Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan.
Int J Eat Disord. 2020 Feb;53(2):229-238. doi: 10.1002/eat.23188. Epub 2019 Oct 22.
To examine suicide risk by eating disorder severity and symptom presentation in a nationwide sample of college students.
The Healthy Minds Study is the largest mental health survey of college populations in the United States. We analyzed the most recent available data (2015-2017) with 71,712 randomly selected students from 77 campuses. We estimated associations between two measures of suicidality (ideation and attempts) and three validated measures of eating disorder symptoms (the SCOFF, weight concerns scale, and the eating disorder examination questionnaire binge and purge items). Importantly, we also controlled for co-occurring symptoms of depression and anxiety, based on validated screening tools. The large, diverse sample provided a unique opportunity to assess whether certain individual characteristics were associated with increased risk.
Eating disorder symptoms, even at subthreshold levels, were highly predictive of suicidality. Relative to students with no apparent eating disorder symptoms, students with the highest symptom levels (a SCOFF score of 5) had 11 times higher odds of attempting suicide, while those with subthreshold symptoms had two times higher odds. We also observed a strong association between suicide attempts and eating disorder presentations that included purging. Students from marginalized backgrounds, particularly gender and sexual minorities, were at increased risk for suicide and eating disorders.
In the largest known study to date, findings suggest that eating disorders should be a priority within broader campus suicide prevention efforts, should be assessed along a continuum of severity and symptom presentation, and should focus on reaching vulnerable students.
在全国大学生样本中，检查饮食障碍严重程度和症状表现与自杀风险的关系。
健康思维研究是美国针对大学生群体进行的最大规模心理健康调查。我们分析了最近（2015-2017 年）可用的数据，该数据来自 77 所校园的 71712 名随机学生。我们评估了两种自杀意念测量指标（想法和尝试）与三种经过验证的饮食障碍症状测量指标（SCOFF、体重关注量表和饮食障碍检查问卷暴食和清除项目）之间的关联。重要的是，我们还根据经过验证的筛查工具，控制了共病的抑郁和焦虑症状。这个大型、多样化的样本为评估某些个体特征是否与增加的风险相关提供了独特的机会。
即使是亚临床水平的饮食障碍症状也与自杀意念高度相关。与没有明显饮食障碍症状的学生相比，症状水平最高（SCOFF 评分为 5）的学生自杀尝试的几率高 11 倍，而有亚临床症状的学生自杀尝试的几率高 2 倍。我们还观察到自杀尝试与包括清除在内的饮食障碍表现之间存在强烈关联。边缘化背景的学生，特别是性别和性少数群体，自杀和饮食障碍的风险增加。
在迄今为止最大规模的已知研究中，研究结果表明，饮食障碍应该成为更广泛的校园自杀预防工作的重点，应该沿着严重程度和症状表现的连续体进行评估，并应重点关注脆弱的学生。
