in OCD patients, particularly those with symptoms of the sexual/religious dimension and comorbid major depressive disorder, PTSD, substance use disorders, and impulse-control disorders.

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... Ölüm nedenleri arasında özkıyımın engellenebilir olması bu fenomeni daha önemli bir hale getirmektedir (6). OKB'de özkıyıma yönelik risk faktörleri pek bilinmemektedir (7). Özellikle bipolar bozukluk ve majör depresyon komorbiditesi özkıyıma aracılık edebilir (7)(8)(9). ...
... OKB'de özkıyıma yönelik risk faktörleri pek bilinmemektedir (7). Özellikle bipolar bozukluk ve majör depresyon komorbiditesi özkıyıma aracılık edebilir (7)(8)(9). 582 hasta ile yapılan bir araştırmada yaygın anksiyete bozukluğu, majör depresif bozukluk (MDB), dürtü kontrol bozukluğu ve travma sonrası stres bozukluğu (TSSB), eştanısının özkıyım düşüncesi ve planıyla; distimik bozukluğun ise özkıyım düşüncesi ve planı; travmatik deneyimlerin özkıyım düşüncesi ile ilişkili olduğu tespit edilmiştir (7). Bekarlık ve aile içerisinde özkıyımın varlığı ile girişimi; sosyoekonomik düzeyin daha düşük olması ve dini uğraşıların yokluğuyla özkıyım düşüncesi arasında anlamlı ilişki gösterilmiştir (7,9). ...
... Özellikle bipolar bozukluk ve majör depresyon komorbiditesi özkıyıma aracılık edebilir (7)(8)(9). 582 hasta ile yapılan bir araştırmada yaygın anksiyete bozukluğu, majör depresif bozukluk (MDB), dürtü kontrol bozukluğu ve travma sonrası stres bozukluğu (TSSB), eştanısının özkıyım düşüncesi ve planıyla; distimik bozukluğun ise özkıyım düşüncesi ve planı; travmatik deneyimlerin özkıyım düşüncesi ile ilişkili olduğu tespit edilmiştir (7). Bekarlık ve aile içerisinde özkıyımın varlığı ile girişimi; sosyoekonomik düzeyin daha düşük olması ve dini uğraşıların yokluğuyla özkıyım düşüncesi arasında anlamlı ilişki gösterilmiştir (7,9). ...
Article
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Objective: Data on the relationship between alcohol use disorder and suicide in patients with obsessive-compulsive disorder (OCD) are limited. The aim of this study was to investigate our hypothesis that there may be a relationship between alcohol use disorder and suicide in patients with OCD. Method: The study included 92 patients with OCD. General sociodemographic and clinical characteristics of the patients were evaluated. Yale-Brown Obsession Compulsion Scale (Y-BOCS) and Beck Suicidal Ideation Scale were administered to OCD patients. Results: The sample consisted of 54 women and 38 men. The rate of past suicide attempts was 19.6%. 16 patients were comorbid with Alcohol Use Disorder. Smoking, family history of mental illness and Beck Suicidal Ideation Scale score were significantly higher in the group with Alcohol Use Disorder. Smoking, alcohol use, family history of mental illness and Beck Suicidal Ideation Scale score were significantly higher in the group with suicide attempt. Conclusion: The results of this study showed that comorbid alcohol use disorder may be associated with past suicidal thoughts and attempts in patients with OCD. It may be appropriate to follow up OCD patients with alcohol use disorder more frequently in terms of suicide.
... Obsessions, but not compulsions, have been suggested to be uniquely associated with suicidal ideation and suicide attempts (Pellegrini et al., 2020). Having been exposed to sexual abuse (Khosravani et al., 2017) and having comorbid post-traumatic stress disorder (PTSD), depression, substance use disorders (Gentil et al., 2009;Torres et al., 2011), and intermittent explosive disorder (Agne et al., 2020) have also been linked to suicidality in OCD. ...
... Factor analytic work has consistently shown that OCD symptoms can be organized under a few broad symptom dimensions, which are thought to have evolutionary roots and partially distinct etiologies (Iervolino et al., 2011;Mataix-Cols et al., 2005). Research on OCD symptom dimensions and suicidality has suggested that sexual and religious obsessions (sometimes referred to as taboo obsessions) may be specifically linked to an increased risk of suicidal thoughts and behaviors (Demirkol et al., 2019;Khosravani et al., 2017;Krebs et al., 2021;Torres et al., 2011); however, this link has not been found in all studies (Agne et al., 2020). ...
... We used this refined model to test the hypothesis that taboo obsessions explain a meaningful part of the variance in suicidality in a large cohort of individuals with OCD. Extending previous research (Khosravani et al., 2017;Krebs et al., 2021;Torres et al., 2011), we found that taboo obsessions were uniquely associated with suicidality, even after rigorously accounting for other symptom dimensions, sociodemographic factors, psychiatric comorbidity, and overall OCD symptom severity in a two-step, exploratory-confirmatory design. ...
Article
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Individuals with obsessive-compulsive disorder (OCD) more often think about, attempt, and die by suicide than individuals from the general population. Sexual and religious obsessions (i.e., taboo obsessions) have been linked to increased risk of suicidality, but it is unclear if they explain additional risk over and above other risk factors. We refined the recently proposed multidimensional hierarchical model of OCD and explored how each symptom dimension in the model was associated with suicidality in a random half (n = 500) of a well-characterized cohort of patients with OCD. Symptom dimensions and other risk factors significantly associated with suicidality were included in a confirmatory multivariable model conducted with the other half of the sample (n = 501). The predictive confirmatory model accounted for 19% of the variance in suicidality. Taboo obsessions, the general OCD factor (i.e., having many different OCD symptoms at the same time), lifetime major depression, and lifetime substance use disorders significantly predicted suicidality in this model. Lifetime major depression explained most unique variance in suicidality (5.6%) followed by taboo obsessions and the general OCD factor (1.9% each). Taboo obsessions explain a small but significant proportion of variance in suicidality and should be considered an independent risk factor for suicidality in patients with OCD.
... There are inconsistent findings regarding the associations between various clinical features and sociodemographic variables of OCD, like the gender of patients [5], age of onset [11], OCD symptoms dimensions, OCD severity, history of suicide attempts, and presence of other psychiatric comorbidities with suicidal behavior. Several studies have reported that sexual-religious [12,13] and aggressive obsessions were associated with suicidality in patients with OCD. ...
... Ego-dystonic suicidal thoughts are defined as common aggressive obsessive thoughts and should be distinguished from real suicidal ideation [14]. Some other studies have reported that washing-contamination [5], and symmetry-ordering [12] were associated with suicidal ideations. OCD severity significantly predicted suicidal ideation [8,11,12,[15][16][17]. ...
... Some other studies have reported that washing-contamination [5], and symmetry-ordering [12] were associated with suicidal ideations. OCD severity significantly predicted suicidal ideation [8,11,12,[15][16][17]. Major depressive disorder [5,16,17] and anxiety disorders [11,12,18] were reported to be associated with current suicidal ideations. ...
Article
Background: There are many controversies about the frequency and burden of suicidality in patients with Obsessive-Compulsive Disorder (OCD). Objectives: This study was done to determine the prevalence and risk factors of current suicidal ideations in patients with OCD. Materials & Methods: In this cross-sectional study, 258 outpatients with OCD (Yale-Brawn Obsessive Compulsive Scale, Y-BOCS ≥16) referring to two psychiatry clinics in Guilan, Iran, from March 2018 to September 2019 were evaluated. Suicidality score of the Brief Psychiatric Rating Scale (BPRS) ≥4 was considered for current suicidal ideation at the first visit. Beck Scale for Suicidal Ideation (BSSI) was used to evaluate the intensity of suicidal ideations a week before evaluation. Simple linear and binary logistic regression analyses were used to analyze data by SPSS v. 20. Results: Current suicidal ideation was found in 22.1% of patients. The previous history of suicide attempt (BPRS, P
... S uicide is a major global public health problem, involving more than 800,000 deaths every year worldwide (World Health Organization, 2014). Many studies have shown that obsessive-compulsive disorder (OCD), which is characterized by obsessions and compulsions (American Psychiatric Association, 2013), is a risk factor for suicidality (Angelakis et al., 2015;Balci and Sevincok, 2010;Brakoulias et al., 2017;Chaudhary et al., 2016;Gupta et al., 2014;Kamath et al., 2007;Torres et al., 2011). In addition, patients with psychiatric disorders and comorbid OCD showed higher suicidal risk compared with those without comorbid OCD (Chen and Dilsaver, 1995;Dold et al., 2018;Overbeek et al., 2002;Quarantini et al., 2011). ...
... In patients with OCD, suicidal risk was found to be higher if they had associated depression, hopelessness, and anxiety (Alonso et al., 2010;Balci and Sevincok, 2010;Brakoulias et al., 2017;Gupta et al., 2014;Hung et al., 2010;Kamath et al., 2007;Quarantini et al., 2011;Torres et al., 2011). Furthermore, suicidal risk was higher in patients with OCD who had more severe obsessions and compulsions (Balci and Sevincok, 2010;Hung et al., 2010), and certain themes of obsessions and compulsions seemed to relate more strongly to suicidal risk (Alonso et al., 2010;Balci and Sevincok, 2010;Torres et al., 2011). ...
... In patients with OCD, suicidal risk was found to be higher if they had associated depression, hopelessness, and anxiety (Alonso et al., 2010;Balci and Sevincok, 2010;Brakoulias et al., 2017;Gupta et al., 2014;Hung et al., 2010;Kamath et al., 2007;Quarantini et al., 2011;Torres et al., 2011). Furthermore, suicidal risk was higher in patients with OCD who had more severe obsessions and compulsions (Balci and Sevincok, 2010;Hung et al., 2010), and certain themes of obsessions and compulsions seemed to relate more strongly to suicidal risk (Alonso et al., 2010;Balci and Sevincok, 2010;Torres et al., 2011). According to a systematic review and meta-analysis, which found a moderate to highly significant association between suicidality and OCD, obsessions were found to correlate more strongly with suicidality than compulsions (Angelakis et al., 2015). ...
Article
In this study, we defined obsessive thoughts (OT) as bothersome, unpleasant thoughts about oneself that keep entering the mind against one's will, and compulsive behavior (CB) as behavior that a person repeats against his or her wishes. The study included 12,532 adults selected randomly through a one-person-per-household method. Each subject selected underwent a face-to-face interview using the Korean version of the Composite International Diagnostic Interview with a questionnaire that examines lifetime suicide attempts (LSAs). Among the participants, 341 (2.74%) had OT and 639 (5.14%) had CB. The highest LSA rate was in subjects with both OT and CB, followed by those with either OT or CB; subjects with neither OT nor CB had the lowest LSA rate. In a multivariate logistic regression analysis of OT and CB, OT, ordering, and rituals of repeating words were significantly associated with LSAs. In subjects with OT and CB, those with MDD had a significantly higher risk of LSAs compared with those without, and MDD with both OT and CB showed odds of approximately 27-fold (adjusted odds ratio, 27.24; 13.29-55.82; p < 0.0001) compared with those without MDD, OT, or CB. OT and CB were associated with increased risk of LSAs, and comorbid MDD further increased LSAs.
