Children at Risk: The Association between Perceived Weight Status and Suicidal Thoughts and Attempts in Middle School Youth *

Article excerpt

Youth suicide is a devastating event for both families and communities. For several years while suicide rates among the general population remained fairly stable, it increased among adolescents. The Centers for Disease Control and Prevention (CDC) reported that the rate of suicide among 15-19 year olds increased by 14% from 1980 to 1996, while the rate for 10-14 year olds increased by 100% during the same period, (1) with a peak in the early 1990s. (2) Although the suicide rate has been declining since the early 1990s, (2) suicide remains the third most common cause of death in young people aged 15-24 years. (3) In response to these national statistics, a 1999 report from the US Surgeon General called for action to prevent suicide, (1) and reducing the rate of suicide attempts among adolescents is one of the objectives of Healthy People 2010. (4) Core strategies from the Surgeon General's report included increasing public awareness of suicide and its risk factors and enhancing research to understand risk and protective factors. (1)

There are many risk factors for suicide including family variables such as a family history of suicide, child maltreatment, parental psychopathology, and parental divorce; environmental variables such as access to fatal methods of suicide, barriers to treatment, and local epidemics of suicide; and personal variables such as previous suicide attempts, history of mental disorders, feelings of hopelessness, impulsive or aggressive tendencies, physical illness, and feelings of isolation. (3,5,6) Some data suggest that body weight may also contribute to suicide risk for adults. (7) Carpenter et al (7) analyzed data from the 1992 National Longitudinal Alcohol Epidemiologic Survey and reported that obese adults were more likely to report suicide attempts than normal-weight adults. This finding differed for men and women, with increasing body mass index (BMI) associated with increased past year suicide ideation and attempts for women but with reduced risk for men.

Much of the published literature around the perception of body weight and suicide is in the context of eating disorders. (8,9) Suicide is one of the most common causes of death for those with anorexia nervosa. (10) Stein et al suggested that female adolescents with anorexia show suicidal tendencies that are comparable to those in psychiatric inpatients, (9) and Pompili et al showed that suicide was more frequent among adolescents and young adults with anorexia than among the general population. (8) However, other studies have addressed perceptions of overweight and its relationship to emotional well-being in a general population of youth. Ge et al (11) analyzed data from the National Longitudinal Study of Adolescent Health to address the hypothesis that perception of overweight is related to depressed mood, somatic complaints, and lower self-esteem. Their results showed that perceptions of overweight were associated with those factors in certain race and gender groups. (These results are discussed below.) Recently, Eaton et al, (12) using Youth Risk Behavior Survey (YRBS) data, showed that when controlling for BMI category, high school students who perceived themselves to be overweight or underweight were more likely to report suicide ideation and attempts.

Suicide risk varies by gender, race, and age. While adolescent males are more likely to die from suicide, females are more likely to plan and attempt suicide. (12,13) High school YRBS data indicate that more females than males report thinking, planning, or trying suicide. (13) Fewer African American than white youth think, plan, attempt, (13,14) or complete suicide. (15) Both completed suicides and suicide attempts increase with age from before puberty through adolescence. (16,17)

Weight perception and concerns also vary by gender and race. Girls are more likely to perceive themselves to be overweight, (18) to report more body dissatisfaction, (19) and to be concerned about their weight than boys. …