Background
Methods
Study sample
Measures
Diagnostic assessment of EDs and other psychiatric disorders
Suicide attempts (SAs)
Sociodemographic covariates
Statistical analysis
Results
Suicidal attempts in EDs
AN | AN-R | AN-BP | BN | BED | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Yes (n = 276) | No (n = 35,895) | Yes (n = 190) | No (n = 35,895) | Yes (n = 86) | No (n = 35,895) | Yes (n = 92) | No (n = 36,079) | Yes (n = 318) | No (n = 35,853) | |
Reporting a history of suicidal attempts | ||||||||||
% (SE) n (population estimates) | 24.9 (3.12)a 60 (467,671) | 5.0 (0.18) 1935 (11,639,864) | 15.7 (3.51)a 28 (199,926) | 5.0 (0.18) 1935 (11,639,864) | 44.1 (7.39)a 32 (267,745) | 5.0 (0.18) 1935 (11,639,864) | 31.4 (6.06)a 29 (203,732) | 5.1 (0.18) 1966 (11,903,803) | 21.8 (2.72)a 64 (436,375) | 5.0 (0.18) 1931 (11,671,160) |
AORs | 5.42‡ | 3.16‡ | 12.07‡ | 6.34‡ | 4.45‡ | |||||
(95% CIs) | (3.82–7.71) | (1.83–5.44) | (6.29–23.16) | (3.38–11.88) | (3.19–6.22) | |||||
The number of SAs1 | ||||||||||
Total sample | 0.5 (0.10)‡ | 0.09 (0.00) | 0.2 (0.05)‡ | 0.09 (0.00) | 1.1 (0.28)‡ | 0.1 (0.00) | 0.7 (0.24)‡ | 0.09 (0.00) | 0.6 (0.11)‡ | 0.09 (0.00) |
With SA history | 2.2 (0.40) | 1.8 (0.08) | 1.6 (0.23) | 1.8 (0.08) | 2.6 (0.68) | 1.8 (0.08) | 2.5 (0.61) | 1.8 (0.08) | 2.8 (0.40)† | 1.8 (0.08) |
Age of first attempt2 | 23.2 (1.60) | 23.8 (0.15) | 24.1 (2.45) | 23.8 (0.31) | 22.6 (1.93) | 23.8 (0.31) | 22.4 (1.70) | 23.8 (0.31) | 25.2 (1.49) | 23.8 (0.30) |
Sociodemographic and clinical characteristics of EDs by SA history
AN | AN-R | AN-BP | BN | BED | ||||||
---|---|---|---|---|---|---|---|---|---|---|
SA Yes (n = 60) | SA No (n = 216) | SA Yes (n = 28) | SA No (n = 162) | SA Yes (n = 32) | SA No (n = 54) | SA Yes (n = 29) | SA No (n = 63) | SA Yes (n = 64) | SA No (n = 254) | |
Current age (in years) | 38.7 (1.92) | 42.9 (1.11) | 40.5 (2.65) | 43.5 (1.25) | 37.3 (2.49) | 41.0 (2.48) | 34.2 (3.23) | 39.5 (2.58) | 38.9 (2.31)† | 44.9 (1.24) |
% female | 89.1 (5.02) | 93.6 (1.64) | 86.7 (7.58)† | 94.6 (1.67) | 90.8 (1.94) | 90.4 (2.62) | 89.6 (6.80) | 87.3 (4.41) | 84.0 (4.49) | 73.9 (3.10) |
Race/ethnicity | ||||||||||
Non-Hispanic White | 79.0 (7.27) | 79.3 (2.72) | 91.6 (3.88) | 80.8 (2.84) | 69.6 (10.43) | 74.4 (4.34) | 72.1 (7.76) | 74.9 (3.41) | 72.8 (5.55) | 73.5 (3.37) |
Non-Hispanic Black | 4.0 (1.50) | 2.3 (0.75) | 3.7 (1.82) | 2.8 (0.96) | 4.2 (0.78) | 0.8 (0.13) | 4.0 (0.79) | 10.8 (1.89) | 6.1 (3.58) | 9.3 (1.99) |
