Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-28T18:06:14.306Z Has data issue: false hasContentIssue false
  • English
  • Français

Body mass index in midlife and risk of attempted suicide and suicide: prospective study of 1 million UK women

Published online by Cambridge University Press:  29 November 2018

Galit Geulayov ,
Anne Ferrey ,
Keith Hawton ,
Carol Hermon ,
Gillian K. Reeves ,
Jane Green ,
Valerie Beral ,
Sarah Floud  and
for the Million Women Study Collaborators
Galit Geulayov
Affiliation:
Department of Psychiatry, University of Oxford, Oxford, UK
Anne Ferrey
Affiliation:
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Keith Hawton
Affiliation:
Department of Psychiatry, University of Oxford, Oxford, UK
Carol Hermon
Affiliation:
Nuffield Department of Population Health, University of Oxford, Oxford, UK
Gillian K. Reeves
Affiliation:
Nuffield Department of Population Health, University of Oxford, Oxford, UK
Jane Green
Affiliation:
Nuffield Department of Population Health, University of Oxford, Oxford, UK
Valerie Beral
Affiliation:
Nuffield Department of Population Health, University of Oxford, Oxford, UK
Sarah Floud*
Affiliation:
Nuffield Department of Population Health, University of Oxford, Oxford, UK
*
Author for correspondence: Sarah Floud, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

High body mass index (BMI) has been associated with lower risks of suicidal behaviour and being underweight with increased risks. However, evidence is inconsistent and sparse, particularly for women. We aim to study this relationship in a large cohort of UK women.

Methods

In total 1.2 million women, mean age 56 (s.d. 5) years, without prior suicide attempts or other major illness, recruited in 1996–2001 were followed by record linkage to national hospital admission and death databases. Cox regression yielded relative risks (RRs) and 95% confidence intervals (CIs) for attempted suicide and suicide by BMI, adjusted for baseline lifestyle factors and self-reported treatment for depression or anxiety.

Results

After 16 (s.d. 3) years of follow-up, 4930 women attempted suicide and 642 died by suicide. The small proportion (4%) with BMI <20 kg/m2 were at clearly greater risk of attempted suicide (RR = 1.38, 95% CI 1.23–1.56) and suicide (RR = 2.10, 1.59–2.78) than women of BMI 20–24.9 kg/m2; p < 0.0001 for both comparisons. Small body size at 10 and 20 years old was also associated with increased risks. Half the cohort had BMIs >25 kg/m2 and, while risks were somewhat lower than for BMI 20–24.9 kg/m2 (attempted suicide RR = 0.91, 0.86–0.96; p = 0.001; suicide RR = 0.79, 0.67–0.93; p = 0.006), the reductions in risk were not strongly related to level of BMI.

Conclusions

Being underweight is associated with a definite increase in the risk of suicidal behaviour, particularly death by suicide. Residual confounding cannot be excluded for the small and inconsistent decreased risk of suicidal behaviour associated with being overweight or obese.

Keywords

Body mass indexprospectiveself-harmsuicideweightwomen
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 13 , October 2019 , pp. 2279 - 2286
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

These authors contributed equally to this work.

†

Collaborators are listed at the end of paper.

