Lee Joonyub, Lee Seung-Hwan, Kim Mee-Kyoung, Kwon Hyuk-Sang, Yun Jae-Seung, Yang Yeoree, Yoon Kun-Ho, Cho Jae-Hyoung, Pae Chi-Un, Han Kyungdo, Son Jang Won
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
BMC Psychiatry. 2025 Jan 8;25(1):27. doi: 10.1186/s12888-024-06381-z.
Suicide is a significant yet preventable public health issue. Body mass index (BMI) is a readily measurable indicator associated with various health outcomes. However, the relationship between BMI and suicidal death risk is complex and warrants further investigation, particularly within contemporary, non-Western contexts with consideration of potential confounders. The purpose of this study was to investigate the relationship between BMI and the risk of suicidal death.
This study was nationwide, retrospective, observational study based on Korean National Health Insurance Service database. We analyzed 4,045,081 participants who were aged > 19 years and underwent national health surveillance in 2009. The participants were categorized according to their BMI (underweight: < 18.5 kg/m², normal weight: 18.5-23 kg/m², overweight: 23-25 kg/m², class I obesity: 25-30 kg/m², and class II obesity: > 30 kg/m²). The primary outcome was the death events caused by suicide which was defined by International Classification of Disorders (ICD-10) codes (X60-X84) and death records documented by the Korea National Statistical Office. Multivariate Cox proportional hazard regression analysis was performed to estimate the risk of suicidal death with respect to BMI categories after adjusting for potential confounders (age, sex, income, diabetes, hypertension, dyslipidemia, smoking, drinking, exercise, self-abuse, waist circumference, schizophrenia, bipolar disorder, eating disorder, cancer, anxiety, and substance use disorder).
Underweight individuals had an increased risk (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.31-1.57) while overweight (HR 0.79, 95% CI 0.76-0.83), class I (HR 0.76, 95% CI 0.71-0.80) and class II obesity (HR 0.71, 95% CI 0.63-0.81) were associated with decreased risks of suicidal deaths compared to those of the normal weight individuals (BMI 18.5-23). This trend was consistent regardless of the presence of major depressive disorder (MDD) or the type of living arrangements of the participants.
Suicidal death risk was inversely correlated with BMI categories, independent of MDD or living arrangements. Our data suggests the importance of physiological factors associated with body mass in understanding suicidal death risk. Furthermore, these data provide valuable insights to where the public health resources should be invested to reduce suicidal death rates.
自杀是一个重大但可预防的公共卫生问题。体重指数（BMI）是一个易于测量的指标，与各种健康结果相关。然而，BMI与自杀死亡风险之间的关系很复杂，值得进一步研究，特别是在当代非西方背景下，并考虑潜在的混杂因素。本研究的目的是调查BMI与自杀死亡风险之间的关系。
本研究是一项基于韩国国民健康保险服务数据库的全国性回顾性观察研究。我们分析了2009年年龄大于19岁且接受国家健康监测的4,045,081名参与者。参与者根据其BMI进行分类（体重过轻：<18.5kg/m²，正常体重：18.5-23kg/m²，超重：23-25kg/m²，I类肥胖：25-30kg/m²，II类肥胖：>30kg/m²）。主要结局是由自杀导致的死亡事件，由国际疾病分类（ICD-10）编码（X60-X84）和韩国国家统计局记录的死亡记录定义。在调整潜在混杂因素（年龄、性别、收入、糖尿病、高血压、血脂异常、吸烟、饮酒、运动、自我伤害、腰围、精神分裂症、双相情感障碍、饮食失调、癌症、焦虑和物质使用障碍）后，进行多变量Cox比例风险回归分析以估计BMI类别与自杀死亡风险的关系。
与正常体重个体（BMI 18.5-23）相比，体重过轻的个体风险增加（风险比[HR] 1.44，95%置信区间[CI] 1.31-1.57），而超重（HR 0.79，95% CI 0.76-0.83）、I类（HR 0.76，95% CI 0.71-0.80）和II类肥胖（HR 0.71，95% CI 0.63-0.81）与自杀死亡风险降低相关。无论是否存在重度抑郁症（MDD）或参与者的生活安排类型如何，这种趋势都是一致的。
自杀死亡风险与BMI类别呈负相关，独立于MDD或生活安排。我们的数据表明与体重相关的生理因素在理解自杀死亡风险方面的重要性。此外，这些数据为应在何处投入公共卫生资源以降低自杀死亡率提供了有价值的见解。
