Importantly, the risk of attempted suicide was substantially reduced, though not entirely eliminated, when the models adjusted for psychiatric comorbidity. This contrasts with deaths by suicide, which were largely independent from such comorbidity. Clinicians should be aware that psychiatric comorbidity is not necessarily a reliable indicator of the actual risk of death by suicide in this group. We did find, however, that comorbid personality and substance use disorders increased the risk of suicide by 40–82%, which is consistent with the high risk associated with these disorders in their own right.2 These particular comorbidities require special attention and monitoring in OCD. In the case of suicide attempts, all psychiatric comorbidities increased the risk, especially substance use and affective disorders. Given the high rates of comorbidity in OCD,5 this becomes particularly relevant. Suicidal thoughts should be explored and frequently monitored in all OCD patients, particularly if comorbidities are present and in patients with previous attempts. A higher level of education was a protective factor for death by suicide but appeared to be a risk factor for attempting suicide. It should be borne