References

Audureau, E, Pouchot, J and Coste, J (2016) Gender-related differential effects of obesity on health-related quality of life via obesity-related comorbidities: a mediation analysis of a French Nationwide Survey. Circulation: Cardiovascular Quality and Outcomes 9, 246–256.Google Scholar
Batty, GD, Whitley, E, Kivimaki, M, Tynelius, P and Rasmussen, F (2010) Body mass index and attempted suicide: cohort study of 1 133 019 Swedish men. American Journal of Epidemiology 172, 890–899.Google Scholar
Bjerkeset, O, Romundstad, P, Evans, J and Gunnell, D (2008) Association of adult body mass index and height with anxiety, depression, and suicide in the general population: the HUNT study. American Journal of Epidemiology 167, 193–202.Google Scholar
Cairns, BJ, Liu, B, Clennell, S, Cooper, R, Reeves, GK, Beral, V and Kuh, D (2011) Lifetime body size and reproductive factors: comparisons of data recorded prospectively with self reports in middle age. BMC Medical Research Methodology 11, 7.Google Scholar
Chang, SS, Wen, CP, Tsai, MK, Lawlor, DA, Yang, YC and Gunnell, D (2012) Adiposity, its related biologic risk factors, and suicide: a cohort study of 542 088 Taiwanese adults. American Journal of Epidemiology 175, 804–815.Google Scholar
Clements, C, Turnbull, P, Hawton, K, Geulayov, G, Waters, K, Ness, J, Townsend, E, Khundakar, K and Kapur, N (2016) Rates of self-harm presenting to general hospitals: a comparison of data from the multicentre study of self-harm in England and hospital episode statistics. BMJ Open 6, e009749.Google Scholar
Elovainio, M, Shipley, MJ, Ferrie, JE, Gimeno, D, Vahtera, J, Marmot, MG and Kivimaki, M (2009) Obesity, unexplained weight loss and suicide: the original Whitehall study. Journal of Affective Disorders 116, 218–221.Google Scholar
Floud, S, Balkwill, A, Moser, K, Reeves, GK, Green, J, Beral, V, Cairns, BJ and Million Women Study C (2016) The role of health-related behavioural factors in accounting for inequalities in coronary heart disease risk by education and area deprivation: prospective study of 1.2 million UK women. BMC Medicine 14, 145.Google Scholar
Gao, S, Juhaeri, J, Reshef, S and Dai, WS (2013) Association between body mass index and suicide, and suicide attempt among British adults: the health improvement network database. Obesity (Silver Spring) 21, E334–E342.Google Scholar
Jee, SH, Kivimaki, M, Kang, HC, Park, IS, Samet, JM and Batty, GD (2011) Cardiovascular disease risk factors in relation to suicide mortality in Asia: prospective cohort study of over one million Korean men and women. European Heart Journal 32, 2773–2780.Google Scholar
Kaplan, MS, McFarland, BH and Huguet, N (2007) The relationship of body weight to suicide risk among men and women: results from the US National Health Interview Survey Linked Mortality File. Journal of Nervous and Mental Disease 195, 948–951.Google Scholar
Kjaer, TK, Jensen, A, Dalton, SO, Johansen, C, Schmiedel, S and Kjaer, SK (2011) Suicide in Danish women evaluated for fertility problems. Human Reproduction 26, 2401–2407.Google Scholar
Kostro, K, Lerman, JB and Attia, E (2014) The current status of suicide and self-injury in eating disorders: a narrative review. Journal of Eating Disorders 2, 19.Google Scholar
Lillis, J, Levin, ME and Hayes, SC (2011) Exploring the relationship between body mass index and health-related quality of life: a pilot study of the impact of weight self-stigma and experiential avoidance. Journal of Health Psychology 16, 722–727.Google Scholar
MacMahon, S, Peto, R, Cutler, J, Collins, R, Sorlie, P, Neaton, J, Abbott, R, Godwin, J, Dyer, A and Stamler, J (1990) Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335, 765–774.Google Scholar
Magnusson, PK, Rasmussen, F, Lawlor, DA, Tynelius, P and Gunnell, D (2006) Association of body mass index with suicide mortality: a prospective cohort study of more than one million men. American Journal of Epidemiology 163, 1–8.Google Scholar
McCarthy, JF, Ilgen, MA, Austin, K, Blow, FC and Katz, IR (2014) Associations between body mass index and suicide in the veterans affairs health system. Obesity (Silver Spring) 22, 269–276.Google Scholar
McLaren, L, Beck, CA, Patten, SB, Fick, GH and Adair, CE (2008) The relationship between body mass index and mental health. Social Psychiatry and Psychiatric Epidemiology 43, 63–71.Google Scholar
Mukamal, KJ and Miller, M (2010) Invited commentary: body mass index and suicide – untangling an unlikely association. American Journal of Epidemiology 172, 900–904, discussion 905–906.Google Scholar
Mukamal, KJ, Kawachi, I, Miller, M and Rimm, EB (2007) Body mass index and risk of suicide among men. Archives of Internal Medicine 167, 468–475.Google Scholar
Mukamal, KJ, Rimm, EB, Kawachi, I, O'Reilly, EJ, Calle, EE and Miller, M (2010) Body mass index and risk of suicide among one million US adults. Epidemiology 21, 82–86.Google Scholar
Office for National Statistics (2017) Suicides in Great Britain: 2016 registrations [Online]. Available at https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2016registration (Accessed 25 October 2017).Google Scholar
Perera, S, Eisen, RB, Dennis, BB, Bawor, M, Bhatt, M, Bhatnagar, N, Thabane, L, de Souza, R and Samaan, Z (2016) Body mass index is an important predictor for suicide: results from a systematic review and meta-analysis. Suicide and Life-Threatening Behavior 46, 697–736.Google Scholar
Plummer, M (2004) Improved estimates of floating absolute risk. Statistics in Medicine 23, 93–104.Google Scholar
R Core Team (2013) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available at http://www.R-project.org/.Google Scholar
Schneider, B, Lukaschek, K, Baumert, J, Meisinger, C, Erazo, N and Ladwig, KH (2014) Living alone, obesity, and smoking increase risk for suicide independently of depressive mood findings from the population-based MONICA/KORA Augsburg cohort study. Journal of Affective Disorders 152–154, 416–421.Google Scholar
Seacat, JD, Dougal, SC and Roy, D (2016) A daily diary assessment of female weight stigmatization. Journal of Health Psychology 21, 228–240.Google Scholar
Sorberg, A, Gunnell, D, Falkstedt, D, Allebeck, P, Aberg, M and Hemmingsson, T (2014) Body mass index in young adulthood and suicidal behavior up to age 59 in a cohort of Swedish men. PLoS One 9, e101213.Google Scholar
Townsend, P, Beattie, A and Phillimore, P (1988) Health and Deprivation: Inequality and the North. London: Croom Helm.Google Scholar
Volpe, U, Tortorella, A, Manchia, M, Monteleone, AM, Albert, U and Monteleone, P (2016) Eating disorders: what age at onset? Psychiatry Research 238, 225–227.Google Scholar
Wang, SS, Brownell, KD and Wadden, TA (2004) The influence of the stigma of obesity on overweight individuals. International Journal of Obesity and Related Metabolic Disorders 28, 1333–1337.Google Scholar
Wright, FL, Green, J, Reeves, G, Beral, V, Cairns, BJ and Million Women Study C (2015) Validity over time of self-reported anthropometric variables during follow-up of a large cohort of UK women. BMC Medical Research Methodology 15, 81.Google Scholar
Supplementary material: File

Geulayov et al. supplementary material

Tables S1-S5

Download Geulayov et al. supplementary material(File)
File 35.1 KB