Print Friendly
The Relationship Between Severity of Obesity and Suicide Attempts
In Session With Birgit Wagner, PhD:
The Relationship Between Severity of Obesity and Suicide Attempts
Medical University of Leipzig, Department of Psychosomatic Medicine, Germany
First published in Psychiatry Weekly, Volume 8, Issue
11, on May 20, 2013
Q: Does the existing literature show an association between obesity and suicidal behavior?
A: In some cases, yes. In our research department at the University of Leipzig, we focus on obesity and suicidal behavior. For example, we recently conducted a systematic review showing that post-bariatric surgery patients are more likely to commit suicide than non-bariatric patients.1 This lies in direct contrast with studies showing that obese people have lower rates of completed suicide compared to normal weight controls. In attempt to further examine these relationships over a spectrum of obesity, we conducted a study of suicidal behavior and attempts in a nationally representative population in Germany (n=2,436). Participants were assessed with the Suicidal Behavior Questionnaire, and participants’ body mass index (BMI) was recorded. Our study2 is one of the few studies of suicide behavior in obesity that uses an actual suicide questionnaire, instead of only relying on one or two clinical items.
Q: How does suicidal behavior vary across the different BMI classes of obesity?
A: We found a relatively high prevalence rate of suicidal behavior and suicide attempts in extreme obesity (class III; BMI >40). Thirty-three percent of female respondents and 13% of male respondents with class III obesity showed suicidal behavior. The figures were similar for suicide attempts: 27% for female respondents, and 13% for male respondents. Although women were more likely to report suicidal behavior, that correlation did not reach statistical significance. We therefore concluded that there were no significant gender differences, which may seem surprising given the relatively high prevalence rates of suicidal behavior and attempts.
We also found significant differences in suicidal behavior among the three classes of obesity. Class I obesity was associated with significantly greater odds for suicidal behavior (adjusted odds ratio 3.49 [1.76–6.90]) compared to normal weight controls. The same was true for class III obesity (OR 12.43 [3.87–39.86]).
Q: What are the most important clinical implications of these findings?
A: I think that suicidal behavior screening is very important, especially as bariatric surgery becomes a more prominent option for the successful weight management of extremely obese people. And then you need to look at what happens to bariatric patients when they lose weight. It would be ideal if bariatric surgery patients received consistent suicide and depression screening, not only before bariatric surgery but also 1–2 years after surgery, when their weight loss may begin to plateau.
Disclosure: Dr. Wagner reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.
Reference:
1. Peterhänsel C, Petroff D, Klinitzke G, Kersting A, Wagner B. Risk of completed suicide after bariatric surgery: a systematic review. Obes Rev. 2013 May;14(5):369-82.
2. Wagner B, Klinitzke G, Brähler E, Kersting A. Extreme obesity is associated with suicidal behavior and suicide attempts in adults: results of a population-based representative sample. Depress Anxiety. 2013 Apr 10. doi: 10.1002/da.22105. [Epub ahead of print]