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Individuals with eating disorders, their relatives have increased risk for attempted suicide

Recent findings indicated an increased risk for suicide attempts among individuals with eating disorders and their relatives, suggesting a familial influence within the association between eating disorders and suicide.

“Based on meta-analyses, approximately one of five premature deaths in patients with [anorexia nervosa] was due to suicide; suicide-specific standardized mortality ratios were estimated to be 18.1 in [anorexia nervosa] and 7.5 in [bulimia nervosa]. However, studies included in the meta-analyses reported considerably varied estimates, possibly owing to differences in follow-up time, source, sample size, and representativeness of the samples,” Shuyang Yao, MSc, of Karolinska Institutet, Stockholm, and colleagues wrote. “Large population-based studies are essential to provide more reliable estimates of the risk of suicide in individuals with eating disorders.”

To investigate the association between eating disorders and suicide attempts and how familial risk factors influence associations, researchers followed a Swedish birth cohort of individuals born between 1979 and 2001 from age 6 years to December 2009 (n = 2,268,786).

Overall, 1.4% (n = 15,457) of females and 0.09% (n = 991) of males had an eating disorder. Specifically, 0.7% (n = 7,680) of females and 0.04% (n = 453) of males had anorexia nervosa and 0.3% (n = 3,349) of females and 0.01% (n = 61) of males had bulimia nervosa.

Individuals with any eating disorder had increased risk for suicide attempts (OR = 5.28; 95% CI, 5.04-5.54) and death by suicide (OR = 5.39; 95% CI, 4-7.25).

When adjusting for comorbid major depressive disorder, anxiety disorder and substance abuse disorder, risk for suicide attempts (aOR = 1.82; 95% CI, 1.72-1.93) and suicide death (aOR = 2.04; 95% CI, 1.49-2.8) was attenuated but remained significant.

Risk was similar for anorexia nervosa (suicide attempts, aOR = 1.7; 95% CI, 1.56-1.85; suicide death, aOR = 2.67; 95% CI, 1.78-4.01) and bulimia nervosa (suicide attempts, aOR = 1.88; 95% CI, 1.68-2.1; suicide death, aOR = 1.48; 95% CI, 0.81-2.72).

Individuals with a sibling with an eating disorder had an increased risk for suicide attempts (OR = 1.41; 95% CI, 1.29-1.53), which was attenuated by an eating disorder in more distant relatives, including maternal half siblings, (OR = 1.1; 95% CI, 0.9-1.34), paternal half siblings (OR = 1.21; 95% CI, 0.98-1.49), full cousins (OR = 1.11; 95% CI, 1.06-1.18), and half cousins,(OR = 0.9; 95% CI, 0.78-1.03).

This familial pattern remained stable when adjusting for eating disorders in index individuals and similar patterns were found for anorexia nervosa and bulimia nervosa, according to researchers.

“To our knowledge, this is one of the largest studies investigating the association between eating disorders and suicide attempts and their coaggregation in families,” the researchers wrote. “The study represents an important step toward understanding the mechanism underlying the association between eating disorders and suicide, and it encourages future studies to distinguish between genetic and environmental risk factors and examine their interaction.” – by Amanda Oldt

Disclosure: Yao reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.