Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Psychiatry, University of North Carolina at Chapel Hill.
JAMA Psychiatry. 2016 Mar;73(3):284-91. doi: 10.1001/jamapsychiatry.2015.2737.
Suicide attempts are common in individuals with eating disorders. More precise understanding of the mechanisms underlying their concomitant occurrence is needed.
To examine the association between eating disorders and suicide attempts and whether familial risk factors contribute to the association.
DESIGN, SETTING, AND PARTICIPANTS: A Swedish birth cohort including individuals born in Sweden between January 1, 1979, and December 31, 2001, was followed up from age 6 years to December 31, 2009 (N = 2,268,786). Information was acquired from Swedish national registers. All individuals were linked to their biological full siblings, maternal half siblings, paternal half siblings, full cousins, and half cousins. Data analysis was conducted from October 5, 2014, to April 28, 2015.
Eating disorders were captured by 3 variables (any eating disorder, anorexia nervosa, and bulimia nervosa) identified by any lifetime diagnoses recorded in the registers. Suicide attempts were defined as any suicide attempts, including death by suicide, recorded in the registers. We examined the association between eating disorders and death by suicide separately, but the study was underpowered to explore familial liability for this association.
Of 2,268,786 individuals, 15,457 females (1.40% of all females) and 991 males (0.09% of all males) had any eating disorder, 7680 females (0.70%) and 453 males (0.04%) had anorexia nervosa, and 3349 females (0.30%), and 61 males (0.01%) had bulimia nervosa. Individuals with any eating disorder had an increased risk (reported as odds ratio [95% CI]) of suicide attempts (5.28 [5.04-5.54]) and death by suicide (5.39 [4.00-7.25]). The risks were attenuated but remained significant after adjusting for comorbid major depressive disorder, anxiety disorder, and substance use disorder (suicide attempts: 1.82 [1.72-1.93]; death by suicide: 2.04 [1.49-2.80]). Similar results were found for anorexia nervosa (suicide attempts: crude, 4.42 [4.12-4.74] vs adjusted, 1.70 [1.56-1.85]; death by suicide: crude, 6.46 [4.38-9.54] vs adjusted, 2.67 [1.78-4.01]) and bulimia nervosa (suicide attempts: crude, 6.26 [5.73-6.85] vs adjusted, 1.88 [1.68-2.10]; death by suicide: crude, 4.45 [2.44-8.11] vs adjusted, 1.48 [0.81-2.72]). Individuals (index) who had a full sibling with any eating disorder had an increased risk of suicide attempts (1.41 [1.29-1.53]). The risk was attenuated for any eating disorder in more-distant relatives (maternal half siblings, 1.10 [0.90-1.34]; paternal half siblings, 1.21 [0.98-1.49]; full cousins, 1.11 [1.06-1.18]; half cousins, 0.90 [0.78-1.03]). This familial pattern remained stable after adjusting for the index individuals' eating disorders. Similar patterns were found for anorexia nervosa and bulimia nervosa.
These results suggest an increased risk of suicide attempts in individuals with lifetime eating disorders and their relatives. The pattern of familial coaggregation suggests familial liability for the association between eating disorders and suicide. Psychiatric comorbidities partially explain this association, suggesting particularly high-risk presentations.
饮食障碍患者自杀企图的发生率很高。需要更精确地了解两者同时发生的机制。
研究饮食障碍与自杀企图之间的关联，以及家族风险因素是否有助于这种关联。
设计、地点和参与者：一项瑞典出生队列研究，纳入了 1979 年 1 月 1 日至 2001 年 12 月 31 日期间在瑞典出生的个体，从 6 岁开始随访至 2009 年 12 月 31 日（n=2268786）。信息来自瑞典国家登记处。所有个体都与他们的生物全同胞、半同胞（母亲）、半同胞（父亲）、全表亲、半表亲相关联。数据分析于 2014 年 10 月 5 日至 2015 年 4 月 28 日进行。
通过登记处记录的任何终身诊断来识别（任何饮食障碍、神经性厌食症和神经性贪食症）的 3 个变量来捕获饮食障碍。自杀企图被定义为登记处记录的任何自杀企图，包括自杀死亡。我们分别研究了饮食障碍与自杀死亡之间的关联，但该研究在探讨这种关联的家族易感性方面能力不足。
在 2268786 名个体中，15457 名女性（所有女性的 1.40%）和 991 名男性（所有男性的 0.09%）患有任何饮食障碍，7680 名女性（0.70%）和 453 名男性（0.04%）患有神经性厌食症，3349 名女性（0.30%）和 61 名男性（0.01%）患有神经性贪食症。患有任何饮食障碍的个体自杀企图（报告为优势比[95%置信区间]）和自杀死亡（报告为优势比[95%置信区间]）的风险增加（自杀企图：5.28[5.04-5.54]；自杀死亡：5.39[4.00-7.25]）。在调整了共病的主要抑郁障碍、焦虑障碍和物质使用障碍后，风险仍然显著（自杀企图：1.82[1.72-1.93]；自杀死亡：2.04[1.49-2.80]）。对于神经性厌食症（自杀企图：未调整，4.42[4.12-4.74] vs 调整，1.70[1.56-1.85]；自杀死亡：未调整，6.46[4.38-9.54] vs 调整，2.67[1.78-4.01]）和神经性贪食症（自杀企图：未调整，6.26[5.73-6.85] vs 调整，1.88[1.68-2.10]；自杀死亡：未调整，4.45[2.44-8.11] vs 调整，1.48[0.81-2.72]），也发现了类似的结果。（索引）有一个全同胞患有任何饮食障碍的个体，自杀企图的风险增加（1.41[1.29-1.53]）。这种风险在更远的亲属中减弱（母亲半同胞，1.10[0.90-1.34]；父亲半同胞，1.21[0.98-1.49]；全表亲，1.11[1.06-1.18]；半表亲，0.90[0.78-1.03]）。在调整了索引个体的饮食障碍后，这种家族模式仍然稳定。对于神经性厌食症和神经性贪食症，也发现了类似的模式。
这些结果表明，饮食障碍患者一生中自杀企图的风险增加，其亲属也是如此。家族聚集的模式表明，饮食障碍与自杀之间存在家族易感性。精神共病部分解释了这种关联，表明存在特别高的高危表现。
