Predictors of Suicide Attempts in Individuals with Eating Disorders

Ahn, Jaeun; Lee, Jung-Hyun; Jung, Young‐Chul

doi:10.1111/sltb.12477

Cited by 30 publications

(20 citation statements)

References 41 publications

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“…Consistent with previous studies [21, 22, 27, 28], SA history was significantly associated with lifetime diagnoses of other psychiatric disorders. Mood disorders, SUD, and personality disorders were prevalent across all EDs with a history of SA, with 73–96% meeting criteria for those diagnoses.…”

Section: Discussionsupporting

confidence: 90%

“…Nonetheless, there were several significant differences in clinical characteristic between those with and without SA histories. In BN and BED, SA history was associated with earlier age of ED onset, which is partially consistent with findings from a clinical sample [21]. In all EDs, the lowest BMI was lower in respondents with a SA history than those without SA history.…”

Section: Discussionsupporting

confidence: 86%

“…There are other possible assessment limitations with the AUDADIS-5 that might have contributed to lower prevalence of EDs in general in this study than other reports [16, 46]. Previous studies on EDs and suicidal behaviors have also investigated the relationship between SA and specific eating pathologies, such as compensation methods (e.g., vomiting, purging) [21, 22, 29], but we were unable to explore such possible relationship with SAs due to the nature of the AUDADIS-5 questions for BN or BED [16, 52]. Relative to AN and BED, the sample size of respondents with lifetime BN diagnosis was smaller, which may have contributed to some non-statistically significant results (e.g., AORs for risk for SAs in those with and without lifetime BN diagnosis); the smaller sample size also precluded us from investigating possible sex or ethnic/racial differences.…”

Section: Discussionmentioning

confidence: 85%

“…A recent meta-analysis of 2611 longitudinal studies also found that ED diagnosis was associated with significantly increased risk for suicide attempt (SA) [18] although the rate of SA varied considerably across studies. In clinic samples, the rate of SA in patients with AN ranges from 3 to 20% [19], 25–35% in BN [19], 12.5% in BED [20], and 20.8% when combining all EDs [21]. Crow et al [22], which specifically examined suicidal behaviors in US adolescents and adults with data from the National Comorbidity Survey-Replication (NCS-R; N = 2980) [23] and the National Comorbidity Survey-Adolescent Supplement (NCS-A; N = 10,123) [24, 25], estimated that the prevalence of SA in adults was 8.8% in AN, 21.3% in BN, and 15.2% in BED, whereas it was only 1.2% in adults without a lifetime psychiatry disorder.…”

Section: Introductionmentioning

confidence: 99%

“…The five studies that considered BED reported significantly increased odds of suicidal behaviors relative to individuals without BED [26]; all these studies, however, were based on previous DSM-IV criteria, and most focused on patients with BED and comorbid conditions. Furthermore, besides several studies that examined comorbid psychiatric conditions [21, 27, 28], body mass index (BMI) [21, 29], and ED pathologies [21, 29] as risk factors for SA in EDs, research on correlates of suicidal behaviors in EDs has been narrow and limited.…”

Section: Introductionmentioning

confidence: 99%

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Suicide attempts in US adults with lifetime DSM-5 eating disorders

Udo

Bitley

Grilo

2019

BMC Med

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Background Rates of suicide are increasing in the US. Although psychiatric disorders are associated with suicide risk, there is a dearth of epidemiological research on the relationship between suicide attempts (SAs) and eating disorders (EDs). The study therefore aimed to examine prevalence and correlates of SAs in DSM-5 EDs—anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)—in a nationally representative sample of US adults. In addition, prevalence and correlates of SAs were examined in the two subtypes of AN—restricting (AN-R) and binge/purge (AN-BP) types. Methods The study included 36,171 respondents in the Third National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III) who completed structured diagnostic interviews (AUDADIS-5) and answered questions regarding SA histories and psychosocial impairment associated with EDs. We evaluated lifetime prevalence of SA, psychosocial impairment, clinical profiles, and psychiatric comorbidity in adults with EDs with and without SA histories, and temporal relationships between age onset of SA and EDs. Results Prevalence estimates of suicide attempts were 24.9% (for AN), 15.7% (for AN-R), 44.1% (for AN-BP), 31.4% (for BN), and 22.9% (for BED). Relative to respondents without specific EDs, adjusted odds ratios (AORs) of SAs were significantly greater in all EDs: AN = 5.40 (95% confidence intervals [CIs] = 3.80–7.67), AN-R = 3.16 (95% CIs = 1.82–5.42), AN-BP = 12.09 (95% CIs = 6.29–23.24), BN = 6.33 (95% CIs = 3.39–11.81), and BED = 4.83 (95% CIs = 3.54–6.60). Among those with SA history, mean age at first SA and number of SAs were not significantly different across the specific EDs. SA was associated with significantly earlier ED onset in BN and BED, longer duration of AN but shorter duration of BN, greater psychosocial impairment in AN and BN, and with significantly increased risk for psychiatric disorder comorbidity across EDs. Onset of BED was significantly more likely to precede SA (71.2%) but onsets of AN (50.4%) and BN (47.6%) were not. Conclusions US adults with lifetime DSM-5 EDs have significantly elevated risk of SA history. Even after adjusting for sociodemographic factors, those with lifetime EDs had a roughly 5-to-6-fold risk of SAs relative to those without specific EDs; the AN binge/purge type had an especially elevated risk of SAs. SA history was associated with distinctively different clinical profiles including greater risk for psychosocial impairment and psychiatric comorbidity. These findings highlight the importance of improving screening for EDs and for suicide histories. Electronic supplementary material The online version of this article (10.1186/s12916-019-1352-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Suicide attempts in US adults with lifetime DSM-5 eating disorders

