{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T08:19:47Z","timestamp":1794212387479,"version":"4.8.0"},"reference-count":42,"publisher":"BMJ","license":[{"start":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T00:00:00Z","timestamp":1705449600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007687","name":"Svenska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006636","name":"Forskningsr\u00e5det om H\u00e4lsa, Arbetsliv och V\u00e4lf\u00e4rd","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2023,11,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population based matched cohort and sibling cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Register linkage in Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Population based cohort including 61\u2009378 people with OCD and 613\u2009780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34\u2009085 people with OCD and 47\u2009874 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>All cause and cause specific mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>4787 people with OCD and 30\u2009619 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2023-077564","type":"journal-article","created":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T20:10:46Z","timestamp":1705522246000},"page":"e077564","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study"],"prefix":"10.1136","volume":"384","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1571-5485","authenticated-orcid":false,"given":"Lorena","family":"Fern\u00e1ndez de la Cruz","sequence":"first","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayoko","family":"Isomura","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Lichtenstein","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Larsson","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"School of Medical Sciences, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Kuja-Halkola","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M","family":"D\u2019Onofrio","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabell","family":"Brikell","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway"},{"name":"Department of Biomedicine, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"R\u00fcck","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Sidorchuk","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mataix-Cols","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden"},{"name":"Department of Clinical Sciences, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,17]]},"reference":[{"key":"2025110102354285000_384.jan17_9.e077564.1","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2008.94"},{"key":"2025110102354285000_384.jan17_9.e077564.2","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association . The Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association, 2013, DSM-5.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2025110102354285000_384.jan17_9.e077564.3","doi-asserted-by":"publisher","DOI":"10.1017\/S1092852900026894"},{"key":"2025110102354285000_384.jan17_9.e077564.4","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2017.3523"},{"key":"2025110102354285000_384.jan17_9.e077564.5","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291718001691"},{"key":"2025110102354285000_384.jan17_9.e077564.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2009.03.004"},{"key":"2025110102354285000_384.jan17_9.e077564.7","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.14m09468"},{"key":"2025110102354285000_384.jan17_9.e077564.8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.14779"},{"key":"2025110102354285000_384.jan17_9.e077564.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2022.104602"},{"key":"2025110102354285000_384.jan17_9.e077564.10","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwt219"},{"key":"2025110102354285000_384.jan17_9.e077564.11","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2015.3105"},{"key":"2025110102354285000_384.jan17_9.e077564.12","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2016.115"},{"key":"2025110102354285000_384.jan17_9.e077564.13","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-019-0417-1"},{"key":"2025110102354285000_384.jan17_9.e077564.14","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-021-02182-x"},{"key":"2025110102354285000_384.jan17_9.e077564.15","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(19)30219-1"},{"key":"2025110102354285000_384.jan17_9.e077564.16","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.2502"},{"key":"2025110102354285000_384.jan17_9.e077564.17","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-009-9350-y"},{"key":"2025110102354285000_384.jan17_9.e077564.18","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-450"},{"key":"2025110102354285000_384.jan17_9.e077564.19","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-017-0316-1"},{"key":"2025110102354285000_384.jan17_9.e077564.20","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-016-0117-y"},{"key":"2025110102354285000_384.jan17_9.e077564.21","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-019-00511-8"},{"key":"2025110102354285000_384.jan17_9.e077564.22","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-59745-423-0_10"},{"key":"2025110102354285000_384.jan17_9.e077564.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2017.12.003"},{"key":"2025110102354285000_384.jan17_9.e077564.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-007520"},{"key":"2025110102354285000_384.jan17_9.e077564.25","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.19r13085"},{"key":"2025110102354285000_384.jan17_9.e077564.26","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cky076"},{"key":"2025110102354285000_384.jan17_9.e077564.27","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2018.288332"},{"key":"2025110102354285000_384.jan17_9.e077564.28","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-024098"},{"key":"2025110102354285000_384.jan17_9.e077564.29","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000002989"},{"key":"2025110102354285000_384.jan17_9.e077564.30","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.V41N3p105"},{"key":"2025110102354285000_384.jan17_9.e077564.31","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.2019185"},{"key":"2025110102354285000_384.jan17_9.e077564.32","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2013.278"},{"key":"2025110102354285000_384.jan17_9.e077564.33","doi-asserted-by":"publisher","DOI":"10.1177\/0004867415577979"},{"key":"2025110102354285000_384.jan17_9.e077564.34","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-198104000-00003"},{"key":"2025110102354285000_384.jan17_9.e077564.35","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1969.01740140054006"},{"key":"2025110102354285000_384.jan17_9.e077564.36","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.111.477.709"},{"key":"2025110102354285000_384.jan17_9.e077564.37","unstructured":"OECD\/Eurostat. Avoidable mortality: OECD\/Eurostat lists of preventable and treatable causes of death. 2019. https:\/\/www.oecd.org\/health\/health-systems\/Avoidable-mortality-2019-Joint-OECD-Eurostat-List-preventable-treatable-causes-ofdeath.pdf (accessed 9 August 2023)."},{"key":"2025110102354285000_384.jan17_9.e077564.38","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20376"},{"key":"2025110102354285000_384.jan17_9.e077564.39","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-018-0070-3"},{"key":"2025110102354285000_384.jan17_9.e077564.40","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cml054"},{"key":"2025110102354285000_384.jan17_9.e077564.41","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2006.110171"},{"key":"2025110102354285000_384.jan17_9.e077564.42","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(23)00058-5"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj-2023-077564","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj-2023-077564","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T09:35:51Z","timestamp":1761989751000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj-2023-077564"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,17]]},"references-count":42,"alternative-id":["10.1136\/bmj-2023-077564"],"URL":"https:\/\/doi.org\/10.1136\/bmj-2023-077564","relation":{},"ISSN":["1756-1833"],"issn-type":[{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,17]]}}}