... positive family history for SA, [2] a previous SA, [16] high severity of obsessive-compulsive (OC) symptoms, [6,7,17,18] high prevalence of the comorbidity with major depression and anxiety disorders, [3,4,7,13,19,21] and increased rates of sexual/religious, violent/aggressive, symmetry/ordering, contamination obsessions, washing, repeating, and hoarding compulsions [4,6,17,18,[20][21][22] were linked to suicidality in OCD patients. The association of hopelessness with current suicide ideation in OCD patients was found to be independent of comorbidity with depression. ...
... It is also well known that childhood physical abuse and neglect, emotional abuse and neglect, and sexual abuse is a significant risk factor for both SA and SI in OCD patients. [7,9,14,20,22,30,31] In particular, childhood sexual abuse may predict later SI and SA among individuals with OCD. [9,30] However, the relations of childhood trauma dimensions to SI have not well been studied in OCD patients with lifetime SA. ...
... [56] Previous studies have found that aggressive and sexual obsessions were associated with suicidal behavior in OCD patients. [17,18,20] Aggressive obsessions may lead patients to consider or attempt suicide to escape from their distressing symptoms. [17] Sexual obsessions can elicit suicidality by reducing self-esteem and inducing pathological guilt. ...
Article
Background: The causes underlying suicidal behaviour in patients with obsessive-compulsive (OCD) are not fully understood. Aim: In this study, we examined whether lifetime suicide attempt (SA), and suicide ideation (SI) was associated with affective temperaments, impulsivity, childhood traumatic events or separation anxiety. Methods: We compared OCD patients with lifetime SA (Group 1; n=25), lifetime suicide ideation (SI) (Group 2; n=62), and without lifetime SI and SA (Group 3; n=73) through Beck Scale for Suicidal Ideation (BSSI), Childhood Trauma Questionnaire Questionnaire (CTQ-SF), Separation Anxiety Symptom Inventory (SASI), Baratt Impulsiveness Scale (BIS-11), Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), and Beck Depression Inventory (BDI). Results: Post hoc tests showed that educational level was significantly lower in Group 1 than in both Group 2 and 3. Childhood abuse were significantly higher in attempters than ideators, and non-suicidal patients. The depressive, cyclothymic, and anxious temperaments were significantly higher in attempters and ideators compared to control subjects. The aggressive obsessions (p=0.002), childhood abuse history (p=0.009), lifetime major depression (p=0.017), and lower educational levels (p=0.006) strongly predicted the increased risk of lifetime SA, compared to non-suicidal patients. Childhood abuse (p=0.022) was the most significant predictor of lifetime SA in OCD. Conclusion: We suggested that childhood abuse history emerged as the most significant variable that distinguished lifetime attempters from only ideators in OCD patients.
... As in previous publications with similar samples (Torres et al., 2011;Velloso et al., 2016), we used a clinical questionnaire about suicide behaviors composed of seven questions with categorical answers ('Yes', 'No', 'I do not know'), and included: 'Have you ever thought that it was not worth living?'; 'Did you ever wish you were dead?'; 'Have you ever thought about taking your own life or committing suicide?'; 'Have you planned to take your own life or commit suicide?'; 'Have you ever tried to take your own life or commit suicide?'; 'Did you need hospitalization/treatment at that time?'; 'Have any of your relatives tried to commit suicide?'; 'Have any of your relatives ever committed suicide?'. ...
... We found 18 possible predictive variables of SA, but only four were clinically and epidemiologically relevant. Regarding sociodemographic variables, our negative finding is in agreement with previous studies showing no association between suicidality and marital status, family status, level of education, employment, religion, quality of life, clinical course, age of onset, or family history of suicide or suicidality (Kamath, Reddy, & Kandavel, 2007;Torres et al., 2007Torres et al., , 2011. ...
... Several studies have pointed out that suicidality in OCD may be associated with the phenomena intrinsic to the psychopathological core of the disorder, which seems to have its effect mediated by the severity of OCD symptoms (Hung et al., 2010;Torres et al., 2007): sexual/religious/moral dimensions (Dell'Osso et al., 2018;Fernández de la Cruz et al., 2017;Torres et al., 2011), aggressiveness/catastrophe (Balci & Sevincok, 2010), and symmetry/organization and arrangement . Obsessions involving sexual/religious/moral and aggressive/catastrophic content are considered as 'taboo thoughts' and could present a higher degree of shame, guilt, and responsibility for the content of their obsessions, which may lead to thoughts of death, suicide ideation, SA, and suicide (Angelakis et al., 2015;Balci & Sevincok, 2010;Gupta, Avasthi, Grover, & Singh, 2014;Kamath et al., 2007). ...
Article
Background Patients with obsessive-compulsive disorder (OCD) are at increased risk for suicide attempt (SA) compared to the general population. However, the significant risk factors for SA in this population remains unclear – whether these factors are associated with the disorder itself or related to extrinsic factors, such as comorbidities and sociodemographic variables. This study aimed to identify predictors of SA in OCD patients using a machine learning algorithm. Methods A total of 959 outpatients with OCD were included. An elastic net model was performed to recognize the predictors of SA among OCD patients, using clinical and sociodemographic variables. Results The prevalence of SA in our sample was 10.8%. Relevant predictors of SA founded by the elastic net algorithm were the following: previous suicide planning, previous suicide thoughts, lifetime depressive episode, and intermittent explosive disorder. Our elastic net model had a good performance and found an area under the curve of 0.95. Conclusions This is the first study to evaluate risk factors for SA among OCD patients using machine learning algorithms. Our results demonstrate an accurate risk algorithm can be created using clinical and sociodemographic variables. All aspects of suicidal phenomena need to be carefully investigated by clinicians in every evaluation of OCD patients. Particular attention should be given to comorbidity with depressive symptoms.
... Suicide-related studies have often focused on mood disorders, psychotic disorders, substance use disorders, and personality disorders. 5 Previous studies reported that the history of suicide attempts was 3-4%, and the completed suicide rates were lower than 1% in patients with OCD. 6,7 However, recent studies have shown that there are higher risks of suicide attempts and death as a result of suicide in OCD patients than healthy individuals. ...
... 8 Suicide risk factors in patients with OCD were, until recently, an often neglected area where there was not enough data. 1,5 Research has shown that comorbid mood disorders have mediating effects on suicide in OCD. 9 A significant relationship was found between being single, family history of suicide attempts, childhood trauma, comorbidity of posttraumatic stress disorder, low socioeconomic level, and lack of religious activities and suicidal thoughts and attempts. 1,5,10 Studies on the relationship between obsessions and compulsions to suicidal behavior have not yielded a common result. ...
... 1,5 Research has shown that comorbid mood disorders have mediating effects on suicide in OCD. 9 A significant relationship was found between being single, family history of suicide attempts, childhood trauma, comorbidity of posttraumatic stress disorder, low socioeconomic level, and lack of religious activities and suicidal thoughts and attempts. 1,5,10 Studies on the relationship between obsessions and compulsions to suicidal behavior have not yielded a common result. Previous studies revealed that sexual, aggressive, [11][12][13] symmetry/order, 1 and religious obsessions and compulsions 5 were related to suicidal thoughts and suicide attempts. ...
Article
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Purpose: Suicide is an important cause of death in patients diagnosed with obsessivecompulsive disorder (OCD) as well as other psychiatric disorders. Early determining of risk factors provides an opportunity for intervention. The mediating effect of psychological pain (also known as psychache) on suicide has been shown in various disorders but has not been investigated in patients with OCD. In this study, we aimed to show the relationship between psychological pain and other clinical variables and suicide in OCD patients. 10 Patients and methods: This cross-sectional study consisted of 67 patients diagnosed with OCD according to DSM-5 criteria with no comorbid psychiatric diagnosis who applied to the psychiatric outpatient clinic of Çukurova University Faculty of Medicine and 63 healthy controls. Among the OCD patients, 12 had previous suicide attempts. In addition to the sociodemographic data form, participants filled out the Yale-Brown Obsessive Compulsive 15 Scale (YBOCS), the Psychache Scale (PS), the Beck Scale for Suicidal Ideation (BSIS), and the Hamilton Depression Scale (HDS). Results: OCD group’s median obsession, compulsion, and the total scores of YBOCS, and the mean PS scores were higher than the control group. There was no difference between the socio- demographic variables of OCD patients with and without previous suicide attempts such as age, 20 gender, years of education, place of residence, marital, and occupational status. The median scores of obsession, avoidance, global severity, and indecisiveness subdimensions of YBOCS, the mean BSIS and PS scores, the rates of current aggressive, current contamination, and the past religious obsessions were higher in the suicidal group. There weremoderately significant relationships in the same direction between the PS, BSIS, and total YBOCS scores. Multivariate regression analysis 25 demonstrated that only the PS scores predicted previous suicide attempts. Conclusion: Our results demonstrated that current aggressive, current contamination, past religious obsessions, and the higher psychological pain are related to previous suicide attempts in OCD patients. Our regression analysis supports Shneidman’s hypothesis: there would be no suicide without psychache. Relieving psychache in OCD patients may reduce 30 suicide attempts even if there is no diagnosis of comorbid depression
... Regarding socio-demographic and clinical features related to different thresholds of SI (lifetime SI or lifetime SSI), our findings are supported by existing literature that underlines a relationship between comorbid mood disorders, greater severity of depressive and/or anxiety symptoms and current/lifetime SI. 5 In the last years some authors suggested that the presence of comorbid disorders, such as comorbid mood disorders, may represents a mediating factor between OCD and suicidality, due to the greater OCD severity, distress and functional impairment of these subjects. 30,31 However, it is not clear whether the depressive symptoms act as a confounder or as a factor in the causal pathway between OCD and suicide. ...
... 41,42 Our study also suggests that measuring the DUI during the initial evaluation of individuals with OCD may be useful in personalizing the approach to patients (e.g. more frequent visits, aggressive treatment, active inquiry about suicidal ideation with a dimensional approach). Concerning the OCD symptoms profiles, the majority of the studies highlighted an association between the unacceptable thoughts symptoms dimension and SI, 30,43 while only Gupta and collaborators 9 found the washing dimension related to SI. In our study, washing compulsions were associated to a greater intensity of SI/lifetime SB. ...
Article
Objectives: Obsessive-Compulsive Disorder has recently been found to be associated with an increased risk of suicide; however, prevalence rates of both suicidal ideation and attempts vary considerably, being the phenomenon mainly categorically evaluated. Our aims were to evaluate the prevalence of suicidal ideation (SI) and behaviors (SB) using a dimensional approach. Methods: 129 patients with OCD were enrolled. Suicidality was assessed through the administration of the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of SI, severe SI, and SB. Results: Lifetime prevalence of SI and SB were 64.3% and 16.3%. Lifetime SI was associated with the number of stressful life events, the duration of illness, HAM-D scores, family history for mood disorders. A positive family history for OCD was associated with lower probability of lifetime SI. Severe SI was related to a greater severity of the highest stressful life event, HAM-D scores and a longer duration of untreated illness. The probability of lifetime SB was related to the HAM-A scores, symmetry obsessions, washing and checking compulsions. The probability of lifetime Non-Suicidal Self-Injurious Behaviors was related to HAM-A scores. Conclusions: The recognition of predictors of SI/SB is crucial to identify those patients at greater risk.
... She believes that this is the underlying cause of her suicidality, which prompted her to seek medical attention. There is scarce evidence examining the relationship between suicide and individuals presenting with OCD and prominent hoarding symptoms [23][24][25][26][27][28]. And as we did not discern HD as a standalone diagnosis until recently, there are even fewer studies evaluating the risk of suicide in patients with HD without comorbid OCD [14,29]. ...
