Patients with obsessive-compulsive disorder (OCD) have been historically considered at low risk for suicide, but recent studies are controversial.

To study the prevalence of suicidal thoughts and attempts in OCD patients and to compare those with and without suicidality according to demographic and clinical variables.

Fifty outpatients with primary OCD (DSM-IV) from a Brazilian public university were evaluated. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess OCD severity, the Beck Depression Inventory (BDI) to evaluate depressive symptoms and the Alcohol Use Disorders Identification Test to assess alcohol problems.

All patients had obsessions and compulsions, 64% a chronic fluctuating course and 62% a minimum Y-BOCS score of 16. Half of them presented relevant depressive symptoms, but only three had a history of alcohol problems. Seventy percent reported having already thought that life was not worth living, 56% had wished to be dead, 46% had had suicidal ideation, 20% had made suicidal plans and five (10%) had already attempted suicide. Current suicidal ideation occurred in 14% of the sample and was significantly associated with a Y-BOCS score of 16 or more. Previous suicidal thoughts were associated with a BDI score of 19 or more.

Suicidality has been underestimated in OCD and should be investigated in every patient, so that appropriate preventive measures can be taken.