Chen Li-Chi, Bai Ya-Mei, Tsai Shih-Jen, Cheng Chih-Ming, Chen Mu-Hong
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan.
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Affect Disord. 2025 Aug 1;382:290-295. doi: 10.1016/j.jad.2025.04.090. Epub 2025 Apr 23.
Evidence suggests a strong association between eating disorders and suicidality, including suicidal ideation and suicide attempts. However, whether eating disorders independently increase the risk of suicide remains unclear.
From Taiwan's National Health Insurance Research Database, we collected the data (2003-2017) of 18,284 patients with eating disorders (case group). Among these patients, 2035 (11.13 %) had anorexia nervosa, 10,658 (58.29 %) had bulimia nervosa, and 5591 (30.58 %) had other eating disorders. These patients were matched (1:4; by age [birth year] and sex) with 73,136 individuals without eating disorders (control group). For both groups, the rates of suicide over the same period were estimated using data from the Database of All-Cause Mortality.
A time-dependent Cox regression model, which was adjusted for demographic characteristics, psychiatric comorbidities, and Charlson Comorbidity Index scores, indicated that the risk of suicide was higher in the case group (hazard ratio [HR]: 2.51), particularly among patients with bulimia nervosa (HR: 2.59) or other eating disorders (HR: 2.31), than in the control group. After adjustments for psychiatric comorbidities, the association between anorexia nervosa and suicide became nonsignificant. Eating disorder-related psychiatric comorbidities, particularly depressive disorder (HR: 15.89), further increased the risk of suicide in the case group.
Eating disorders, particularly bulimia nervosa and other eating disorders, serve as independent risk factors for suicide, regardless of psychiatric comorbidities. Thus, clinicians and mental health providers should develop suicide prevention strategies targeting eating disorders.
有证据表明饮食失调与自杀行为之间存在密切关联，包括自杀意念和自杀未遂。然而，饮食失调是否会独立增加自杀风险仍不明确。
我们从台湾国民健康保险研究数据库中收集了18284例饮食失调患者（病例组）的数据（2003 - 2017年）。在这些患者中，2035例（11.13%）患有神经性厌食症，10658例（58.29%）患有神经性贪食症，5591例（30.58%）患有其他饮食失调症。这些患者与73136名无饮食失调症的个体（对照组）按年龄（出生年份）和性别进行1:4匹配。对于两组，使用全因死亡率数据库的数据估计同期的自杀率。
一个根据人口统计学特征、精神疾病共病情况和查尔森合并症指数评分进行调整的时间依赖性Cox回归模型表明，病例组的自杀风险更高（风险比[HR]：2.51），尤其是神经性贪食症患者（HR：2.59）或其他饮食失调症患者（HR：2.31），高于对照组。在对精神疾病共病情况进行调整后，神经性厌食症与自杀之间的关联变得不显著。与饮食失调相关的精神疾病共病，尤其是抑郁症（HR：15.89），进一步增加了病例组的自杀风险。
饮食失调，尤其是神经性贪食症和其他饮食失调症，是自杀的独立危险因素，无论是否存在精神疾病共病。因此，临床医生和心理健康服务提供者应制定针对饮食失调症的自杀预防策略。
