Kim Shin Tae, Seo Jun Ho, Park Chun Il, Kim Hae Won, Boo Young Jun, Kim Heeyeon, Jeon Sumoa, Kang Jee In, Kim Se Joo
Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Psychiatry Clin Neurosci. 2023 Feb;77(2):110-117. doi: 10.1111/pcn.13503. Epub 2022 Nov 24.
Suicidality in obsessive-compulsive disorder (OCD) is underestimated and it is important for clinicians to understand the factors that contribute to suicidal ideation. The present study aimed to estimate a network of the core clinical symptoms of OCD including obsessions, compulsions, and obsessive-compulsive (OC) symptom dimensions, depressive symptoms, and psychological traits, and to examine which symptoms contribute to suicidal ideation in patients with a primary diagnosis of obsessive-compulsive disorder.
A total of 444 patients with OCD were assessed with the Yale-Brown Obsessive-Compulsive Scale, the Montgomery-Asberg Depression Rating Scale, and various other measures. Network analysis was conducted to estimate the network of obsessive-compulsive and depressive symptoms, psychological traits including alexithymia and impulsivity, and demographic covariates. Symptoms directly related to suicidal ideation in the network were examined for their relative contribution to suicidal ideation.
Suicidal ideation was directly related to degree of control over compulsive behaviors, distress associated with compulsive behaviors, time spent performing compulsive behaviors, and unacceptable thoughts, along with depressive symptoms and alexithymia. In the network of OC and depressive symptoms the most central symptoms among the former were interference due to compulsive behaviors and interference due to obsessive thoughts, and among the latter were pessimistic thoughts and reported sadness.
The findings suggest that along with depressive symptoms and alexithymia, compulsions and unacceptable thoughts dimension may contribute to suicidality, and thus, should be carefully monitored in patients with OCD.
强迫症（OCD）中的自杀倾向被低估，临床医生了解导致自杀意念的因素很重要。本研究旨在评估强迫症的核心临床症状网络，包括强迫观念、强迫行为和强迫症状维度、抑郁症状及心理特质，并研究哪些症状导致原发性强迫症患者出现自杀意念。
共444例强迫症患者接受了耶鲁-布朗强迫量表、蒙哥马利-艾斯伯格抑郁量表及其他多种测量。进行网络分析以评估强迫和抑郁症状网络、包括述情障碍和冲动性在内的心理特质以及人口统计学协变量。研究网络中与自杀意念直接相关的症状对自杀意念的相对影响。
自杀意念与对强迫行为的控制程度、与强迫行为相关的痛苦、进行强迫行为所花费的时间、不可接受的想法以及抑郁症状和述情障碍直接相关。在强迫和抑郁症状网络中，前者最核心的症状是强迫行为导致的干扰和强迫观念导致的干扰，后者是悲观想法和报告的悲伤情绪。
研究结果表明，除抑郁症状和述情障碍外，强迫行为和不可接受的想法维度可能导致自杀倾向，因此，对强迫症患者应仔细监测这些方面。
