Suicide predictors identified for women with eating disorders
Women with eating disorders are at considerable risk of attempting suicide, report researchers who stress the need for clinicians to be aware of such risk throughout the course of treatment.
To investigate potential predictors of suicide attempt among women with eating disorders, Debra Franko (Massachusetts General Hospital, Boston, USA) and colleagues interviewed 136 women with anorexia nervosa and 110 with bulimia nervosa and assessed for suicidal intent every 6 to 12 months over a 9-year period.
During the study, 15% of participants reported at least one prospective suicide attempt. Furthermore, contrary to the researchers' expectations, women with anorexia were significantly more likely than bulimic women to attempt suicide, with rates of 22.1% and 10.9%, respectively.
Further analysis indicated that eating disorder symptoms only appeared to predict suicide attempt in bulimic patients, with the use of laxatives significantly predicting such attempts.
For women with anorexia, however, severity of both depressive symptoms and drug use over the course of the study were the unique predictors of suicide attempt.
A history of drug use was also found to be a predictive factor for suicide attempt in women with bulimia.
Interestingly, Franko and team found that, at enrollment, suicide attempters and non-attempters differed on the subscales of the Eating Disorder Inventory that measure personality characteristics and interpersonal relations, including ineffectiveness, interoceptive awareness, and interpersonal distrust for bulimic participants.
"These data suggest that clinicians need to consider both personality variables and temperament when assessing an eating disorder patient's risk for suicidal behavior," say the researchers."
They conclude in the journal Psychological Medicine: "Clinicians should monitor suicidal risk on a regular basis, particularly for those with significant comorbidity and long-term illness, even if a substantial amount of psychosocial treatment has been provided."
Psychol Med 2004; 34: 843-853