Eating disorders, psychiatric comorbidities, and suicide

Abstract

Background: Evidence suggests a strong association between eating disorders and suicidality, including suicidal ideation and suicide attempts. However, whether eating disorders independently increase the risk of suicide remains unclear.

Methods: From Taiwan's National Health Insurance Research Database, we collected the data (2003-2017) of 18,284 patients with eating disorders (case group). Among these patients, 2035 (11.13 %) had anorexia nervosa, 10,658 (58.29 %) had bulimia nervosa, and 5591 (30.58 %) had other eating disorders. These patients were matched (1:4; by age [birth year] and sex) with 73,136 individuals without eating disorders (control group). For both groups, the rates of suicide over the same period were estimated using data from the Database of All-Cause Mortality.

Results: A time-dependent Cox regression model, which was adjusted for demographic characteristics, psychiatric comorbidities, and Charlson Comorbidity Index scores, indicated that the risk of suicide was higher in the case group (hazard ratio [HR]: 2.51), particularly among patients with bulimia nervosa (HR: 2.59) or other eating disorders (HR: 2.31), than in the control group. After adjustments for psychiatric comorbidities, the association between anorexia nervosa and suicide became nonsignificant. Eating disorder-related psychiatric comorbidities, particularly depressive disorder (HR: 15.89), further increased the risk of suicide in the case group.

Conclusion: Eating disorders, particularly bulimia nervosa and other eating disorders, serve as independent risk factors for suicide, regardless of psychiatric comorbidities. Thus, clinicians and mental health providers should develop suicide prevention strategies targeting eating disorders.

Keywords: Anorexia nervosa; Bulimia nervosa; Eating disorder; Psychiatric comorbidity; Suicide; Taiwan.