A comprehensive meta-analysis of the risk of suicide in eating disorders.
Level 2 - randomized trial
Systematic review and meta-analysis of observational cohort studies
PubMed 21092024 · doi:10.1111/j.1600-0447.2010.01641.x
What was done
PubMed and Medline were searched for eating disorder studies with a sample size of 40 or more and a follow-up of 5 years or longer. The meta-analysis included 40 studies on anorexia nervosa, 16 studies on bulimia nervosa, and 3 studies on binge eating disorder.
What was found
In anorexia nervosa (16,342 patients, mean follow-up 11.1 years), 245 suicides occurred, giving a suicide rate of 0.124 per 100 person-years and a standardized mortality ratio (SMR) of 31.0 (Poisson 95% CI 21.0-44.0), with a clear decrease in suicide risk over recent decades. In bulimia nervosa (1,768 patients, mean follow-up 7.5 years), 4 suicides occurred, giving a suicide rate of 0.030 per 100 person-years and an SMR of 7.5 (95% CI 1.6-11.6). In binge eating disorder (246 patients, mean follow-up 5.3 years), 0 suicides occurred.
Why it matters
This meta-analysis demonstrates that suicide risk is markedly elevated above general population rates in anorexia nervosa and bulimia nervosa, with anorexia exhibiting substantially higher suicide rates per person-year.
Limits
The search was restricted to PubMed and Medline. Sample sizes and suicide counts were very small for bulimia nervosa (4 events) and binge eating disorder (0 events), limiting statistical power. Psychiatric comorbidities, treatment status, and causes of heterogeneity were not reported in the abstract.