Udo

Bitley

Grilo

2019

BMC Med

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Emotion dysregulation and suicidality in eating disorders

Rania

Monell

Sjölander

et al. 2020

Intl J Eating Disorders

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Objective Suicidality in eating disorders (EDs) is high, and identification of therapeutically targetable traits associated with past, current, and future suicidality is of considerable clinical importance. We examined overall and ED subtype‐specific associations among suicidal ideation, suicide attempts, and general and specific aspects of emotion dysregulation in a large sample of individuals with ED, at presentation for treatment and 1‐year follow‐up. Method Using registry data from 2,406 patients, scores on the Difficulties in Emotion Dysregulation Scale (DERS) at initial registration were examined as predictors of recent suicidal ideation and self‐report lifetime suicide attempts. Associations were examined in the full sample and in each ED subtype. In 406 patients, initial DERS scores were examined as predictors of suicidality at 1‐year follow‐up. Results Overall DERS was associated with suicidal ideation and suicide attempts, even when adjusting for ED psychopathology and current depression. Perceived lack of emotion regulation strategies showed unique associations with suicidal ideation and suicide attempts, both in the full sample and in most ED subtypes. Initial DERS was also associated with follow‐up suicidal ideation and suicide attempts, although this association did not remain when adjusting for past suicidality. Discussion Results suggest that emotion dysregulation may be a potential mechanism contributing to suicidality in EDs, beyond the effects of ED psychopathology and current depression. Although the prevalence of suicidality differs across ED subtypes, emotion dysregulation may represent a risk trait for future suicidality that applies transdiagnostically. Results support addressing emotion dysregulation in treatment in order to reduce suicidality.

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Comorbid eating, depressive, and anxiety psychopathology is associated with elevated shame in women with food insecurity

Davis

Kells

Todorov

et al. 2023

Intl J Eating Disorders

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Objective: To compare participants with current food insecurity and different psychopathology profiles on shame, guilt, anxiety, and depression using a cross-sectional design.Method: Women with current food insecurity (n = 99; 54% White) were placed into four groups based on their endorsement of symptoms of psychopathology: eating disorder with depression/anxiety comorbidity (ED-C group; n = 17), depression/ anxiety only (Depression/anxiety group; n = 34), eating disorder only (ED group; n = 12), and No-diagnosis group (n = 36). Groups were compared on self-report measures of shame, guilt, depression, and anxiety using analysis of covariance. Results:The presence of an eating disorder was associated with quadruple the risk of screening positive for comorbid depression and anxiety. The ED-C group reported elevated shame relative to the ED and No-diagnosis groups. The ED-C group reported the highest levels of anxiety, followed by the Depression/anxiety group, and the ED and No-diagnosis groups.Discussion: The presence of an eating disorder with comorbidity among women with food insecurity is associated with heightened shame. Given shame's status as a transdiagnostic predictor of psychopathology, it may serve as a putative mechanism underlying the relationship between food insecurity and eating disorder comorbidity.Public Significance Statement: Women with food insecurity and an ED were more likely to also screen positive for depression and/or anxiety than women with food insecurity and no ED. Overlap between ED, depression, and anxiety was associated with elevated shame, a harmful, maladaptive emotion with negative psychosocial consequences.

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Predictors of Suicide Attempts in Individuals with Eating Disorders

Abstract: Because modifying risk factors of suicide attempt is important for preventing completed suicide, clinicians should carefully evaluate and monitor the risk factors of suicide attempt.

Cited by 30 publications

References 41 publications

Suicide attempts in US adults with lifetime DSM-5 eating disorders

Suicide attempts in US adults with lifetime DSM-5 eating disorders

Emotion dysregulation and suicidality in eating disorders

Comorbid eating, depressive, and anxiety psychopathology is associated with elevated shame in women with food insecurity

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