Suicide attempts requiring hospitalization in patients with eating disorders: A retrospective cohort study

Abstract

Objective: Suicide attempts requiring hospitalization are known to be common in patients who are diagnosed with eating disorders. Attempting suicide is a major indicator for those at risk of completed suicide. Both the specific eating disorder diagnosis and the influence of psychiatric comorbidities on suicide attempts requiring hospitalization were investigated, with demographic and socioeconomic variables as confounders, over a 10-year observation period from These data include all diagnoses for inpatient admissions. Hazard ratios, with 95% confidence intervals (CIs), were calculated from cox regression analyses and the effects of a number of confounders were estimated by performing multivariable analyses.Results: In total, 4,895 patients were diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder otherwise not specified (EDNOS). Of these, 331 (6.7%) had attempted suicide requiring hospitalization and 21 (0.04%) completed suicide. The eating disorder category associated with the highest risk of a suicide attempt was AN (HR: 1.43, 95%CI: 1.08-1.89, p = .01). The risk was significantly increased further if the patient had a comorbid diagnosis of personality disorder, depression, bipolar affective disorder, and substance misuse.Discussion: Suicide attempts requiring hospitalization have a high incidence rate among patients with eating disorders, and the risk is significantly increased in AN. Comorbid psychiatric illness and suicidal ideation should be carefully assessed in all eating disorder patients. K E Y W O R D Sanorexia nervosa, bulimia nervosa, eating disorder, self-harm, suicide, suicide attempt

Social and economic cost of eating disorders in the United States: Evidence to inform policy action

“…Our study has several limitations, including: (1) reliance on several prevalence studies using varying estimation techniques, which may have led to uncertain estimates across age groups; (2) an inability to comprehensively control for all confounding factors, and in particular comorbidities, which are common among individuals with eating disorders—for example, some premature mortality costs may occur due to comorbid psychiatric illness among individuals with eating disorders (Cliffe et al, 2020); (3) the utilization of average group effects across all model inputs (there is inherent variability in costs across individuals and systems in the U.S. that no existing datasets could comprehensively address for the purposes of our study); (4) other limitations in the available epidemiological data precluded a comprehensive analysis of costs across all eating disorder diagnostic groups or major demographic groups (e.g., data on avoidant restrictive food intake disorder are lacking although it has been attracting increasing research attention; see Bourne, Bryant‐Waugh, Cook, & Mandy, 2020); and (5) our inability to estimate costs associated with the longer‐term physical and psychological health sequelae of eating disorders that persist or emerge over time (e.g., reproductive or obstetric complications, osteoporosis, gastrointestinal dysfunction or cancers, etc. ; Mantel, Hirschberg, & Stephansson, 2020; Thornton et al, 2017).…”

Emotion dysregulation and suicidality in eating disorders

“…In fact, in the national US epidemiologic survey, between 17–45% reported a suicide attempt before the onset of their EDs (Udo et al, 2019). Possible explanations for this co‐occurrence include comorbid psychiatric disorders such as depression, bipolar disorder, and substance abuse (Cliffe et al, 2020; Franko & Keel, 2006; Smith, Zuromski, et al, 2018), psychological and personality traits (Bulik et al, 2008; Milos et al, 2004; Pisetsky et al, 2015), self‐image (Andersén & Birgegård, 2017), early cognitive schema (Portzky, van Heeringen, & Vervaet, 2014), interoceptive deficits (Smith, Forrest, & Velkoff, 2018), alexithymia (Carano et al, 2012), and impulsivity (Sagiv & Gvion, 2020). Some of these traits are subsumed under the multidimensional concept of emotion dysregulation (Gratz & Roemer, 2004).…”

Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort

“…This way, we followed procedures used by other published studies in the field. 79 – 81 However, even when following standardised procedures, in many cases we were not able to distinguish between SA and NSSI. In the records, we found that the attending clinicians had difficulties to make this distinction and did not always agree.…”