Hispanic | 3.9 (1.66) | 10.0 (1.51) | 1.2 (0.21) | 9.1 (1.81) | 6.0 (1.10) | 12.7 (3.11) | 15.1 (6.79) | 11.8 (2.41) | 14.7 (5.10) | 12.5 (2.04) |
Other | 13.0 (7.47) | 8.4 (2.21) | 3.5 (3.45) | 7.3 (2.13) | 20.2 (11.48) | 12.1 (2.31) | 8.8 (4.57) | 8.8 (4.57) | 6.4 (3.15) | 4.7 (1.84) |
Education | ||||||||||
< High school | 13.6 (4.89) | 5.7 (1.40) | 24.1 (8.91) | 6.1 (1.65) | 5.8 (4.20) | 4.4 (1.67) | 12.5 (3.68) | 9.3 (1.42) | 14.1 (4.01) | 11.6 (1.95) |
High school or GED | 17.8 (5.71) | 14.6 (2.22) | 9.7 (3.76) | 11.3 (2.08) | 23.8 (7.27) | 24.8 (4.42) | 20.8 (7.03) | 17.6 (2.13) | 22.6 (5.52) | 21.7 (2.45) |
Some college+ | 68.6 (7.01) | 79.7 (2.49) | 66.1 (8.72) | 82.6 (2.42) | 70.4 (8.43) | 70.7 (4.83) | 66.7 (7.65) | 73.1 (2.69) | 63.3 (6.40) | 66.8 (3.61) |
Income level | ||||||||||
< $25,000 | 26.0 (5.50) | 13.6 (2.36) | 22.0 (7.22) | 11.4 (2.06) | 29.0 (7.24) | 20.5 (6.09) | 24.0 (5.34) | 30.0 (3.09) | 26.3 (5.38) | 26.2 (2.61) |
$25,000–39,999 | 17.2 (5.52) | 11.6 (1.86) | 21.0 (8.31) | 10.4 (1.74) | 14.4 (4.77) | 15.5 (4.75) | 18.0 (3.67) | 13.0 (3.18) | 20.3 (5.41) | 16.6 (2.51) |
$40,000–69,999 | 42.5 (7.77) | 25.7 (2.78) | 41.4 (8.15) | 25.6 (3.11) | 43.4 (9.30) | 26.3 (4.09) | 49.1 (8.8)† | 20.6 (2.46) | 33.9 (6.61) | 23.0 (2.93) |
≥ $70,000 | 14.2 (4.92)† | 49.0 (3.26) | 15.5 (8.09) | 52.6 (3.37) | 13.2 (6.13) | 37.7 (5.57) | 8.9 (5.20)† | 36.4 (5.25) | 19.4 (5.05) | 34.2 (3.84) |
Age of ED onset | 18.7 (0.16) | 19.0 (0.03) | 19.3 (0.15) | 18.2 (0.08) | 18.7 (1.37) | 20.2 (1.20) | 18.2 (0.76)‡ | 20.3 (0.69) | 23.5 (0.39)† | 24.4 (0.39) |
Years with ED episodes | 13.9 (0.12)‡ | 11.4 (0.13) | 12.2 (0.95) | 11.3 (0.55) | 14.1 (0.80)‡ | 10.5 (0.63) | 12.8 (0.18)† | 13.4 (0.17) | 14.1 (1.02) | 14.4 (0.29) |
Current BMI | 26.3 (1.03) | 25.4 (0.86) | 25.9 (0.49) | 25.4 (0.61) | 25.5 (1.60) | 25.9 (1.22) | 28.6 (1.35) | 29.0 (0.94) | 34.6 (1.36) | 33.4 (0.69) |
Lowest BMI | 16.5 (0.25)† | 17.3 (0.21) | 16.8 (0.25) | 17.0 (0.21) | 16.6 (0.32)‡ | 17.5 (0.27) | 21.0 (0.50)‡ | 23.1 (0.27) | 23.3 (0.70)† | 25.0 (0.47) |
Interfere with normal daily activities | ||||||||||
% (SE) | 30.2 (7.72)† | 16.4 (2.42) | 9.9 (4.69) | 11.8 (2.35) | 45.4 (10.14) | 30.7 (4.84) | 68.4 (9.68) | 49.9 (5.41) | 44.0 (6.19) | 54.4 (3.98) |
Serious problems getting along with others | ||||||||||
