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Original Investigation |

Mortality Among Persons With Obsessive-Compulsive Disorder in Denmark

Sandra M. Meier, PhD1,2,3; Manuel Mattheisen, MD2,4; Ole Mors, PhD2,5; Diana E. Schendel, PhD1,2,6; Preben B. Mortensen, DrMedSc1,2,7; Kerstin J. Plessen, MD, PhD2,3
[+] Author Affiliations
1National Centre for Register-Based Research, Aarhus University, Aarhus V, Denmark
2Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
3Child and Adolescent Mental Health Centre–Mental Health Services Capital Region, Copenhagen, Denmark
4Department of Biomedicine, Aarhus University, Aarhus C, Denmark
5Research Department P, Aarhus University Hospital, Risskov, Aarhus, Denmark
6Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus C, Denmark
7Centre for Integrated Register-Based Research, Aarhus University, Aarhus C, Denmark
JAMA Psychiatry. 2016;73(3):268-274. doi:10.1001/jamapsychiatry.2015.3105.
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Importance  Several mental disorders have consistently been found to be associated with decreased life expectancy, but little is known about whether this is also the case for obsessive-compulsive disorder (OCD).

Objective  To determine whether persons who receive a diagnosis of OCD are at increased risk of death.

Design, Setting, and Participants  Using data from Danish registers, we conducted a nationwide prospective cohort study with 30 million person-years of follow-up. The data were collected from Danish longitudinal registers. A total of 3 million people born between 1955 and 2006 were followed up from January 1, 2002, through December 31, 2011. During this period, 27 236 people died. The data were analyzed primarily in June 2015.

Main Outcomes and Measures  We estimated mortality rate ratios (MRRs), adjusted for calendar year, age, sex, maternal and paternal age, place of residence at birth, and somatic comorbidities, to compare persons with OCT with persons without OCD.

Results  Of 10 155 persons with OCD (5935 women and 4220 men with a mean [SD] age of 29.1 [11.3] years who contributed a total of 54 937 person-years of observation), 110 (1.1%) died during the average follow-up of 9.7 years. The risk of death by natural or unnatural causes was significantly higher among persons with OCD (MRR, 1.68 [95% CI, 1.31-2.12] for natural causes; MRR, 2.61 [95% CI, 1.91-3.47] for unnatural causes) than among the general population. After the exclusion of persons with comorbid anxiety disorders, depression, or substance use disorders, OCD was still associated with increased mortality risk (MRR, 1.88 [95% CI, 1.27-2.67]).

Conclusions and Relevance  The presence of OCD was associated with a significantly increased mortality risk. Comorbid anxiety disorders, depression, or substance use disorders further increased the risk. However, after adjusting for these and somatic comorbidities, we found that the mortality risk remained significantly increased among persons with OCD.

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Figure.
Mortality Rate Ratios of Persons With Pure or Comorbid OCD (2002-2011)

Mortality rate ratios were adjusted for calendar year, age, sex, maternal and paternal age, place of residence at time of birth, somatic comorbidity, and the interaction of age and sex. “Pure” obsessive-compulsive disorder (OCD) indicates OCD without comorbidities. Comorbidities include anxiety disorders, depression, and substance abuse disorders.

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