... This suggests that people with HD may try to attempt suicide without thinking of their actions or consequences. However, we must also consider that some of these research studies included subjects with OCD as the primary diagnosis [24][25][26][27][28]. ...
Article
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Hoarding Disorder is a syndrome marked by persistent difficulty in discarding items due to a perceived need to save the objects, regardless of value or worth. Consequently, a large number of items accumulate in residential spaces, which leads to significant distress with impaired social/occupational functioning. This diagnosis is commonly seen in association with depression and obsessive-compulsive disorder and has recently achieved recognition as a standalone diagnosis. Response to treatment among patients with hoarding disorder is variable, with some individuals experiencing associated suicidality. This case report details a 77-year-old female with a history of major depressive disorder, who was found to have hoarding symptoms at the time of hospital admission. The patient was provided with cognitive behavioral therapy and numerous psychotropic agents were added to the treatment plan. Over the course of 8-weeks of psychopharmacological management, the patient showed minimal improvement of symptomatology, with a PHQ-9 score change from 27 to 24. The purpose of this case report is to recognize the lack of sufficient evidence for appropriate pharmacologic and psychotherapeutic management for patients with hoarding disorder. Most of the scientific literature on the efficacy of pharmacotherapy in hoarding disorder was conducted in obsessive-compulsive disorder patients with a prominent hoarding component. Also, most of the studies analyzing the effectiveness of cognitive behavioral therapy in hoarding disorder demonstrated varying benefit. Moreover, our goal in this report is to increase the awareness of hoarding disorder as a potential cause of suicidality. Take-home message: Currently, we do not have sufficient evidence for the effective management of hoarding disorder. Moreover, future studies are necessary to investigate a more direct relationship between this syndrome and suicidality.
... Therefore, the current study analysed data from a large sample of adult OCD patients to investigate whether transformation obsessions and/or compulsions are associated with specific clinical characteristics. Based on the literature, it was hypothesised that OCD patients with transformation obsessions would be characterised by an earlier age at onset of the OCS, higher frequency of males (Monzani et al., 2015;Volz and Heyman, 2007), higher severity of OCS (Catapano et al., 2010), poorer insight (Catapano et al., 2010), a progressive course (Van Oudheusden et al., 2018), increased suicidality reports (Massons et al., 2017;Torres et al., 2011), higher severity of 'sensory phenomena' (Fontenelle et al., 2008), higher frequencies of family history of psychosis and/or disorders associated with bodily distortions (Buchanan et al., 2011;Catapano et al., 2010) and a later age at final OCD diagnosis (Volz and Heyman, 2007). Finally, based on the findings by Monzani et al. (2015), it was hypothesised that OCD patients and transformation obsessions would report an increased severity of fear of harm/taboo thoughts when compared with OCD patients without transformation obsessions. ...
... This supports the initial findings of Monzani et al. (2015), whereby transformation obsessions were found to load onto a 'forbidden thoughts' factor that included obsessions that were sexual or religious in nature. Notably, the sexual/religious dimension has been identified as being associated with several concerning outcomes in OCD patients, including higher suicidality, greater severity of OCD symptoms, and lower responses to general Cognitive Behavioural Therapy (CBT) treatment methods (Thorsen et al., 2018;Torres et al., 2011). Transformation obsessions can be speculatively linked to religious obsessions through the shared elevated involvement of thought-action fusion, magical ideation and a preoccupation with the occurrence of supernatural/impossible events (Coughtrey et al., 2013;Zysk et al., 2015). ...
Article
Background The obsession of turning into another person (transformation obsessions [TO]), and its related compulsions have been initially conceptualised as a form of mental contamination. Nevertheless, it has remained understudied in the current obsessive-compulsive disorder (OCD) literature. In parallel, disturbances of the self have been identified as markers of prodromal psychosis in patients with schizophrenia. Based on the later association, this study aimed to investigate the sociodemographic and clinical correlates of TO. Methods In all, 1001 OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used to compare 48 OCD patients with TO with 953 OCD patients without TO. A repression model investigated the relationships between the presence of current TO and statistically significant univariate test outcomes. Results Participants with TO presented an overall younger age, a longer period of time between the onset of the OCD symptoms and an OCD diagnosis, greater severity of the sexual/religious dimension and increased suicidality symptoms. Conclusions These results indicate that TO may be better conceptualised as a form of forbidden/taboo thoughts rather than contamination. While no significant associations with psychotic features (e.g. decreased insight) were observed, TO patients displayed increased suicidality, overall younger age and a significantly larger disparity between seeking treatment and OCD diagnosis. This demonstrates that further clinical awareness and research into TO as an OCD symptom is most needed.
... Besides the possibility of misdiagnosis, the relevance of the intersection between PTSD and OCD lies in the fact that some specific aspects of the comorbidity could interfere with the treatment response or adherence, 12 as the association to a lower level of insight, 13 higher levels of OCS severity, 10 higher suicidality 10,[14][15][16] and higher prevalence of psychotic features, 17 including dissociation. [18][19][20][21] But, unexpectedly, Shavitt et al (2010), found that OCD patients with PTSD presented a greater magnitude of response when compared with OCD without PTSD patients in specific OCD symptom dimensions. ...
... suicide attempts, 27,3% of current suicidal ideation, and 47,3% of lifetime suicidal ideation. 51 Severity of obsessions, some specific content of obsessions (eg.: unacceptable thoughts, sexual/religious) comorbid disorders (e.g.: substance use, intermittent explosive disorder), depressive/anxious symptoms, history of suicidality increased the risk, 14,51,[116][117] whereas compulsions had a comparatively protective effect. 51 Thus, both PTSD and OCD are strongly related to suicidality, although the reasons and risk factors may be diverse for both disorders. ...
Article
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Introduction: Although Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, what may lead to misdiagnosis and to wrong therapeutical decisions. This scoping review explores the psychopathological similitudes and differences of both disorders. Methods: It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and included articles published in Portuguese, English or Spanish in the last 50 years in the PubMed database. Case-reports were excluded. Results: Fifty-three studies with different designs were included (30(56.5%) were cross-sectional; 8 (15.1%) were case control; 1 (1.9%) was cohort; 3 (5.7%) were clinical trials; 9 (17.0%) were reviews/systematic reviews; and 2 (3.8%) were meta-analysis.). The main described interfaced psychopathological aspects by the included studies were flashbacks x obsessions; avoidant behavior; depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection of clinical features seems to be on the extrinsic psychopathological dimension. Conclusions: The psychopathological symptoms core (intrinsic characteristics) is distinctly different, since flashbacks and obsessions are consequences of predominant diverse defective mental function: the former from memory, the last from thought. In the same way, the avoidant behaviors are derived from different purposes and inner necessities.
... Among these dimensions, responsibility for harm and unacceptable thoughts play an important role in the maintenance of OCD (Abramowitz et al., 2006;Arntz et al., 2007;Neal et al., 2017) and are associated with poor treatment outcomes Mataix-Cols et al., 2002;Shetti et al., 2005;Steketee et al., 2019;Williams et al., 2014). In addition, the responsibility for harm and unacceptable thoughts dimensions are more strongly related to suicidality than other OC symptom dimensions above and beyond depression and OCD severity (Albert et al., 2019;Balci & Sevincok, 2010;De Berardis et al., 2015;DeVylder et al., 2012;Kim et al., 2016;Krebs et al., 2020;Rajabi Khamesi et al., in press;Torres et al., 2011;Velloso et al., 2016). ...
... The results of the current study showed that, among the OC symptom dimensions, responsibility for harm and unacceptable obsessional thoughts as well as OCD severity indirectly affected suicidal ideation through stress responses in reaction to the pandemic, specifically traumatic stress symptoms and compulsive checking, after controlling for covariates of general depression and anxiety, comorbidity, and lifetime suicide attempts. These results are consistent with prior findings showing the significant role of these same OC symptom dimensions and OCD severity in suicidality, including suicidal ideation (e.g., Albert et al., 2019;Balci & Sevincok, 2010;De Berardis et al., 2015;DeVylder et al., 2012;Kim et al., 2016;Krebs et al., 2020;Rajabi Khamesi et al., in press;Torres et al., 2011;Velloso et al., 2016). Further, the present findings are consistent with the results of previous studies reporting the relationships between COVID-19 and suicidal ideation in patients with OCD (Benatti, Albert, et al., 2020). ...
Article
Suicidal ideation is prevalent in patients with obsessive‐compulsive disorder (OCD); but, during COVID‐19 it may be increased. The present study aimed to examine the effects of obsessive‐compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID‐19 in a clinical sample of patients with OCD. In a cross‐sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID‐19‐related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID‐19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID‐19 may be an underlying mechanism. Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.
... OCD encompasses a number of relatively independent symptom dimensions (Bloch et al., 2008;Mataix-Cols et al., 2005;Mataix-Cols et al., 2008), which have distinct aetiologies, neural substrates, and clinical correlates (Iervolino et al., 2011;Mataix-Cols et al., 2005;Mataix-Cols et al., 2008). There is some suggestion that suicidality may be especially linked to taboo obsessions, such as sexual, aggressive, and religious obsessions (Balci and Sevincok, 2010;Khosravani et al., 2017;Kim et al., 2016;Storch et al., 2015;Torres et al., 2011;Velloso et al., 2016), but findings have been mixed and further clarification is needed (Pellegrini et al., in press). ...
... Our findings therefore indicate that such "taboo obsessions" are robustly linked with suicidality across developmental stages. This is consistent with previous studies showing that taboo obsessions are associated with suicidality among OCD patients (Balci and Sevincok, 2010;Khosravani et al., 2017;Kim et al., 2016;Storch et al., 2015;Torres et al., 2011;Velloso et al., 2016). We also found that symptoms relating to symmetry and ordering (e.g., arranging things in a special order) were positively associated with suicidality at age 18 but not age 24. ...
Article
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Background : Obsessive-compulsive disorder (OCD) has been linked with elevated risk of suicidality. However, most previous studies have been cross-sectional, and little is known about the aetiology of the association between obsessive-compulsive symptoms (OCS) and suicidality in young adults. Methods : Participants were members of the Child and Adolescent Twin Study in Sweden, at ages 18 (n=9,162) and 24 (n=3,466). Twins completed self-report measures, including assessment of OCS, suicidal ideation, and suicidal attempts. Logistic regression models tested concurrent and prospective associations of total OCS and OCS dimensions with suicidality, with and without adjustment for depression and anxiety symptoms. Genetic models tested the extent to which the main phenotypic associations were accounted for by genetic and environmental influences. Results : Total OCS were significantly associated with concurrent reports of suicidality at age 18 and 24, even when controlling for depressive and anxiety symptoms. Taboo obsessions (e.g., sexual and aggressive thoughts) were more robustly associated with suicidality than other OCS dimensions, and prospectively predicted suicidality symptoms over time, even when controlling for baseline suicide attempts. Genetic factors accounted for most of the concurrent and longitudinal covariance between OCS and suicidality, with substantial non-shared environmental influences. Limitations : We relied on self-report measures and did not include diagnostic assessment of OCD. Conclusions : OCS, particularly taboo obsessions, are associated with significantly elevated risk of suicidality in late adolescence and early adulthood. This relationship is explained by a combination of common genetic liability and non-shared environmental effects, suggesting that effective OCS treatment might reduce suicidality risk in this group.
