Historically, patients with OCD have been considered to be at a relatively low risk of dying by suicide.8, 9, 10 However, this appreciation derives from a small number of modestly sized studies, generally conducted in specialist clinics, which were not only underpowered to study deaths by suicide (a relatively rare event) but also subject to potential selection biases (patients with OCD seen in specialist clinics are typically more severe).11, 12 In addition, these studies have typically included short follow-up times,12 probably insufficient to detect the true risk of suicide in OCD. A meta-analysis established the suicide risk in OCD to be 10 times higher than expected, but these conclusions were based on two single studies including a combined total of three deaths by suicide.13 A recent epidemiological study concluded that individuals with OCD (n=10 155) were three times more likely to die by suicide than population controls.14 However, this figure was also based on a small number of suicide cases (44 cases of unnatural causes of death were reported, including deaths by suicide, accidents and homicides). Therefore, more accurate and unbiased estimates of death by suicide in OCD are needed.
