Factors associated with increased suicide risk in obsessive-compulsive disorder

Objectives: Obsessive-Compulsive Disorder (OCD) is in itself at greater risk for suicide (suicidal ideation, suicide attempts and completed suicide) as compared to the general population. However, the majority of individuals with OCD do not have current or lifetime suicidal ideation nor did attempt suicide in their lifetime. Methods: The present paper aims to provide an updated review on factors (socio-demographic and personal factors, OCD-related variables, comorbidities, emotion-cognitive factors, and biological variables) contributing to the increased suicide risk in patients with OCD. Results: Several factors have been found to be strongly associated with suicide risk in patients with OCD, such as the severity of OCD, the unacceptable thoughts symptom dimension, having a comorbid Axis I disorder (Bipolar Disorder, Major Depressive Disorder, Substance Use Disorder), the severity of comorbid depressive and anxiety symptoms, a previous history of suicide attempts, having high levels of alexithymia and hopelessness. Conclusions: Several contributing factors should be evaluated and identified in the clinical practice in order to improve early detection of suicide risk. Risk identification and stratification of risk remain essential components of suicide prevention and should guide the clinical approach to patients with OCD. Whether and how these risk factors for suicide in patients with OCD work together, and whether the specific factors act as moderators or mediators, remains to be fully clarified.