% (SE) | 28.5 (8.08) | 16.2 (2.67) | 10.8 (4.68) | 14.3 (2.80) | 41.6 (10.78) | 22.2 (4.65) | 33.5 (8.95) | 32.6 (2.91) | 18.7 (6.23) | 18.6 (2.78) |
Serious problems fulfilling responsibilities | ||||||||||
% (SE) | 24.8 (7.30)† | 9.5 (1.77) | 6.1 (3.98) | 5.5 (1.57) | 38.8 (9.92) | 21.9 (3.90) | 54.6 (13.25)† | 27.7 (3.92) | 17.5 (5.76) | 26.8 (3.45) |
Any form | ||||||||||
% (SE) | 36.8 (8.09) | 24.8 (3.20) | 19.8 (6.36) | 18.9 (3.18) | 49.4 (10.81) | 43.2 (5.87) | 76.8 (8.53) | 58.4 (5.75) | 44.0 (6.19) | 54.9 (3.98) |
Lifetime comorbid DSM-5 psychiatric diagnosis by SA history
AN | AN-R | AN-BP | BN | BED | ||||||
---|---|---|---|---|---|---|---|---|---|---|
SA Yes (n = 60) | SA No (n = 216) | SA Yes (n = 28) | SA No (n = 162) | SA Yes (n = 32) | SA No (n = 54) | SA Yes (n = 63) | SA No (n = 29) | SA Yes (n = 64) | SA No (n = 254) | |
Any mood disorders | 86.4 (5.37) | 43.5 (2.82) | 81.7 (7.52) | 38.7 (3.32) | 89.9 (7.09) | 58.6 (5.55) | 96.0 (2.96) | 72.0 (4.57) | 88.1 (3.01) | 64.9 (3.09) |
Major depressive disorder | 83.1 (5.98) | 38.4 (3.06) | 74.1 (9.04) | 36.0 (3.19) | 89.9 (7.09) | 46.0 (6.48) | 96.0 (2.96) | 67.3 (4.75) | 88.1 (3.01) | 59.3 (3.14) |
Persistent depression | 46.9 (7.85) | 14.2 (2.05) | 50.2 (8.39) | 12.2 (1.89) | 44.4 (9.10) | 20.7 (3.05) | 56.5 (9.29) | 24.8 (6.18) | 53.7 (6.85) | 27.0 (3.05) |
Bipolar I | 21.3 (6.75) | 3.7 (1.68) | 19. (7.90) | 2.8 (0.98) | 22.8 (6.83) | 6.5 (0.84) | 32.1 (11.11) | 4.3 (0.37) | 24.9 (6.08) | 4.2 (1.52) |
Any anxiety disorders | 58.8 (8.04) | 34.4 (2.85) | 45.1 (8.81) | 33.5 (2.35) | 69.1 (9.45) | 37.3 (5.52) | 60.5 (11.17) | 37.3 (5.85) | 76.1 (5.21) | 54.2 (3.29) |
Panic disorder | 36.3 (7.73) | 16.0 (2.47) | 23.1 (8.61) | 14.0 (1.69) | 46.1 (9.75) | 22.0 (3.33) | 32.2 (11.09) | 11.2 (2.52) | 45.7 (5.83) | 16.1 (2.16) |
Agoraphobia | 17.7 (7.74) | 8.6 (2.32) | 9.3 (7.21) | 5.6 (1.80) | 23.9 (11.27) | 18.0 (3.85) | 13.6 (2.46) | 8.0 (2.27) | 23.6 (4.78) | 10.6 (1.92) |
Social anxiety disorder | 18.1 (5.57) | 5.6 (1.35) | 14.6 (7.39) | 4.8 (1.07) | 20.6 (3.80) | 8.0 (3.80) | 22.8 (6.77) | 10.1 (2.18) | 30.7 (5.53) | 17.8 (3.00) |
Specific phobia | 24.7 (7.74) | 12.2 (2.38) | 13.7 (4.82) | 12.2 (2.20) | 32.9 (10.25) | 12.3 (3.02) | 20.8 (7.19) | 11.5 (3.65) | 20.5 (5.06) | 25.5 (2.89) |
General anxiety disorder | 31.8 (7.95) | 18.7 (2.39) | 22.1 (7.55) | 17.3 (1.52) | 39.1 (10.74) | 23.1 (4.52) | 27.9 (9.82) | 24.9 (5.63) | 41.1 (6.29) | 30.7 (2.69) |