... Несмотря на современные доказательные данные, исторически считалось, что пациенты с ОКР имеют низкий риск совершения попыток суицида [10]. Обозначенные противоречивые результаты относительно связи между ОКР и попытками самоубийства объяснялись тем, что для пациентов с данным синдромом характерна тенденция регулировать свои агрессивные импульсы, избегать ситуации в высокой вероятностью причинения вреда, ущерба, фиксировать и контролировать суицидальные мысли и соответствующее поведение, особенно при наличии сопутствующих расстройств [11]. ...
... Despite the current evidence, historically OCD patients have been considered to have a low risk of attempting suicide [10]. The indicated conflicting results regarding the relationship between OCD and suicide attempts were explained by the fact that patients with this syndrome tend to regulate their aggressive impulses, avoid situations with a high probability of causing harm or damage, record and control suicidal thoughts and corresponding behavior, especially in the presence of concomitant disorders [11]. ...
... In terms of absolute risk, estimates vary. Among 582 patients with OCD, 36% reported lifetime suicidal thoughts, 20% had made suicidal plans, 11% had already attempted suicide and 10% presented with current suicidal thoughts (Torres et al., 2011). In another study of 425 outpatients, recruited by the ICOCS network, 14.6% of the sample reported at least one suicide attempt during their lifetime (Dell'Osso et al., 2018). ...
... In another study of 425 outpatients, recruited by the ICOCS network, 14.6% of the sample reported at least one suicide attempt during their lifetime (Dell'Osso et al., 2018). In the study by Torres et al. (2011), comorbid depressive disorder and posttraumatic stress disorder were associated with a range of suicidal behaviours. Sexual/religious symptoms and comorbid substance use disorders were associated with suicidal thoughts and plans, while impulse control disorders were associated with current suicidal thoughts, suicide plans and attempts. ...
Article
In this position statement, developed by The International College of Obsessive-Compulsive Spectrum Disorders, a group of international experts responds to recent developments in the evidence-based management of obsessive-compulsive disorder (OCD). The article presents those selected therapeutic advances judged to be of utmost relevance to the treatment of OCD, based on new and emerging evidence from clinical and translational science. Areas covered include refinement in the methods of clinical assessment, the importance of early intervention based on new staging models and the need to provide sustained well-being involving effective relapse prevention. The relative benefits of psychological, pharmacological and somatic treatments are reviewed and novel treatment strategies for difficult to treat OCD, including neurostimulation, as well as new areas for research such as problematic internet use, novel digital interventions, immunological therapies, pharmacogenetics and novel forms of psychotherapy are discussed.
... OCD has been linked to multiple comorbidities and substantial quality of life impairment during childhood, adolescence, and adulthood [1][2][3][4][5][6]. However, even when symptoms do not reach the diagnostic threshold, the mere presence of OCS has also been associated with psychiatric comorbidities and impaired functioning [7][8][9]. ...
... Training procedures lasted two full days. Lay interviewers attended to instruction sections provided by clinical psychiatrists from the research team covering the following topics: (1) project structure and design; (2) main aspects of psychiatric syndromes, psychopathology, and risk factors; (3) how to deal with difficult situations/interviews; (4) confidentiality and ethical issues of collecting psychiatric information. Researchers reviewed the full protocol together with the interviewers several times and simulated difficult situations and potential doubts in roleplaying activities. ...
Article
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Environmental factors are at least as important as genetic factors for the development of obsessive–compulsive symptoms (OCS), but the identification of such factors remain a research priority. Our study aimed to investigate the association between a broad scope of potential risk factors and OCS in a large community cohort of children and adolescents. We evaluated 1877 participants and their caregivers at baseline and after 3 years to assess various demographic, prenatal, perinatal, childhood adversity, and psychopathological factors. Mean age at baseline was 10.2 years (SD 1.9) and mean age at follow-up was 13.4 years (SD 1.9). Reports of OCS at baseline and follow-up were analyzed using latent variable models. At preliminary regression analysis, 15 parameters were significantly associated with higher OCS scores at follow-up. At subsequent regression analysis, we found that eight of these parameters remained significantly associated with higher follow-up OCS scores while being controlled by each other and by baseline OCS scores. The significant predictors of follow-up OCS were: lower socioeconomic status (p = 0.033); lower intelligence quotient (p = 0.013); lower age (p < 0.001); higher maternal stress level during pregnancy (p = 0.028); absence of breastfeeding (p = 0.017); parental baseline OCS (p = 0.038); youth baseline anxiety disorder (p = 0.023); and youth baseline OCS scores (p < 0.001). These findings may better inform clinicians and policymakers engaged in the mental health assessment and prevention in children and adolescents.
... Cultural components and other sociodemographic variables have thus far not appeared to mediate significant correlations with SI. 22,27,53 Being unmarried has been identified from various studies but requires further replication to affirm its role. 31,54 Marital status may be indicative of other factors (such as social disconnectedness, age, etc) and therefore may be an indirect marker. Being female and having higher parental education may operate as protective variables, but findings are contradictory. ...
Article
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Suicidal ideation (SI) is understudied in obsessive-compulsive disorder (OCD). Nonetheless, evidence suggests increased risk for SI in individuals with OCD compared to the general population. Understanding the relationship between SI and OCD involves investigating risk factors associated with SI. Furthering knowledge of links is essential for enhancing outcomes and decreasing experiences of SI through improving treatment interventions. Additionally, increasing awareness of factors that lead SI to suicide attempts (SA) is vital. To best illustrate the current state of knowledge, this scoping review examines risk factors for SI, including symptom profiles or phenotypes, comorbid diagnoses, sociodemographic and lifestyle factors, childhood trauma, and genetic and familial contributions. Important treatment considerations for targeting SI within the context of OCD are detailed with respect to the current evidence for psychotherapy, pharmacology, brain stimulation, and neurosurgery. Gaps in the literature and future directions are identified, broadly with respect to studies examining the treatment of SI within the context of OCD, particular OCD phenotypes, and factors influencing SI in pediatric OCD. Due to the relative novelty of this area of exploration, many unknowns persist regarding onset of SI in OCD, factors contributing to the maintenance of SI in OCD, and relevant treatment protocols. Findings suggest that individuals with previous SI or SA, history of childhood trauma, significant life stress, and psychiatric comorbidities, particularly depression, should be closely monitored and screened for SI.
... Suicide is an important cause of death for persons with various mental health conditions such as depression (G. K. Brown et al., 2000), borderline personality disorder (Black et al., 2004), obsessive-compulsive disorder (Torres et al., 2011), post-traumatic stress disorder (Schafer et al., 2022) or schizophrenia (Caldwell & Gottesman, 1990). Among a large group of patients with schizophrenia spectrum disorders, 13% died of suicide (Moreno-Kustner et al., 2021). ...
Article
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Suicide is an important cause of death in patients with mental health disorders, but little is known about the occurrence of suicidal ideation and attempts in outpatient psychotherapy patients. The aim of this study was to identify the proportion of patients with and correlates of suicidal ideation and attempts in community-based psychotherapy practices. Using 983 applications for reimbursement of psychotherapy from individual patients, reports about suicidal thoughts and suicide attempts were extracted along with demographic, biographic, and clinical data. Multivariate logistic regression analysis was used to identify correlates of suicidal ideation and attempts by calculating odds ratios (OR). Among the patients, 19% presented with suicidal thoughts (11% currently and 8% in the past) and 6% with suicide attempts. Important correlates of suicidal thoughts were male gender (OR 1.7), lower education (OR 1.8), early retirement (OR 2.9), death of a parent when younger than 5 years old (OR 3.3), violence experienced from various people (OR 2.1), self-harm behavior (OR 7.9), and alcohol misuse (OR 1.7). Suicide attempts were associated with male gender (OR 5.6), lower education (OR 4.2), violence experienced from partner (OR 2.5) or from various people (OR 9.5), and self-harm behavior (OR 15.0). These results show that the proportion of suicidal patients seeking outpatient psychotherapy is high. It should therefore be a central topic in clinical training. Biographic data such as the loss of a parent at an early age or experiencing violence are associated with who is at increased risk and should be explored in detail.
... To complicate the process of differentiating between SO and SI, a substantial proportion of people with OCD have been found to experience SI (Angelakis et al., 2015;Hellberg et al., 2022;Torres et al., 2007Torres et al., , 2011. For instance, in one sample, approximately 27% of psychiatric patients with OCD reported previous suicide attempts (Kamath et al., 2007). ...
Article
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Suicidal obsessions (SO) can be challenging to distinguish from suicidal ideation (SI). This can be in part due to low familiarity with diverse presentations of OCD, as well as the limited scope of common measurement tools for assessing suicide-themed thoughts within a cognitive, affective, and behavioral framework. Inaccurate assessment increases the risk of misdiagnosis and inappropriate treatment, which are critical to prevent. Therefore, we present a practical guide with a case example highlighting potential cognitive, affective, and behavioral criteria to consider in differentiating SO from SI, grounded upon a cognitive-behavioral framework and the extant literature regarding the phenomenology and assessment of OCD and suicidality. Through illustrative figures we also demonstrate examples of SO and SI with resulting cognitive, affective, and behavioral responses, and how they functionally interrelate with each other. We conclude with suggestions for future research validating the criteria provided in this guide. In summary, using this evidence-based guide to assess suicide-themed thoughts, emotions, and behaviors may help clinicians accurately distinguish between SO and SI, in turn optimizing interventions for their clients.
... Suicidality appears relatively common in paediatric OCD where one small study with 54 patients found 13% with clinically significant suicidal ideation [53]. In adults with OCD, 16 to 63% experience suicidal ideation, with as many as 25% reporting at least one prior suicide attempt [54][55][56]. To avoid risks of confounding effects, we do not allow concomitant treatment with antidepressant medication. ...
Article
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Background: Cognitive behavioural therapy (CBT) is the recommended first-line treatment for children and adolescents with obsessive-compulsive disorder (OCD), but evidence concerning treatment-specific benefits and harms compared with other interventions is limited. Furthermore, high risk-of-bias in most trials prevent firm conclusions regarding the efficacy of CBT. We investigate the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation and relaxation training (FPRT) in youth with OCD in a trial designed to reduce risk-of-bias. Methods: This is an investigator-initiated, independently funded, single-centre, parallel group superiority randomised clinical trial (RCT). Outcome assessors, data managers, statisticians, and conclusion drawers are blinded. From child and adolescent mental health services we include patients aged 8-17 years with a primary OCD diagnosis and an entry score of ≥16 on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). We exclude patients with comorbid illness contraindicating trial participation; intelligence quotient < 70; or treatment with CBT, PRT, antidepressant or antipsychotic medication within the last 6 months prior to trial entry. Participants are randomised 1:1 to the experimental intervention (FCBT) versus the control intervention (FPRT) each consisting of 14 75-min sessions. All therapists deliver both interventions. Follow-up assessments occur in week 4, 8 and 16 (end-of-treatment). The primary outcome is OCD symptom severity assessed with CY-BOCS at end-of-trial. Secondary outcomes are quality-of-life and adverse events. Based on sample size estimation, a minimum of 128 participants (64 in each intervention group) are included. Discussion: In our trial design we aim to reduce risk-of-bias, enhance generalisability, and broaden the outcome measures by: 1) conducting an investigator-initiated, independently funded RCT; 2) blinding investigators; 3) investigating a representative sample of OCD patients; 3) using an active control intervention (FPRT) to tease apart general and specific therapy effects; 4) using equal dosing of interventions and therapist supervision in both intervention groups; 5) having therapists perform both interventions decided by randomisation; 6) rating fidelity of both interventions; 7) assessing a broad range of benefits and harms with repeated measures. The primary study limitations are the risk of missing data and the inability to blind participants and therapists to the intervention. Trial registration: ClinicalTrials.gov : NCT03595098, registered July 23, 2018.
