Skip to main content Accessibility help

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

  • Bernardo Dell’Osso (a1) (a2), Beatrice Benatti (a1), Chiara Arici (a1), Carlotta Palazzo (a1), A. Carlo Altamura (a1), Eric Hollander (a3), Naomi Fineberg (a4), Dan J. Stein (a5), Humberto Nicolini (a6) (a7), Nuria Lanzagorta (a7), Donatella Marazziti (a8), Stefano Pallanti (a9), Michael van Ameringen (a10), Christine Lochner (a11), Oguz Karamustafalioglu (a12), Luchezar Hranov (a13), Martijn Figee (a14), Lynne Drummond (a15), Carolyn I. Rodriguez (a2), John Grant (a16), Damiaan Denys (a14), Jose M. Menchon (a17) and Joseph Zohar (a18)...



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


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


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


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


Corresponding author

*Address correspondence and reprint requests to: Bernardo Dell’Osso, Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico–Milano, Via Francesco Sforza 35, 20122 Milano, Italy. (Email:


Hide All

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



Hide All
1. Grabe, HJ, Ruhrmann, S, Ettelt, S, et al. Familiality of obsessive-compulsive disorder in nonclinical and clinical subjects. Am J Psychiatry. 2006; 163(11): 19861992. Accessed February 6, 2017.
2. Fontenelle, LF, Mendlowicz, MV, Versiani, M. The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006; 30(3): 327337. Epub ahead of print Jan 18.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
4. Kamath, P, Reddy, YC, Kandavel, T. Suicidal behavior in obsessive-compulsive disorder. J Clin Psychiatry. 2007; 68(11): 17411750.
5. Angelakis, I, Gooding, P, Tarrier, N, Panagioti, M. Suicidality in obsessive-compulsive disorder (OCD): a systematic review and meta-analysis. Clin Psychol Rev. 2015; 39: 115. Epub ahead of print Mar 25.
6. Fernández de la Cruz, L, Rydell, M, Runeson, B, et al. Suicide in obsessive-compulsive disorder: a population-based study of 36,788 Swedish patients. Mol Psychiatry. 2016; 22: 17. Accessed February 7, 2017.
7. Velloso, P, Piccinato, C, Ferrao, Y, et al. The suicidality continuum in a large sample of obsessive-compulsive disorder ( OCD ) patients. Eur Psychiatry. 2016; 38: 17. Epub ahead of print Sep 6.
8. Marusic, A. History and geography of suicide: could genetic risk factors account for the variation in suicide rates? Am J Med Genet C Semin Med Genet. 2005; 133C(1): 4347.
9. Burvill, PW 1998. Migrant suicide rates in Australia and in country of birth. Psychol Med. 28(1): 201208.
10. Dell’Osso, B, Nicolini, H, Lanzagorta, N, et al. Cigarette smoking in patients with obsessive compulsive disorder: A report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS). CNS Spectr. 2015; 20(5): 469473. Epub ahead of print Sep 9.
11. Balci, V, Sevincok, L. Suicidal ideation in patients with obsessive-compulsive disorder. Psychiatry Res. 2010; 175(1–2): 104108. Epub ahead of print Nov 17, 2009.
12. Dhyani, M, Trivedi, JK, Nischal, A, Sinha, PK, Verma, S. Suicidal behaviour of Indian patients with obsessive compulsive disorder. Indian J Psychiatry. 2013; 55(2): 161166. Accessed February 7, 2017.
13. Gupta, G, Avasthi, A, Grover, S, Singh, SM. Factors associated with suicidal ideations and suicidal attempts in patients with obsessive compulsive disorder. Asian J Psychiatr. 2014; 12: 140146.
14. De Berardis, D, Serroni, N, Campanella, D, et al. Alexithymia, responsibility attitudes and suicide ideation among outpatients with obsessive-compulsive disorder: an exploratory study. Compr Psychiatry. 2015; 58: 8287.
15. De Berardis, D, Campanella, D, Gambi, F, et al. Insight and alexithymia in adult outpatients with obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci. 2005; 255(5): 350358. Epub ahead of print Feb 21.
16. Carpenter, L, Chung, MC. Childhood trauma in obsessive compulsive disorder: the roles of alexithymia and attachment. Psychol Psychother. 2011; 84(4): 367388. Epub ahead of print Feb 25.
17. De Berardis, D, Serroni, N, Campanella, D, et al. Suicide risk among patients with obsessive-compulsive disorder: the role of alexithymia and insight. Ital J Psychopathology. 2008; 14(2): 185196. Accessed February 7, 2017.
18. Pompili, M. Exploring the phenomenology of suicide. Suicide Life Threat Behav. 2010; 40(3): 234244.
19. Papakostas, GI, Ongür, D, Iosifescu, DV, Mischoulon, D, Fava, M. Cholesterol in mood and anxiety disorders: review of the literature and new hypotheses. Eur Neuropsychopharmacol. 2004; 14(2): 135142.
20. De Berardis, D, Serroni, N, Marini, S, et al. Alexithymia, suicidal ideation, and serum lipid levels among drug-naïve outpatients with obsessive-compulsive disorder. Rev Bras Psiquiatr. 2014; 36(2): 125130. Epub ahead of print Jan 17. Accessed February 7, 2017.
21. Dell’Osso, B, Benatti, B, Hollander, E, et al. Childhood, adolescent and adult age at onset and related clinical correlates in obsessive-compulsive disorder: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Int J Psychiatry Clin Pract. 2016; 20(4): 210217. Epub ahead of print Jul 19.