Posttraumatic stress disorder | 49.5 (7.91) | 13.8 (2.79) | 37.0 (8.90) | 11.3 (2.86) | 58.9 (8.49) | 21.5 (4.15) | 57.1 (13.19) | 21.2 (2.63) | 58.4 (7.31) | 24.1 (2.41) |
Any substance use disorder | 82.9 (4.80) | 52.8 (3.45) | 91.2 (4.58) | 45.4 (4.27) | 76.7 (5.84) | 76.1 (4.71) | 82.1 (3.74) | 60.0 (5.92) | 75.9 (6.04) | 65.4 (3.08) |
Alcohol use disorder | 72.8 (5.90) | 41.4 (2.76) | 71.0 (8.77) | 34.2 (3.23) | 74.2 (6.40) | 64.1 (5.81) | 79.9 (4.85) | 52.3 (5.79) | 61.3 (6.08) | 49.4 (3.29) |
Nicotine use disorder | 59.1 (9.01) | 31.7 (3.79) | 77.4 (8.40) | 26.4 (4.44) | 45.5 (8.93) | 48.2 (6.89) | 68.5 (9.97) | 30.7 (3.23) | 50.9 (5.87) | 37.3 (3.42) |
Other drug use disorder | 37.1 (6.74) | 11.2 (1.89) | 39.8 (9.45) | 6.5 (2.00) | 35.1 (7.16) | 25.9 (4.32) | 45.2 (10.92) | 22.4 (4.25) | 39.0 (6.61) | 20.8 (2.30) |
Any personality or conduct disorder | 73.3 (8.47) | 22.5 (2.76) | 57.3 (8.19) | 16.9 (2.60) | 85.2 (5.78) | 40.4 (5.42) | 78.7 (14.13) | 38.4 (3.90) | 81.5 (4.83) | 48.9 (3.48) |
Antisocial | 18.6 (5.61) | 5.5 (1.81) | 16.4 (6.74) | 2.2 (0.97) | 20.1 (4.85) | 15.9 (3.63) | 22.5 (7.17) | 5.2 (1.89) | 30.7 (5.65) | 11.7 (2.10) |
Borderline | 62.1 (8.86) | 19.7 (2.79) | 48.6 (8.50) | 13.8 (2.44) | 72.2 (8.94) | 38.4 (5.45) | 77.2 (14.01) | 34.6 (4.06) | 77.6 (4.90) | 41.3 (3.77) |
Schizotypal | 40.7 (7.71) | 9.1 (2.04) | 24.7 (8.24) | 5.2 (1.19) | 52.6 (9.62) | 21.1 (4.35) | 40.3 (9.61) | 17.4 (3.23) | 36.9 (5.70) | 25.3 (3.05) |
Conduct | 24.3 (6.26) | 5.7 (1.82) | 29.9 (9.35) | 2.5 (1.02) | 20.1 (4.85) | 15.9 (3.63) | 22.5 (7.17) | 8.7 (1.99) | 30.7 (5.65) | 12.0 (2.12) |
AN | AN-R | AN-BP | BN | BED | |
---|---|---|---|---|---|
Any mood disorders | 8.60 (3.13–23.64)‡ | 6.74 (1.95–23.26)‡ | 8.32 (1.72–40.15)† | 13.30 (1.71–103.34)† | 3.49 (1.77–6.88)‡ |
Major depressive disorder | 9.03 (3.36–24.28)‡ | 6.17 (2.06–18.46)‡ | 15.06 (2.67–84.89)‡ | 14.39 (2.05–100.99)‡ | 4.32 (2.18–8.55)‡ |
Persistent depression | 5.29 (2.47–11.35)‡ | 5.55 (2.54–12.09)‡ | 3.63 (1.27–10.35)† | 7.68 (2.82–20.90)‡ | 3.36 (1.82–6.20)‡ |
Bipolar I | 5.42 (1.30–22.64)† | 6.56 (1.97–21.80)‡ | 1.73 (0.36–8.40) | 25.40 (10.96–58.87)‡ | 6.73 (2.58–17.55)‡ |
Any anxiety disorders | 2.60 (1.27–5.33)† | 1.63 (0.75–3.56) | 3.48 (1.34–9.03)† | 3.78 (1.16–12.34)† | 2.72 (1.39–5.32)‡ |
Panic disorder | 2.38 (1.19–4.57)† | 1.23 (0.57–2.69) | 2.07 (1.04–4.10)† | 3.68 (1.34–10.09)† | 4.21 (2.33–7.60)‡ |