... Suicide attempts and suicidal ideation have different prevalence rates in different regions of the world. The prevalence rates of Suicide idea and suicide attempt in the whole population are 27.5% and 4.3% (20) in Turkey, 20% and 10% (21) in Brazil and 15.2% and 3.2% in Korea, respectively. In a meta-analysis study in China (22), the prevalence rate of suicide attempt was 2.94% (23) and in Mexico 2.7% (24). ...
Article
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Objective: After accidents and disasters, people suffer from mental disorders due to physical, economic and social injuries. These include anxiety, stress, depression, suicidal ideation, and suicide attempts. Due to the fact that some of these measures can endanger a person’s life, as a result, it is important to pay attention to these psychological factors. Accordingly, the present study was conducted to investigate the prevalence of suicidal ideation and suicide attempt after disaster in the world. Methods: The present study was a systematic review and meta-analysis of the prevalence of suicidal ideation and suicide attempt after disaster in the world. Accordingly, all English-language articles published from the beginning of 2000 to the end of 2019 were extracted through searches in the databases of Scopus, Web of Science, PubMed, Cochrane Library, Science Direct and Google scholar and then evaluated. Statistical analysis of data was performed using fixed and random effects model in meta-analysis, Cochran test and meta-regression. Results: A total of 33 studies with a sample size of 61,180 people entered the meta-analysis process. Accordingly, the prevalence of suicidal ideation was estimated at 12.9% (CI95%: 10.3% -15.5%) in the whole population, 5.2% (CI95%: 2.9% - 7.4%) in male and 15.8% (CI95%: 10.0% - 21.6%) in female. Moreover, the prevalence of suicide attempt after disasters was estimated at 8.8% (CI95%: 6.6% - 11.0%). Conclusion: Based on the findings of the present study, the prevalence of suicidal ideation and suicide attempt after disaster is high. Due to the fact that many people in the world are exposed to disasters every year, relatively many people deal with suicidal ideation or suicide attempts.
... Hence, OCD sufferers never want to act on the obsession, but wish to stop thinking about it. Due to their persistent and distressing nature, sexual obsessions almost triple the likelihood for suicide (Osso et al. 2012;Torres et al. 2011), Although sexual intrusive thoughts rarely produce sexual arousal (Gordon 2002), they often urge sufferers to repeatedly scan their genitals for signs of sexual excitement. Due to such over-focus, individuals might feel tingling, nervous feelings on their genitals. ...
Thesis
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This study is broadly an exploration of how people who suffer from sexual orientation OCD (SO-OCD) and gender identity OCD (GI-OCD) use language to construct their identity, and how that process is framed by (hetero)normative idealogies. Instead of writing the abstract of the study (which you can find on page 4), I will highlight the different chapters that might be the most interesting for different readers: PSYCHOLOGISTS WORKING ON OCD should especially read: - CHAPTER 1 where I review the literature on OCD, and especially section 1.4 where I identify the gap my project fills. - CHAPTER 3 where I operationalize the concept of the feared self not as a fixed cognitive construct, but one that is discursively negotiated through language. - CHAPTERS 6-9 a detailed analysis of OCD sufferers' language use and how they construct their identity by distancing themselves from their feared self. - CHAPTER 10 is really where my argument comes together. I interpret the linguistic findings from chapters 6-7 through queer theory and Foucauldian self-governmentality. I especially argue that by distancing from a feared self, OCD sufferers run towards what I call an "idealized pure self" that is always and only the identity they wish to embody. This idealized self is constituted by a strong adherence to heteronormative understandings of gender and sexuality. The idea of a "pure self" is inscribed withing a sociocultural frame that has constructed sexuality as the locus of the "true self". In addition, I challenge the assumption that homophobia is the sociocultural factors causing SO-OCD. I demonstrate that this assumption doesn't account for LGBTQA+ OCD sufferers who obsess about being not LGBTQA+. As such, I suggest to conceptualize OCD not as a fear of "becoming" something that is socially taboo, but rather as a fear of "losing" something that is socially cherished. This fear of becoming or losing are two sides of the same coin that are shaped by (hetero)normative Discourses. Thus, the sociocultural factor shaping SO-/GI-OCD fears is argued to be tied to the notion of normativity. - CHAPTER 11: summarizes the whole study and section 11.3 explicitly states the contributions to the research on OCD SOCIOLINGUISTS INTERESTED IN LANGUAGE, GENDER, SEXUALITY & CORPUS LINGUISTICS should read: - Chapter 2 reviews Foucault's work on self-governmentality, queer theory and how all of this can be operationalized through linguistics - One of the major contributions of my thesis to sociolinguistics is a methodological one. In fact, I triangulated corpus-assisted discourse analysis with ethnographic approaches. Chapter 4 describes how I constructed a forum and conducted a 18 month long ethnography (or netnography), and CHAPTER 5 describes the methodic steps in my analysis. - CHAPTERS 6-9 are a detailed accounts of my participants' language use. - CHAPTER 10 interprets the findings through queer theory (see above), and section 10.5 suggests an additional way to conceptualize normativity in the field of language, gender and sexuality. - CHAPTER 11 gives a summary of everything, and sections 11.4 and 11.5 explicitly highlight the contributions to sociolinguistics and avenues for future research.
... OKB, bu tanıya sahip olanların yanı sıra bu bireylerin yakınlarının da yaşam kalitesinde azalmaya ve psikososyal fonksiyonlarında bozulmaya yol açmaktadır (4,5). Bununla birlikte OKB tanısı olanların intihar düşünceleri veya intihar girişimi açısından risk altında olduğu belirtilmektedir (6). ...
Article
INTRODUCTION[|]This study aims to examine the relationship between partner focused and romantic relationship obsessive compulsive with ruminative thinking style, body image, social appearance anxiety. The second aim of the study is to examine the sociodemographic variables thought to be related to relationship centered and partner focused obsessive compulsive symptoms.[¤]METHODS[|]The data has been collected via internet from 689 individuals who were in a romantic relationship between the ages of 18-30. For the aim of collecting information, demographic information form, Partner Related Obsessive Compulsive Scale, Relationship Obsessive Compulsive Inventory, Ruminative Thought Style Questionnaire, Social Appearance Anxiety Scale and Body-Cathexis Scale have been used. [¤]RESULTS[|]According to the performed structural equation modelling, it has been observed that ruminative thinking style predicts the relationship centered and partner focused obsessive compulsive symptoms and sub-dimensions positively. Body image and social appearance anxiety positively predict the partner focused obsessive compulsive symptoms and its sub-dimensions. Furthermore, it was found that partner focused obsessive compulsive symptoms positively predict relationship centered obsessive compulsive symptoms.[¤]DISCUSSION AND CONCLUSION[|]In this study, it was concluded that the model created with ruminative thinking style, body image and social appearance anxiety, which is thought to be effective in revealing partner focused and romantic relationship obsessive compulsive symptoms is an acceptable model. It is thought that investigating the structures that may be effective in revealing the symptoms will serve to better understand this obsessive compulsive disorder (OCD) subtype and overall OCD and contribute to the diagnosis / treatment of this area.[¤]
... Suicidality. The questions used to assess suicidality were the same employed by Torres et al. (2011) and have been used in subsequent studies investigating suicidality from the same group (e.g. (Velloso et al., 2016). ...
Article
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Despite generalized anxiety disorder (GAD) being one of the most prevalent comorbidities in obsessive-compulsive disorder (OCD), few studies have researched its impact on the OCD phenotype. The present study investigated how the sociodemographic and clinical profile of people with OCD with comorbid GAD differs from people with OCD without comorbid GAD. We hypothesised that the phenotype of the comorbid group would be closely related to GAD, in that it would more likely be female, have an earlier age at onset of OCD, and show an increased severity of fear-related OCD symptoms (aggressive, sexual/religious, and contamination dimensions), more avoidant behaviours, greater suicidality, more severe anxiety symptoms, and increased rates of comorbid anxiety and mood disorders. The study included 867 participants with OCD, with GAD being comorbid in 33.56%. Mann-Whitney U tests, chi-square tests with continuity correction, and logistic regressions were performed. Results showed that comorbid GAD was uniquely associated with an increased number of avoidant behaviours, greater anxiety severity, panic disorder without agoraphobia, social phobia, specific phobia, and type II bipolar disorder. These results illustrate the clinical severity associated with this comorbidity and highlight markers that can aid diagnosis of GAD in OCD. Future studies should investigate whether this comorbidity has an impact on the treatment of OCD.
... Examining the relationship between obsessive symptoms and childhood traumas, we found that aggression and sexual obsessions were more common in patients with suicide attempts. These results are consistent with the findings of other studies, in which current suicide ideas or suicidal behaviors in OCD are often associated with the severity of OCD symptoms such as aggression, symmetry or order and sexual or religious obsessions (18,38,39). In OCD patients who attempted suicide, these dimensions may be associated with the feeling of guilt. ...
Article
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Objective: The aim of this research is to determine the differences in childhood traumas and the probability of suicide in obsessive-compulsive disorder (OCD) patients with and without suicide attempts. Method: Sixty-five OCD patients without suicide attempt history and 39 OCD patients with a history of suicide attempts were included in the study. To measure the clinical variables The Childhood Trauma Questionnaire (CTQ), Suicide Probability Scale, Yale-Brown Obsessive-Compulsive Scale and Beck Depression Inventory were applied. Results: We found that the OCD group with suicide attempts was significantly higher than the OCD group without a suicide attempt due to emotional neglect, physical neglect, sexual abuse, and CTQ total scores. Aggression and sexual obsessions were higher in the OCD group who has attempted suicide. Obsessive-compulsive symptoms, depression and insight scores of OCD patients with suicide attempts were worse than OCD patients without suicide attempts. Also, correlations were observed between childhood traumas and suicidal probability scores. Conclusion: This study showed that childhood traumas may be a contributing factor to suicide probability and attempt in patients with OCD. Moreover, this study reveals that the current probability of suicide is a higher risk in OCD patients who had previously attempted suicide in the past. Keywords: Childhood trauma, lifetime suicide attempt, obsessive-compulsive disorder, suicide
... Moreover, there is evidence that the risk of suicidal behaviour must be explored, particularly in those with symptoms in the sexual/religious dimension. 15 Likewise, individuals with obsessive thoughts from different symptom dimensions might avoid the disclosure of sexual obsessions, even after disclosing other types of intrusive thoughts, because they are perceived as less acceptable: Cathey (2013) found that the disclosure of an intrusive thought relating to a sexual theme was associated with more social rejection than the disclosure of a contamination-related intrusive thought. 3 Thus, it is important that healthcare providers normalise these types of concerns when interviewing OCD patients: Steinberg,14 in a study about stigmatising attitudes in clinicians, found that, when engaging with professionals with cognitive-behavioural backgrounds, participants were more likely to socially reject or be concerned about individuals with obsessions related with contamination, harming, and sexual obsessions than those with scrupulous obsessions, and that they would be less likely to reveal sexual obsessions to others if they were experiencing those rather than the other three types of obsessions. ...
