Suicide Awareness: Not Just a Depression Problem

Written by Evelyn Attia, MD. Contributions by Deborah R. Glasofer, PhD.

Suicide is not only a problem for those who are depressed.

Suicide accounts for more than 800,000 annual deaths worldwide, and, according to the CDC, there are more suicides in the US each year than fatal car accidents. Commonly, information about suicide risk and suicide prevention finds its way into the media in response to reports of suicide by a celebrity or other well-known personalities. This makes sense as we are most often receptive to thinking and talking about a difficult topic like suicide when we feel, directly or indirectly, its impact.

Most discussion about suicide focuses on depression. Major depression accounts for many suicides, and the need for improved identification of, and optimized treatment services for depression is an important message on a day dedicated to preventing suicide. Yet, it is not the only message.

Eating disorders, including anorexia and bulimia nervosa, are associated with high suicide rates, even in the absence of depression, and this association is often neglected in conversations about suicide risk.

Individuals with anorexia nervosa are 8 times more likely to attempt suicide than those in the general population. Anorexia nervosa is known to be associated with a mortality rate as high as that seen in any psychiatric illness and suicide accounts for a significant number of those deaths.  Bulimia nervosa is associated with somewhat lower rates of successful suicide, but approximately one-third of adult samples with bulimia nervosa have had thoughts of suicide and 25-30% have made attempts.

As a research psychiatrist who has studied and treated eating disorders for over twenty years, I have been struck by the power of the suicidal symptoms in some of my patients with eating disorders.  Their suicidal thoughts haven’t been among the first things they’ve chosen to discuss with me. Their worries about food, and beliefs about body shape and weight are usually the first, second and third things they report. It is easy to get lost in the talk of food records and the discussions of eating meals with family. It is easy to forget to ask more generally about low mood, which is known to be direct consequence of malnutrition in anorexia nervosa and a common co-occurring symptom in bulimia nervosa, and about a patient’s thoughts of suicide.

At the hospital where I work, we recently incorporated a suicide screening tool into the admission interview for all inpatients with eating disorders. Patients are asked a short series of questions about whether they have current or past history of suicidal thoughts or actions. Despite my years of clinical experience, I was surprised by our initial findings: of the first 50 inpatients completing the questions, nearly 50% had thought about ending their life during the month prior to admission, and nearly 25% had made at least one prior attempt during their lifetime.

As we work to enhance suicide awareness in our communities, let’s remember that suicide prevention starts with an awareness about all of the groups at risk and renew our commitment to further identifying those who need our help.

Need help? For information on eating disorder treatment and research, contact the Center for Eating Disorders at 646-774-8066 (New York State Psychiatric Institute/Columbia University Medical Center).  In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

This article was originally posted in the Huffington Post on September 17, 2014.

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