Agoraphobia | 2.03 (0.66–6.27) | – | 1.07 (0.29–3.99) | – | 2.88 (1.45–5.74)‡ |
Social anxiety disorder | 2.06 (0.80–5.32) | 1.71 (0.56–5.21) | 2.50 (0.53–11.86) | – | 2.02 (1.04–3.92)‡ |
Specific phobia | 2.64 (1.00–6.96)† | 1.15 (0.45–2.97) | 3.26 (1.17–9.06)† | 3.86 (1.66–9.00)‡ | 0.73 (0.34–1.54) |
General anxiety disorder | 1.99 (0.91–4.37) | – | 2.03 (0.61–6.76) | 2.02 (0.62–6.56) | 1.67 (0.91–3.09) |
Posttraumatic stress disorder | 5.71 (2.73–11.92)‡ | 4.78 (1.80–12.70)‡ | 4.88 (2.22–10.70)‡ | 12.84 (4.70–35.06)‡ | 4.27 (2.02–8.99)‡ |
Any substance use disorder | 3.33 (1.65–6.71)‡ | 10.38 (2.84–37.85)‡ | 0.83 (0.29–2.32) | 2.26 (1.13–4.51)† | 1.64 (0.78–3.47) |
Alcohol use disorder | 3.53 (1.82–6.84)‡ | 6.27 (2.33–16.89)‡ | 1.55 (0.56–4.27) | 3.05 (1.50–6.24)‡ | 1.63 (0.93–2.86) |
Nicotine use disorder | 2.24 (0.90–5.55) | 7.70 (2.59–22.92)‡ | 0.45 (0.13–1.50) | 4.01 (0.97–16.49) | 1.45 (0.84–2.50) |
Other drug use disorder | 4.59 (2.30–9.14)‡ | 12.57 (3.12–50.68)‡ | 1.37 (0.48–3.89) | 2.41 (0.74–7.84) | 2.17 (1.15–4.10)† |
Any personality or conduct disorder | 6.85 (2.84–16.53)‡ | 4.52 (1.97–10.37)‡ | 7.80 (3.06–19.86)‡ | 15.49 (3.30–72.67)‡ | 4.82 (2.29–10.16)‡ |
Antisocial | 3.17 (1.21–8.30)† | 15.45 (2.29–104.00)‡ | 1.21 (0.38–3.80) | 11.39 (2.94–44.08)‡ | 4.15 (2.09–8.22)‡ |
Borderline | 4.54 (1.93–10.68)‡ | 3.52 (1.45–8.57)‡ | 3.36 (0.99–11.38) | 11.89 (3.22–43.97)‡ | 4.93 (2.33–10.46)‡ |
Schizotypal | 6.32 (2.45–16.32)‡ | 4.60 (1.86–11.37)‡ | 3.90 (1.22–12.53)† | 3.72 (1.14–9.60)‡ | 1.61 (0.84–3.11) |
Conduct | 4.27 (1.68–10.87)† | 20.45 (3.52–118.96)‡ | 1.21 (0.38–3.80) | 5.41 (1.59–18.46)† | 3.99 (2.01–7.90)‡ |
Temporal relationship between EDs and SA
AN (n = 60) | AN-R (n = 28) | AN-BP (n = 32) | BN (n = 29) | BED (n = 64) | |
---|---|---|---|---|---|
ED onset first (% [SE]) 95% confidence limits | 50.4 (6.87) | 44.4 (3.04) | 54.9 (6.35) | 47.6 (10.6) | 71.2 (4.47)† |
(35.3–65.5) | (34.7–54.0) | (37.2–72.5) | (18.3–76.9) | (61.6–80.8) | |
SAs first (% [SE]) 95% confidence limits | 44.1 (6.73) | 43.6 (3.24) | 44.5 (6.32) | 17.5 (2.41) | 26.6 (4.65) |
(29.3–58.9) | (33.3–53.9) | (27.0–62.0) | (10.9–24.2) | (16.6–36.6) | |
Both in the same year (% [SE]) 95% confidence limits | 5.5 (1.71) | 12.1 (4.02) | 0.63 (0.04) | 34.9 (11.7) | 2.2 (0.70) |
(1.7–9.3) | (0.00–24.8) | (0.51–0.75) | (2.3–67.5) | (0.7–3.7) |