Article
In obsessive-compulsive disorder, pedophilia-themed obsessions-distressing intrusive thoughts about being sexually attracted to, or sexually abusing, children-are the most distressing for patients and the most misdiagnosed among healthcare professionals. Our aim is to present a case report highlighting the role stigma plays in delaying treatment, the clinical challenges in the diagnosis, and in the treatment of pedophilia-themed obsessive-compulsive disorder, in order to address the lack of literature on the subject. The case concerns a 33-year-old man with suicidal thoughts associated with the unbearable suffering caused by pedophilia-themed obsessions he had been having over the previous decade, without ever asking for help. This situation was highly disabling, leaving him mostly isolated in his bedroom. After the differential diagnosis was made, a treatment plan combining pharmacological and cognitive-behavioural therapy was implemented. After 18 months he showed a degree of remission that made it possible for him to apply for a job.
... Clinicians should therefore inquire about the overall severity of the disorder when assessing an individual with OCD, but remember to specifically evaluate the severity of obsessions and compulsions separately, as severe obsessions could be an OCD-specific marker of suicidality. As to the specific effect of different obsessive-compulsive dimensions on suicide attempts and suicidal ideation rates, controversies emerge from the literature; individual studies suggested that the unacceptable thoughts dimension (aggressive, sexual and religious obsessions) is associated with greater risk for suicidal ideation (Balci and Sevincok, 2010;Torres et al., 2011;Kim et al., 2016;Velloso et al., 2016;Khosravani et al., 2017) and for suicide attempts (Velloso et al., 2016;Khosravani et al., 2017). However, in our meta-regression analyses we found no effect on suicide attempts rates of aggressive, sexual or religious obsessions, and again intriguingly a protective effect of these dimensions on suicidal ideation. ...
Article
Introduction : There is controversy on the magnitude of suicide risk in OCD and on the psychopathological features that raise the risk. This systematic review and meta-analysis aims to estimate the pooled prevalence of suicide attempts and suicidal ideation (current/lifetime) in subjects with OCD and identify sociodemographic and clinical factors associated with greater risk. Methods : We conducted a literature search in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases up to June 20, 2019, according to PRISMA guidelines. Stata statistical software (Version 15) was used to obtain forest plots, execute subgroup analyses and perform univariate and multivariate meta-regressions. Results : We found 61 eligible studies including OCD patients: 52 investigated suicide attempts and reported a pooled prevalence of 0.135 (95% CI 0.123-0.147); 26 explored current suicidal ideation and reported a pooled prevalence of 0.273 (95% CI 0.214-0.335); 22 researched lifetime suicidal ideation and reported a pooled prevalence of 0.473 (95% CI 0.397-0.548). Severity of obsessions, comorbid substance use and depressive/anxious symptoms increased the risk, whereas compulsions had a comparatively protective effect. Limitations : Owing to the small number of studies reporting completed suicide rates, this metric was not included in the meta-analysis. The degree of heterogeneity between the studies was high. Conclusion : Clinicians should keep in mind that one out of ten patients with OCD attempts suicide during his/her lifetime, about one third has current suicidal ideation and about half has had suicidal ideation in the past. Several clinical features are associated with increased risk and should be factored into clinical risk management.
... As many as 1/3 of cases are classified as "treatment resistant", with patients remaining severely symptomatic despite multiple courses of pharmacological and psychotherapeutic care [4,5]. Patients with treatment-resistant illness experience increased morbidity and mortality, and treatment alternatives are urgently needed [6,7]. ...
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Obsessive compulsive disorder (OCD) and major depressive disorder (MDD) are common, often refractory, neuropsychiatric conditions for which new treatment approaches are urgently needed. Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel surgical technique permitting incisionless ablative neurosurgery. We examined the safety profile, clinical response, and imaging correlates of MRgFUS bilateral anterior capsulotomy in patients with refractory obsessive compulsive disorder (OCD, N = 6) and major depressive disorder (MDD, n = 6). There were no serious adverse events. Nonserious adverse events included headaches and pin-site swelling in 7/12 patients. The response rate was 4/6 and 2/6 in the OCD and MDD cohorts respectively. To delineate the white-matter tracts impacted by capsulotomy, a normative diffusion MRI-based structural connectome was used, revealing tracts terminating primarily in the frontal pole, medial thalamus, striatum, and medial-temporal lobe. Positron emission tomography (PET) analysis (nine subjects) revealed widespread decreases in metabolism bilaterally in the cerebral hemispheres at 6 months post treatment, as well as in the right hippocampus, amygdala, and putamen. A pretreatment seed-to-voxel resting-state functional magnetic resonance imaging (rs-fMRI) analysis (12 subjects) revealed three voxel clusters significantly associated with eventual clinical response. MRgFUS capsulotomy appears to be safe, well tolerated, and according to these initial results, may be an important treatment option for patients with refractory OCD and MDD. MRgFUS capsulotomy results in both targeted and widespread changes in neural activity, and neuroimaging may hold potential for the prediction of outcome.
... ОК-симптоматика характеризуется хроническим течением, существенным снижением качества жизни как самих пациентов, так и их близкого окружения, нередкими случаями инвалиди-зации человека, что привело к квалификации Всемирной организацией здравоохранения данного заболевания как одного из 10 наиболее тяжелых психических расстройств, связанных с переживанием выраженного психологического дискомфорта, а также с нарушениями в сфере повседневной и профессиональной деятельности [3]. Наличие навязчивого неразряжаемого напряжения в системе психической деятельности, кумуляция влияний стрессоров, неадаптивная регуляция собственных процессов в контексте «психологического поля», а также условия эмоционально-личностной декомпенсации и болезненного состояния как кризиса психологической системы [4][5][6] обусловливают высокий риск антивитального и суицидального поведения при ОКР, который исторически считался незначительным [7]. Так, на 2017 г. частота попыток суицида при ОКР составила 14,6%, следовательно, риск актуализации суицидального поведения при ОКР сопоставим с риском при других серьезных психических расстройствах, таких как шизофрения и депрессия [8]. ...
... Major Depressive disorder (MDD) is the most common comorbidity with obsessive-compulsive disorder (OCD); more than 50% of OCD patients meet lifetime criteria for MDD or dysthymia [1]. Depression can significantly worsen OCD treatment outcomes [2] and elevate the risk for suicide [3]. While the multi-center-tested and FDA indicated deep transcranial magnetic stimulation (dTMS) treatment for OCD uses the H7 coil, to target dorsomedial prefrontal cortex (dmPFC) and anterior cingulate cortex (ACC) [4], the treatment for MDD uses the H1 coil to target the dorsolateral prefrontal cortex (dlPFC) bilaterally with preference to the left [5]. ...
... Suicidal ideation and behaviours have been independently associated with symmetry/ordering symptoms [56] and with sexual/religious symptoms [57]. Sexual/religious symptoms were also associated with poorer social functioning [12]. ...
Chapter
Obsessive–compulsive disorder (OCD) is a chronic, and often severe, disorder that is associated with substantial distress and impairment. Sustained research efforts have led to a better understanding of the classification, aetiology, presentation, and treatment of OCD. Further, the clinical heterogeneity of OCD has led to efforts to identify meaningful subtypes of the disorder, based on age of onset, the presence of comorbid tics, or the focus of OCD symptoms. There is substantial support for a multi-dimensional model of OCD where symptoms are conceptualized as multiple overlapping dimensions, consisting of symmetry/ordering, contamination/cleaning, harm/aggression, or sexual/religious symptoms. Evidence suggests that these dimensions may have differential associations with a range of genetic, neural, and clinical factors. The multi-dimensional approach to OCD is thus a promising future direction for OCD research.
... Keywords: Obsessive-compulsive disorder, Neuroimaging, fMRI, Unaffected siblings, Brain signatures, Neurocognitive, Global mental health Background Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% [1,2] and results in reduced quality of life [3,4], lower educational attainment [5], suicidality [6,7], and even premature death [8,9]. A leading global cause of disability [10,11], OCD contributes to significant economic burden [12] that is expected to increase over the next 20 years [13]. ...
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Background: Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results. Methods: We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations. Discussion: Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it.
... OCD and depression are frequently comorbid (Millet et al., 2004). Moreover, comorbid depression is associated with aggravated OCD symptoms and higher rates of suicide (Torres et al., 2011;Brown et al., 2015). Understanding the complex relationships among OCD and depression symptoms may provide valuable insight for clinicians and researchers. ...
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In this Research Topic, the two editors bring together a series of articles that use facet theory and allied approaches to research. Since its inception in the work of Louis Guttman in the mid-twentieth century, facet theory has become an established approach within social science research. In addition, over the past 70 years, a wide range of research publications have appeared operating within the theoretical and analytic rubric of facet theory and for the last two decades, a biennial international conference has been held devoted to facet theory research. When using a facet theory approach, an implicit aim of the research within this framework is to bring together in an explicit manner a clear definition of the content area that is being investigated along with data analysis procedures. Integrating the explicit design of research content (for example, attitudes, values, etc) and it's subsequent analysis (for example to identify the variables that are influential to respondents in relation to the specific area under investigation,) allows for the construction of theory relating to the content area and for the meaningful measurement of complex research areas.
... First, we cannot obtain data directly from those who died from suicide to address factors related to suicide Meyer et al., 2010). Second, suicide is complex, consisting of a set of behaviors from suicide ideation, plan, attempt, and suicide death (Cooperman & Simoni, 2005;Meyer et al., 2010;Torres et al., 2011). These suicide behaviors cannot be adequately understood with the conventionally used linear and continuous approach (Nicolis, 2007;Nicolis & Delvenne, 2014;Schiepek et al., 2011). ...
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The number of people living with HIV (PLWH) increases rapidly with advancement in antiretroviral therapy. Suicide prevention is challenging, particularly for PLWH because of the negative impact of HIV-related stigma and social capital reduction. However, only a small proportion of the variance in suicide risk can be explained by these variables if a linear paradigm is used as guidance. In this study, we tested a nonlinear cusp catastrophe modeling. Participants (N = 523) were PLWH selected through a risk venue-based method in Wuhan, a provincial capital city in China. Suicidal ideation post HIV+ diagnosis and in the past 30 days and suicide plan and attempt were assessed. Data were collected using self-report questionnaire and were analyzed using both the direct and multivariate stochastic cusp catastrophe modeling methods with social capital as asymmetry variable and HIV-related stigma as bifurcation variable. The analysis was executed using R, including nls() function for the direct method and 'cusp' package for the stochastic modeling. Results from stochastic cusp modeling analysis indicated that social capital was significantly associated with risk of suicide after controlling for key covariates; the association was significantly bifurcated by HIV-related stigma. The data fit the cusp model better than the alternative linear model (R2 =.483 vs. .127). Findings of this study indicate suicide behaviors among Chinese PLWH follow a nonlinear dynamic system. In addition to enhancing our understanding of suicide risk, findings of this study underscore the significance in social capital enhancement and stigma reduction for suicide prevention among PLWH in China.
Article
Suicidality in obsessive compulsive disorder (OCD) is underestimated, and it is important for clinicians to understand the factors that contribute to suicidal ideation. The present study aimed to estimate a network of the core clinical symptoms of OCD including obsessions, compulsions, and obsessive-compulsive (OC) symptom dimensions, depressive symptoms, and psychological traits, and to examine which symptoms contribute to suicidal ideation in patients with a primary diagnosis of obsessive-compulsive disorder. Methods: A total of 444 patients with OCD were assessed with the Yale-Brown Obsessive Compulsive Scale, the Montgomery-Asberg Depression Rating Scale, and various other measures. Network analysis was conducted to estimate the network of obsessive-compulsive and depressive symptoms, psychological traits including alexithymia and impulsivity, and demographic covariates. Symptoms directly related to suicidal ideation in the network were examined for their relative contribution to suicidal ideation. Results: Suicidal ideation was directly related to degree of control over compulsive behaviors, distress associated with compulsive behaviors, time spent performing compulsive behaviors, and unacceptable thoughts, along with depressive symptoms and alexithymia. In the network of OC and depressive symptoms, the most central symptoms among the former were interference due to compulsive behaviors and interference due to obsessive thoughts, and among the latter were pessimistic thoughts and reported sadness. Conclusion: The findings suggest that along with depressive symptoms and alexithymia, compulsions and unacceptable thoughts dimension may contribute to suicidality, and thus, should be carefully monitored in patients with OCD. This article is protected by copyright. All rights reserved.
