Summary: A new study highlights a concerning link between obsessive-compulsive disorder (OCD) and an increased risk of death from both natural and unnatural causes. The study, using data from over 60,000 people with OCD, shows an 82% higher overall mortality risk compared to those without the disorder.
Among the natural causes, increased risks were found for diseases of the respiratory system, genitourinary system, and others. Unnatural causes, particularly suicide, showed a significantly higher risk of death in individuals with OCD. The researchers emphasize the need for better surveillance and intervention strategies to mitigate these risks.
Key Facts:
- People with OCD have an 82% increased risk of death from any cause compared to those without OCD.
- The study found heightened risks for various natural causes and a nearly fivefold increased risk of death from suicide.
- The research underscores the necessity of enhanced surveillance and early intervention strategies for individuals with OCD.
Source: BMJ
People with obsessive-compulsive disorder (OCD) may have an increased risk of death from both natural and unnatural causes than those without the disorder, finds a study from Sweden published in The BMJ today.
The researchers point out that many of the natural causes of death are preventable, suggesting that better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.
OCD is typically a long-term psychiatric disorder affecting about 2% of the population. It is characterized by intrusive thoughts, urges or images that trigger high levels of anxiety and other distressing feelings—known as obsessions—that the person tries to neutralize by engaging in repetitive behaviors or rituals—known as compulsions.
OCD is also associated with academic underachievement, poor work prospects, alcohol and substance use disorders, and an increased risk of death.
Previous studies on specific causes of death in OCD have mainly focused on unnatural causes (e.g., suicide), but little is known about specific natural causes.
To fill this knowledge gap, researchers set out to estimate the risk of all cause and cause specific death in people with OCD compared with matched unaffected people from the general population and with their unaffected siblings.
Using data from several Swedish population registers, they identified 61,378 people with OCD and 613,780 individuals without OCD matched (1:10) by sex, birth year, and county of residence, and a further sibling group of 34,085 people with OCD and 47,874 without OCD.
Average age at OCD diagnosis was 27 years and groups were monitored for an average of 8 years from January 1973 to December 2020.
Overall, people with OCD had a higher death rate than matched individuals without OCD (8.1 versus 5.1 per 1,000 person-years, respectively).
After adjusting for a range of potentially influential factors such as birth year, sex, county, migrant status, education and family income, people with OCD had an 82% increased risk of death from any cause. The excess risk of death was higher for both natural (31% increased risk), and particularly, unnatural causes of death (a 3-fold increased risk).
Among the natural causes of death, people with OCD had increased risks due to respiratory system diseases (73%), mental and behavioral disorders (58%), diseases of the genitourinary system (55%), endocrine, nutritional, and metabolic diseases (47%), diseases of the circulatory system (33%), nervous system (21%), and digestive system (20%).
Among the unnatural causes, suicide showed the highest risk of death (a nearly fivefold increased risk), followed by accidents (a 92% increased risk).
The risk of all-cause death was similar in both women and men, although women with OCD had a higher relative risk of dying due to unnatural causes than men with OCD, likely due to the lower baseline risk among women in the general population, note the researchers.
In contrast, people with OCD had a 10% lower risk of death due to tumors (neoplasms).
This is an observational study, so it can’t establish cause, and the researchers point out that registry data only includes diagnoses made in specialist care. It’s also unclear whether the findings generalize to other settings with different populations, health systems and medical practices.
Nevertheless, this was a large study based on high quality national data, and the results remained largely unchanged after further adjustment for psychiatric conditions and family factors, suggesting that they withstand scrutiny.
As such, the researchers conclude, “Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.”
About this OCD and mortality research news
Author: BMJ Media Relations
Source: BMJ
Contact: BMJ Media Relations – BMJ
Image: The image is credited to Neuroscience News
Original Research: Open access.
“All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study” by Lorena Fernández de la Cruz et al. BMJ
Abstract
All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study
Objective
To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings.
Design
Population based matched cohort and sibling cohort study.
Setting
Register linkage in Sweden.
Participants
Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020.
Main outcome measures
All cause and cause specific mortality.
Results
4787 people with OCD and 30 619 unaffected people died during the study period (crude mortality rate 8.1 and 5.1 per 1000 person years, respectively). In stratified Cox proportional hazards models adjusted for birth year, sex, county, migrant status (born in Sweden versus abroad), and sociodemographic variables (latest recorded education, civil status, and family income), people with OCD had an increased risk of all cause mortality (hazard ratio 1.82, 95% confidence interval 1.76 to 1.89) and mortality due to natural causes (1.31, 1.27 to 1.37) and unnatural causes (3.30, 3.05 to 3.57). Among the natural causes of death, those due to endocrine, nutritional, and metabolic diseases, mental and behavioural disorders, and diseases of the nervous, circulatory, respiratory, digestive, and genitourinary systems were higher in the OCD cohort. Conversely, the risk of death due to neoplasms was lower in the OCD cohort compared with the unaffected cohort. Among the unnatural causes, suicide showed the highest hazard ratio, followed by accidents. The results were robust to adjustment for psychiatric comorbidities and familial confounding.
Conclusions
Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.
