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Cited by 123Eating Disorders and BehaviorsSuicide and Self-Harm StudiesNutrition, Health and Food Behavior

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

Open access
Udo, Tomoko, Bitley, Sarah, Grilo, Carlos M.·2019·BMC Medicine
DOI 10.1186/s12916-019-1352-3PMC PMC6591971
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Abstract

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.

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  • Emerging research worldwide has indicated the prevalence of BED relative to other eating disorders and established the clinical and public health significance of this diagnostic construct.

    “Emerging research worldwide has indicated the prevalence of BED relative to other eating disorders and established the clinical and public health significance of this diagnostic construct [89, 90].”

    From Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies (2020) · cites this paper as [90]

    The Discussion (page unavailable) reports that 22.9% of US adults with lifetime BED had attempted suicide and that their adjusted odds of an attempt were 4.83 times those of adults without a specific eating-disorder diagnosis, supporting BED’s clinical significance. The paper does not establish BED’s prevalence relative to both other eating disorders worldwide: its study is limited to US adults, and the comparative percentages concern suicide attempts, not the prevalence of the disorders. (LLM, conf=0.83)

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  1. [36]Grant BF Goldstein RB Chou SP Saha TD Ruan WJ Huang B Smith SM Zhang H Jung J Pickering RP The alcohol use disorder and associated disabilities interview schedule-diagnostic and statistical manual of mental disorders, fifth edition version (AUDADIS-5) 2011 Rockville National Institute on Alcohol Abuse and Alcoholism

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Authors
Udo, T., Bitley, S., & Grilo, C. M.
Affiliations
  • State University of New York (US)
  • University at Albany, State University of New York (US)
  • Yale University (US)
Corresponding author
Udo, Tomoko
ORCID
Venue
BMC Medicine
Publisher
Springer Science and Business Media LLC
Published
2019-06-25
Volume
17
Issue
1
Pages
120-120
ISSN
1741-7015 (ISSN-L)
DOI
10.1186/s12916-019-1352-3
PMC
PMC6591971
OpenAlex
W2951686557
Cited by
123
References
54
Citations by year
2026: 5 · 2025: 14 · 2024: 18 · 2023: 25 · 2022: 21 · 2021: 20 · 2020: 18 · 2019: 1
FWCI
17.52
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institutes of Health (UL1TR001863)
  • National Institute on Alcohol Abuse and Alcoholism
  • National Institute of Diabetes and Digestive and Kidney Diseases
  • National Center for Advancing Translational Sciences
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
suicide attempts, eating disorders, anorexia nervosa, bulimia nervosa, binge eating disorder, anorexia nervosa subtypes, psychiatric comorbidity, psychosocial impairment, age of onset, suicide risk, adults, prevalence, NESARC-III
MeSH terms
Adult, Feeding and Eating Disorders, Female, Humans, Male, Suicide, Attempted, United States, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders, Young Adult

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