Perera Stefan, Eisen Rebecca B, Dennis Brittany B, Bawor Monica, Bhatt Meha, Bhatnagar Neera, Thabane Lehana, de Souza Russell, Samaan Zainab
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.
Suicide Life Threat Behav. 2016 Dec;46(6):697-736. doi: 10.1111/sltb.12244. Epub 2016 Apr 20.
Public health concerns for the independent management of obesity and suicidal behavior are rising. Emerging evidence suggests body weight plays an important role in quantifying the risk of suicide. In light of these findings, we aimed to clarify the association between body mass index (BMI) and suicidal behavior by systematically reviewing and evaluating the literature. Studies were identified by searching MEDLINE, EMBASE, PsycINFO, and CINAHL from inception to January 2015, supplemented by hand and grey literature searches. Study screening, data extraction, and risk of bias assessment were conducted in duplicate. We included 38 observational studies. Meta-analyses supported an inverse association between BMI and completed suicide. Pooled summary estimates demonstrated that underweight was significantly associated with an increased risk of completed suicide (HR = 1.21, 95% CI 1.07 to 1.36, p = .002), and obesity (HR = 0.71, 95% CI 0.56 to 0.89, p = .003) and overweight (HR = 0.78, 95% CI 0.75 to 0.82, p < .0001) were significantly associated with a decreased risk of completed suicide relative to normal weight. A qualitative summary of the literature demonstrated conflicting evidence regarding the association between BMI and attempted suicide and revealed no association between BMI and suicidal ideation. BMI may be used to aid the assessment of suicide risk, especially that of completed suicide. However, unmeasured confounders and systematic biases of individual studies limit the quality of evidence.
肥胖与自杀行为独立管理引发的公共卫生问题日益受到关注。新出现的证据表明，体重在量化自杀风险方面起着重要作用。鉴于这些发现，我们旨在通过系统回顾和评估文献来阐明体重指数（BMI）与自杀行为之间的关联。通过检索MEDLINE、EMBASE、PsycINFO和CINAHL数据库，从建库至2015年1月获取相关研究，并辅以手工检索和灰色文献检索。研究筛选、数据提取和偏倚风险评估均由两人独立进行。我们纳入了38项观察性研究。荟萃分析支持BMI与自杀死亡之间存在负相关。汇总的总结估计表明，体重过轻与自杀死亡风险增加显著相关（HR = 1.21，95%CI 1.07至1.36，p = 0.002），与正常体重相比，肥胖（HR = 0.71，95%CI 0.56至0.89，p = 0.003）和超重（HR = 0.78，95%CI 0.75至0.82，p < 0.0001）与自杀死亡风险降低显著相关。文献的定性总结表明，关于BMI与自杀未遂之间的关联存在相互矛盾的证据，且未发现BMI与自杀意念之间存在关联。BMI可用于辅助自杀风险评估，尤其是自杀死亡风险评估。然而，个体研究中未测量的混杂因素和系统偏倚限制了证据质量。
