Directionality of change in obsessive compulsive disorder (OCD) and suicidal ideation over six years in a naturalistic clinical sample✰
LA Brown, E Wakschal, S Russman-Block… - Journal of affective …, 2019 - Elsevier
LA Brown, E Wakschal, S Russman-Block, CL Boisseau, MC Mancebo, JL Eisen…
Journal of affective disorders, 2019•ElsevierBackground Obsessive compulsive disorder (OCD) is associated with elevated suicide risk,
but the directionality of the association between OCD severity and suicidal ideation has not
been established, which was the goal of this study. Methods Participants (n= 325) were
adults with either a current or past diagnosis of Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition (DSM-IV) OCD who were assessed annually for suicidal ideation and
OCD symptom severity for six years. Cross-lagged panel analyses statistically compared …
but the directionality of the association between OCD severity and suicidal ideation has not
been established, which was the goal of this study. Methods Participants (n= 325) were
adults with either a current or past diagnosis of Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition (DSM-IV) OCD who were assessed annually for suicidal ideation and
OCD symptom severity for six years. Cross-lagged panel analyses statistically compared …
Background
Obsessive compulsive disorder (OCD) is associated with elevated suicide risk, but the directionality of the association between OCD severity and suicidal ideation has not been established, which was the goal of this study.
Methods
Participants (n = 325) were adults with either a current or past diagnosis of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) OCD who were assessed annually for suicidal ideation and OCD symptom severity for six years. Cross-lagged panel analyses statistically compared unidirectional and bidirectional models over time. Serious suicide-related adverse events were reported.
Results
The best-fitting and most parsimonious model included paths predicting suicidal ideation from OCD symptom severity, but not vice versa. These results were confirmed by comparing a model with cross-lagged paths constrained equal to a freely estimated model. Higher OCD symptom severity in a given year was associated with a higher suicidal ideation severity in the subsequent year. Five suicide-related adverse events were reported throughout the duration of the study, including two suicide deaths and three suicide attempts.
Limitations
The study relied on a single-item, annual measure of suicidal ideation in adults, with substantial variability in severity of suicide risk, and missing data increased with later observations in the study.
Discussion
OCD symptom severity predicted next year suicidal ideation severity. In contrast, suicidal ideation severity in a given year did not predict next-year OCD symptom severity in this OCD sample. Thus, rather than waiting for suicidal ideation to resolve, clinicians should consider providing empirically supported treatments for OCD.
Elsevier
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