Article
Background Depressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depressive and OCD: functional inter-relationships across the symptoms of these conditions. The few network studies in this area have relied largely on item, rather than process-level constructs, and have not examined relationships dimensionally. Methods Network analytic methods were applied to data from 463 treatment-seeking adults with OCD. Patients completed self-report measures of OCD and depression. Factor analysis was used to derive processes (i.e., nodes) to include in the network. Networks were computed, and centrality, bridge, and stability statistics examined. Results Networks showed positive relations among specific OCD and depressive symptoms. Obsessions (particularly repugnant thoughts), negative affectivity, and cognitive-somatic changes (e.g., difficulty concentrating) were central to the network. Unique relations were observed between symmetry OCD symptoms and cognitive-somatic changes. No direct link between harm-related OCD symptoms and depression was observed. Conclusions Our results bring together prior findings, suggesting that both negative affective and psychomotor changes are important to consider in examining the relationship between OCD and depression. Increased consideration of heterogeneity in the content of OCD symptoms is key to improving clinical conceptualizations, particularly when considering the co-occurrence of OCD with other disorders.
Article
Background A growing body of evidence suggest individuals with obsessive-compulsive disorder (OCD) are at an increased risk for suicidal thoughts and behaviors (SITB). However, the literature on suicidality in OCD remains limited. Thus, the present study examined the prevalence and predictors of suicidality in a sample of adults seeking treatment for OCD. Methods A total of 687 patients seeking care through a network of intensive treatment centers consented to participate. Participants completed validated self-report questionnaires of depression and OCD symptom severity, as well as psychodiagnostic interviews. Results Almost half of the participants reported current suicidal ideation. The presence of a comorbid diagnosis was associated with increased likelihood of more severe SITB. Specifically, the presence of a co-occurring anxiety, depressive, or bipolar mood disorder predicted increased severity of SITB. In addition, obsession severity was positively associated with suicidality, while compulsion severity negatively predicted the severity of SITB. Regarding OCD symptom dimensions, repugnant thoughts emerged as a significant predictor of SITB severity. Conclusions SITB is a prevalent concern in treatment-seeking patients with OCD. Clinicians are encouraged to assess and consider the treatment implications of SITB, particularly among patients with co-occurring mood and anxiety disorders, or symptoms involving taboo thought content. Future directions and theoretical considerations are discussed.
Poster
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Despite being a significantly disabling condition, the risk associated with obsessive-compulsive disorder (OCD) is commonly underestimated in clinical practice. To shed more light on the suicidality in OCD, this systematic review was piloted, aiming to provide more insight into actual suicide risk and potential predictors of suicidal behaviour in OCD patients.
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Introduction Obsessive-compulsive disorder (OCD), characterized by repetitive anxiety-inducing intrusive thoughts and compulsive behaviors, is associated with higher suicide ideation and suicide attempts than the general population. This study investigates the prevalence and the correlates of current suicide risk in adult outpatients in an international multisite cross-sectional sample of OCD outpatients. Methods Data were derived from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) network’s cross-sectional data set (N=409). Current suicide risk (assessed by Item C of the MINI) and diagnoses of psychiatric disorders were based on DSM-IV. Chi-squared test for categorical variables and t-test for continuous variables were used to make statistical inferences about main features associated with current suicide risk. P<0.05 was considered as statistically significant. Results The prevalence of current suicidal risk was 15.9%, with equal likelihood in sociodemographic variables, including age and gender. Increased rates of major depression and generalized anxiety disorder were associated to higher current suicide risk. Current suicide risk was also associated with higher severity of OCD, depressive comorbidity and higher levels of disability. There were no significant differences in treatment correlates—including type of treatment and psychiatric hospitalizations—between the groups of individuals with and without current suicide risk. Conclusion Our findings suggest that current suicide risk is common in patients with OCD and associated with various forms of pathology. Our work also provides further empirical data to support what is already known clinically: a worse clinical picture characterized by a high severity of OCD, high distress related to obsessions and compulsions, and the presence of comorbidities such as major depression and generalized anxiety disorder should be considered as relevant risk factors for suicide risk.
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Introduction Previous meta-analyses showed that OCD is associated with a substantial risk of suicidal behaviours. Conclusive rates of suicidal ideation (current and lifetime) and suicide attempts based on pooled prevalence rates have not so far been calculated using meta-analysis for the other DSM-5 Obsessive-Compulsive Related Disorders (OCRDs). Objectives This meta-analysis aims to separately calculate the pooled prevalence rates of lifetime suicide attempts and current or lifetime suicidal ideation in BDD, Hoarding Disorder (HD), Skin Picking Disorder (SPD) and Trichotillomania (TTM) and to identify factors associated with increased suicide rates. Methods Our protocol was pre-registered with PROSPERO (CRD42020164395). A systematic review and meta-analysis following PRISMA reporting guidelines was performed by searching in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases from the date of the first available article to April 20th, 2020. Stata version 15 was used for the statistical analysis. Given the small number of studies in TTM and SPD, the two grooming disorders were grouped together. Meta-analyses of proportions based on random effects (Der-Simonian and Laird method) were used to derive the pooled estimates. Results Thirty-nine studies (N = 4559 participants) were included: 23 for BDD, 8 for HD, 7 for Grooming Disorders. For BDD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was, respectively 35.2% (CI:23.4–47.8), 37.2% (CI:23.8–51.6) and 66.1% (CI:53.5–77.7). For HD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was 24.1% (CI:12.8–37.6), 18.4% (CI:10.2–28.3) and 38.3% (CI:35.0–41.6), respectively. For Grooming Disorders, the pooled prevalence of lifetime suicide attempts and current suicidal ideation were 13.3% (CI:5.9–22.8) and 40.4% (CI:35.7–45.3), respectively (no data available for lifetime suicidal ideation). Conclusions The OCRDs as a group are associated with relatively high rates of suicidal behaviour. Through indirect comparisons, we infer that BDD has the greatest risk. Comorbid substance abuse, possibly reflecting poor underlying impulse control, is associated with higher rates of suicidal behaviour in BDD. Our data emphasize the need for clinicians to consider the risk of suicidal behaviour in the management of patients presenting with all forms of OCRDs.
Article
Objectives: Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder, often complicated with comorbidities. Social phobia (SP) is the most frequent co-occurring anxiety disorder in OCD, associated with increased clinical severity. However, no study had examined the relevance of interpersonal processes in this comorbidity, which are at the core of SP. This study characterized the clinical (i.e., symptom profile, age of onset, chronicity, and comorbidity), vulnerability (i.e., childhood trauma, negative life events), and interpersonal (attachment style, expressed emotion, and social support) correlates of comorbid SP in a large sample of OCD patients. Methods: We analysed the data of 382 OCD patients participating in the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. We examined the correlates of SP in OCD using self-report questionnaires and structured clinical interviews. In addition, data of 312 non-OCD SP patients were drawn from the Netherlands Study of Depression and Anxiety (NESDA), to compare the age of onset of SP between groups. Descriptive univariate analyses were followed by backward stepwise logistic regression analyses. Results: Social phobia was present among approximately 20% of OCD patients. Social phobia in OCD was associated with increased depression severity and decreased ratings of secure attachment style. Among OCD patients, SP had a significantly earlier age onset as compared to SP in non-OCD patients. Conclusion: Social phobia in OCD might render a vulnerable clinical picture, characterized with early onset of SP symptoms, insecure attachment style, and increased depressive symptoms. Future studies should use prospective designs to better understand the nature of comorbid SP in OCD. Practitioner points: Approximately one fifth of OCD patients were diagnosed with comorbid social phobia in a large representative clinical sample. OCD patients with comorbid social phobia presented with a vulnerable clinical picture, characterized with increased depression severity and decreased ratings of secure attachment style. Social phobia in OCD was associated with an earlier AOO as compared to the AOO of social phobia without OCD. The findings are limited by a cross-sectional design; thus, causality could not be assessed. Research is needed to further examine the mechanisms of comorbid social phobia in OCD.
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Background Suicidal ideations were reported in many studies among patient with obsessive-compulsive disorder (OCD); this study aimed to evaluate the prevalence and factors associated with current suicidal ideations among Egyptian patients with obsessive-compulsive disorder (OCD). A consecutive sample of 120 Egyptian OCD patients was included in the study. OCD was diagnosed using the structured clinical interview for DSM-V axis Ι disorders, clinical version (SCID-I-CV). Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was also applied to the patients. Presence of current suicidal ideations was assessed using Scale for Suicidal Ideation (SSI). Results Twenty eight (23.3%) of the OCD patients reported presence of current suicidal ideations, religious obsessions OR = 3.53, P = 0.009, and presence of comorbid major depressive disorder OR = 1.77, P = 0.04. Conclusion Religious obsessions and comorbid major depressive disorder were found to be significant predictors for the current suicidal ideations in patients with OCD; however, religious obsessions were the strongest predictor. Religious obsessions should be evaluated and treated to decrease the risk of suicidal thoughts in Egyptian OCD patients.
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Aim: Obsessive-compulsive disorder (OCD) is associated with suicide risk, but controversy remains about the frequency and burden of suicidality in OCD. This study aimed to identify the relationship between anxiety sensitivity and suicidal idea in patients with OCD. Methods: This controlled study included 36 OCD patients and 36 healthy controls. All individuals were evaluated with Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Sensitivity Index-3 (ASI-3) and Suicide Probability Scale (SPS). Demographic data were obtained from each patient. Results: Seventy-two individuals with a mean age of 31.89 (9.69) years were included in this study. No significant differences were found between the groups with regards to individual and family histories of suicide attempt and the presence of other chronic diseases (P>0.05 for each). The patients had significantly higher BDI, BAI and ASI-3 scores than the controls (P>0.05 for each). There were significant correlations between BDI, BAI, ASI-3 and SPS desperation, suicide ideation scores, hostility scores and total scores (P
Article
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Objectives To estimate prevalence rates of suicide attempts and suicidal ideation in individuals with a principal diagnosis of obsessive-compulsive related disorders (OCRDs); 2. to identify predictors of suicide risk among subjects with OCRDs (where available). Results In BDD, data concerning lifetime suicide attempts are consistent across studies: mean rate is 21.5% (range 9-30.3%). Mean rate of current suicidal ideation is 37.4% (range 26.5-49.7%) and mean rate of lifetime suicidal ideation is 74.5% (range 53.5-85%). BDD-specific factors such as early onset, severity, poor insight and muscle dysmorphia and comorbid disorders increase the risk of suicide attempts or suicidal ideation. Only 2 studies recruited individuals with DSM-5 HD: suicidality appears to be low, with rates of current suicidal ideation comprised between 5% and 10%, although 19% of individuals attempted suicide during their lifetime. Concerning the grooming disorders, lifetime rates of suicide attempts are low as compared to rates in other OCRDs; approximately 40% of individuals, however, reported lifetime suicidal ideation. Conclusions OCRDs taken together may be at risk for suicide attempts and suicidal ideation independently from comorbid disorders (and specifically independently from comorbid OCD); BDD remains the disorder more strongly associated with an increased risk for suicide, followed by HD and then the grooming disorders.
Article
Single (N = 472, 51.7%), married or living in stable cohabitation (N = 375, 41.1%) and divorced or separated (N = 66, 7.2%) patients with obsessive-compulsive disorder (OCD) were compared in terms of their sociodemographic features, OCD phenotypes, and comorbidity profile. Using single status as a reference group, a multinominal regression analysis found increased age, lower severity of hoarding, increased rates of panic disorder without agoraphobia, and lower rates of dysthymic disorder to be associated with married or stable cohabitation status. Concomitantly, increased age, higher severity of symmetry symptoms, and increased rates of skin picking disorder were found to be associated with divorced status. These findings suggest that there is a relationship between marital status and different OCD phenotypes.
Article
Background: There are limited data on suicidal behaviour in obsessive-compulsive disorder (OCD). This study aimed to evaluate several aspects affecting suicidality in OCD patients and determine whether impulsivity or hostility are associated with suicide attempts in this vulnerable group. Methods: Eighty-one patients with OCD were assessed by structured clinical interview for DSM-IV (SCID I), Yale-Brown Obsessive–Compulsive Scale (Y-BOCS), Suicide Probability Scale (SPS), Barratt impulsivity scale-11 (BIS) and Scale for suicide ideation (SSI). Results: Of the 81 patients, 22 (27%) had suicide ideation, 29 (33%) attempted suicides with OCD and 30 (37%) OCD patients who never experienced suicide ideation nor attempted suicide. Suicide ideation was associated with high hopelessness, higher severity of OCD and the presence of aggressive obsessions. On the other hand, suicide attempts were associated with longer duration of untreated illness, cognitive impulsivity, higher severity of OCD symptoms and the presence of religious obsessions. Conclusion: Higher severity of OCD symptoms is associated with both suicide ideation and attempts. And while hopelessness was related to suicidal thoughts, cognitive impulsivity may have acted as a facilitating factor for suicide attempts. Higher frequency of symptoms like religious/ aggressive obsessions was also associated with suicidality. It is vital that patients with OCD undergo detailed assessment for suicide risk. • Key points • OCD is associated with a high risk for suicidal behaviour. • Suicide ideation was associated with high levels of hopelessness, OCD severity, and the presence of aggressive obsessions. • Suicide attempts were associated with longer duration of untreated illness, cognitive impulsivity, severity of OCD, and the presence of religious obsessions.
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Free access (read-only) https://rdcu.be/b1BFA Objective: Many therapists are reluctant to conduct exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD). Negative beliefs about the safety and tolerability of ERP are common, especially for harm-related OCD symptoms. The study examined the nature and frequency of ERP-related serious negative consequences (SNC) and therapist attitudes and experiences providing ERP for harm-related OCD. Methods: An anonymous survey was completed by 277 therapists with experience treating OCD using ERP. Questions assessed clinical experiences of harm-related exposures, the nature of SNC, and concerns and clinical considerations regarding ERP. Results: Therapist's willingness to treat harm-related OCD was high. SNCs were reported for 6 clients (per-client risk: adults 0.05%, youth 0.01%) and 13 therapists (per therapist risk 4.73%, therapist per-year risk 0.004%). Qualitative analysis identified themes relating to the conduct of treatment, specific exposure types, professional issues, and negative perceptions of ERP. Conclusion: SNC associated with ERP for OCD are rare and primarily represent unintended secondary consequences of OCD or misunderstandings regarding the process and rationale behind ERP. Improving access to ERP will require good communication with clients, families, and other professionals regarding the rationale and safety of ERP.
Article
Background: There is current interest in the elaboration of early intervention programs for obsessive-compulsive disorder (OCD). To this end, it is important to investigate the speed of progression from subthreshold symptoms to diagnosable OCD. In this study, we have retrospectively investigated the speed of progression towards full-blown OCD and sociodemographic and clinical factors associated with a faster transition. Methods: Patients enrolled in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (N = 954) were interviewed with a comprehensive assessment battery that included the interval (in years) between the onset of subthreshold OCD symptoms and the onset of full-blown OCD. Results: It took a median of 7 years (interquartile range: 2-13 years) for subthreshold symptoms to convert to diagnosable OCD. Faster OCD onset was associated with lower age at the time of assessment, male gender, being in new romantic states as precipitants for compulsions, greater severity of sexual/religious symptoms and lower severity of hoarding and YBOCS compulsions severity scores, greater rates of generalized anxiety disorder and agoraphobia without panic disorder, and negative family history for OCD. Limitations: The retrospective design of this study allowed for susceptibility to memory bias about age at onset of OCD symptoms. We were unable to capture progressions taking less than 12 months. Conclusions: We could identify a specific phenotype that was more likely to escalate rapidly to clinical levels within this large clinical sample. This phenomenon may be particularly relevant in the context of selecting individuals for early intervention initiatives in situations when resources are scarce.
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OBJETIVO: O transtorno obsessivo-compulsivo acomete entre 1,6 a 3,1% da população. Em virtude de uma maior compreensão do sofrimento associado aos sintomas, aumentaram os estudos e o interesse no bem-estar geral e na qualidade de vida dos portadores. MÉTODO: Foi realizada uma revisão bibliográfica de trabalhos que investigaram a qualidade de vida em portadores de transtorno obsessivo-compulsivo. A busca foi feita nas bases de dados Medline, SciELO e PsychoInfo, utilizando como palavras-chave quality of life e obsessive-compulsive disorder. Foram selecionados 27 artigos que abordaram o tema, sendo descritas as áreas mais afetadas pelo transtorno, bem como a sua relação com a qualidade de vida foram descritas. Também foram apresentados efeitos de tratamentos na qualidade de vida dos pacientes. RESULTADOS: Os relacionamentos sociais e familiares, seguidos pelo desempenho ocupacional (capacidade para trabalhar e estudar), foram as áreas mais afetadas pelo transtorno e, apesar de melhorarem com tratamento, permanecem insatisfatórios. As obsessões foram associadas a prejuízos mais significativos na qualidade de vida do que as compulsões (rituais). CONCLUSÕES: Apesar das limitações, os estudos mostram evidências do comprometimento da qualidade de vida de indivíduos com transtorno obsessivo-compulsivo, sendo este comparável ao de pacientes com esquizofrenia. Pesquisas futuras com diferentes delineamentos são necessárias para estabelecer resultados mais consistentes.
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Recent factor-analytic studies in obsessive-compulsive disorder (OCD) identified consistent symptom dimensions. Support for the validity of these dimensions comes from studies of psychiatric comorbidity, functional brain imaging, genetic transmission, and treatment response to medications. This study examined whether previously identified OCD symptom dimensions are associated with treatment compliance and response to behaviour therapy (BT) for OCD. One hundred and fifty-three OCD outpatients who participated in a multi-centre randomised controlled trial of computer- versus clinician-guided BT for OCD were included in the study. Logistic and multiple regression models tested for significant predictors of compliance with and response to BT and relaxation. The patients studied were phenomenologically comparable (including the presence of 'pure' obsessions and mental rituals) to those in previous serotonin reuptake inhibitor (SRI) trials and those in clinical epidemiology studies. High scorers on the 'hoarding' dimension were more likely to drop out prematurely from the study and tended to improve less. For those completing treatment, the strongest predictor of outcome was pre-treatment severity. Initial depression scores were unrelated to outcome. After controlling for symptom severity, higher scores on the 'sexual/religious obsessions' factor predicted poorer outcome with BT, especially when computer-guided. BT is especially indicated for OCD patients with aggressive/checking, contamination/cleaning and symmetry/ordering symptoms. Previous accounts of unsuccessful BT in patients with hoarding symptoms may be due in part to their propensity to drop out earlier from treatment. Patients with sexual/religious obsessions, but not those with mental rituals, might respond less well to traditional BT techniques. Existing treatments need to be refined and/or new treatments developed to improve these patients' adherence and response to treatment.
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The study presented was conducted to analyze the effects of obsessive-compulsive symptoms on patients' quality of life and the costs incurred by patients and society for the treatment of obsessive-compulsive disorder (OCD). To accomplish this, a detailed 410-item questionnaire of psychosocial function and economic cost was sent to every fourth member of the Obsessive Compulsive Foundation. Of the 2,670 members who received the survey, 701 (26.9%) returned it. Outcome measures included symptomatology, course of illness, impact of illness on psychosocial and other functioning, effects of diagnosis and treatment, and economic consequences. The demographics of this group were similar to those in smaller treatment-seeking clinical samples, but not necessarily to OCD sufferers within the US population as a whole. More than half of the patients reported moderate to severe interference in family relationships, socializing, and ability to study or work, secondary to OCD symptoms. A 10.2-year gap was observed between the onset of symptoms and the first attempt to seek professional help, and a 17.2-year gap was observed between the onset of symptoms and receipt of effective treatment. Specific treatments, such as serotonin reuptake inhibitors and behavior therapy, showed greater symptom improvement, and significantly reduced the total annual fees incurred by OCD patients when compared with nonspecific treatments. Our study results indicate that OCD has a profound effect on psychosocial functioning and quality of life. Large direct costs for OCD and even larger indirect costs due to lost wages and underemployment were found. Greater awareness of OCD among practitioners may result in earlier diagnosis and more appropriate and cost-effective treatments.
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This study investigates lifetime prevalence rates, demographic characteristics, childhood conduct disorder and adult antisocial features, suicide attempts, and cognitive impairment in individuals with obsessive-compulsive disorder (OCD) uncomplicated by or comorbid with any other psychiatric disorder. The data are from the NIMH Epidemiological Catchment Area (ECA) study, and the current analyses compared subjects with uncomplicated OCD (no history of any other lifetime psychiatric disorder) comorbid OCD (with any other lifetime disorder), other lifetime psychiatric disorders, and no lifetime psychiatric disorders across these variables. OCD in its uncomplicated and comorbid form had significantly higher rates of childhood conduct symptoms, adult antisocial personality disorder problems, and of suicide attempts than did no or other disorders. Comorbid OCD subjects had higher rates of mild cognitive impairment on the Mini-Mental Status Exam than did subjects with other disorders. These findings suggest that a subgroup of OCD patients may have impulsive features, including childhood conduct disorder symptoms and an increased rate of suicide attempts; wider clinical attention to these outcomes is needed.
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Background: General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied. Methods: Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis. Results: Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt. Conclusions: Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.
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Our objective was to determine whether the presence of an anxiety disorder was a risk factor for future suicide attempts. Data were drawn from the 13-year follow-up Baltimore Epidemiological Catchment Area survey (n=1,920). Multiple logistic regression analysis was used to determine the association between baseline anxiety disorders (social phobia, simple phobia, obsessive-compulsive disorder, panic attacks, or agoraphobia) and subsequent onset suicide attempts. The presence of one or more anxiety disorders at baseline was significantly associated with subsequent onset suicide attempts (adjusted odds ratio 2.20, 95% confidence interval 1.04–4.64) after controlling for sociodemographic variables and all baseline mental disorders assessed in the survey. These findings suggest that anxiety disorders are independent risk factors for suicide attempts, and underscore the importance of anxiety disorders as a serious public health problem. Depression and Anxiety 0:1–5, 2007. Published 2007 Wiley-Liss.