22. Menchón, JM, van Ameringen, M, Dell’Osso, B, et al. Standards of care for obsessive-compulsive disorder centres. Int J Psychiatry Clin Pract. 2016; 20(3): 204208. Accessed February 7, 2017.
23. Gibbon, M, Spitzer, RL, Williams, JBW, et al. Structured Clinical Interview for DSM–IV Axis II Personality Disorders (SCID–II). Washington, DC: American Psychiatric Press; 1997.
24. First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM–IV–TR Axis I Disorders, Research Version, Patient Edition (SCID–I/P). New York: Biometrics Research, New York State Psychiatric Institute; 2002.
25. First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM–-IV–TR Axis I Disorders, Research Version, Non-Patient Edition (SCID–I/NP). New York: Biometrics Research, New York State Psychiatric Institute; 2002.
26. Goodman, WK, Price, LH, Rasmussen, SA, et al. The Yale–Brown Obsessive Compulsive Scale, I: development, use and reliability. Arch Gen Psychiatry. 1989; 46(11): 10061011.
27. Nock, MK, Borges, G, Bromet, EJ, Cha, CB, Kessler, RC, Lee, S. Suicide and suicidal behavior. Epidemiol Rev. 2008; 30: 133154. Accessed February 7, 2017.
28. Hollander, E, Greenwald, S, Neville, D, Johnson, J, Hornig, CD, Weissman, MM. Uncomplicated and comorbid obsessive-compulsive disorder in an epidemiologic sample. Depress Anxiety. 1996–7; 4(3): 111119.
29. Hollander, E, Stein, DJ, Kwon, J, Rowland, C. Psychosocial function and economic costs of obsessive-compulsive disorder. CNS Spectr. 1997; 2(10): 1625. Epub Nov 1, 2014.
30. Torres, AR, de Abreu Ramos-Cerqueira, AT, Torresan, RC, et al. Prevalence and associated factors for suicidal ideation and behaviors in obsessive-compulsive disorder. CNS Spectr. 2007; 12(10): 771778.
31. Torres, AR, Ramos-Cerqueira, AT, Ferrão, YA, Fontenelle, LF, do Rosário, MC, Miguel, EC. Suicidality in obsessive-compulsive disorder: prevalence and relation to symptom dimensions and comorbid conditions. J Clin Psychiatry. 2011; 72(1): 1726. quiz 119–20.
32. Alonso, P, Segalàs, C, Real, E, et al. Suicide in patients treated for obsessive-compulsive disorder: a prospective follow-up follow-up study. J Affect Disord. 2010; 124(3): 300308. Epub ahead of print Jan 13.
33. Goldsmith, SK, Pellmar, TC, Kleinman, AM, Bunney, WE. eds. Reducing Suicide: A National Imperative. Washington, DC: National Academies Press; 2002.
34. Klonsky, ED, May, AM, Saffer, BY. Suicide, suicide attempts, and suicidal ideation. Annu Rev Clin Psychol. 2016; 12: 307330.
35. Lochner, C, Fineberg, NA, Zohar, J, et al. Comorbidity in obsessive-compulsive disorder (OCD): a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Compr Psychiatry. 2014; 55(7): 15131519. Epub ahead of print Jun 9.
36. Viswanath, B, Narayanaswamy, JC, Rajkumar, RP, et al. Impact of depressive and anxiety disorder comorbidity on the clinical expression of obsessive-compulsive disorder. Compr Psychiatry. 2012; 53(6): 775782.
37. Brezo, J, Paris, J, Turecki, G. Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatr Scand. 2006; 113(3): 183206.
38. Rosario-Campos, MC, Leckman, JF, Mercadante, MT, et al. Adults with early-onset obsessive-compulsive disorder. Am J Psychiatry. 2001; 158(11): 18991903. Accessed February 7, 2017.
39. Storch, EA, Hanks, CE, Mink, JW, et al. Suicidal thoughts and behaviors in children and adolescents with chronic tic disorders. Depress Anxiety. 2015; 32(10): 744753. Accessed February 7, 2017.
40. Dávila, G, Berthier, ML, Kulisevsky, J, Jurado Chacón, S. Suicide and attempted suicide in Tourette’s syndrome. J Clin Psychiatry. 2010; 71(10): 14011402. Accessed February 7, 2017.
41. Sanna, L, Stuart, AL, Pasco, JA, et al. Suicidal ideation and physical illness: does the link lie with depression? J Affect Disord. 2014: 152154; 422–6. Epub ahead of print Oct 10, 2013.
42. Lee, SH, Tsai, YF, Chen, CY, Huang, LB. Triggers of suicide ideation and protective factors of actually executing suicide among first onset cases in older psychiatric outpatients: a qualitative study. BMC Psychiatry. 2014; 14: 269. Accessed February 7, 2017.
43. Ruscio, A, Stein, D, Chiu, W, Kessler, RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2008; 15(1): 5363. Epub ahead of print Aug 26, 2008. Accessed February 7, 2017.
44. Brakoulias, V, Sara, G. Hospital admissions for obsessive-compulsive disorder in NSW, 1997 to 2010. Australas Psychiatry. 2011; 19(5): 502506. Accessed February 7, 2017.
45. National Institute for Health and Clinical Excellence. Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. London: NIHCE; 2005.
46. Geller, DA, March, J. Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 2012; 51(1): 98113. Accessed February 7, 2017.
47. Albert, U, Barbaro, F, Aguglia, A, Maina, G, Bogetto, F. Combined treatments in obsessive-compulsive disorder: current knowledge and future prospects [in Italian]. Riv Psichiatr. 2012; 47(4): 255268. Accessed February 7, 2017.
48. Dell’Osso, B, Benatti, B, Buoli, M, et al. The influence of age at onset and duration of illness on long-term outcome in patients with obsessive-compulsive disorder: a report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS). Eur Neuropsychopharmacol. 2013; 23(8): 865871. Epub ahead of print Jun 21.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed