Advertisement

Association of Obesity, Suicide Behaviors, and Psychosocial Wellness Among Adolescents in the United States

  • Eriko Iwatate
    Correspondence
    Address correspondence to: Eriko Iwatate, M.P.H., Department of Epidemiology, Human Genetics & Environmental Sciences, UTHealth School of Public Health, Dallas Regional Campus, Trinity Towers, 2777 N Stemmons Fwy, Dallas, TX 75207.
    Affiliations
    Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas
    Search for articles by this author
  • Folefac D. Atem
    Affiliations
    Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas

    Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, Texas
    Search for articles by this author
  • Eric C. Jones
    Affiliations
    Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas
    Search for articles by this author
  • Jennifer L. Hughes
    Affiliations
    Department of Psychiatry and Behavioral Health, Big Lots Behavioral Health Services, College of Medicine, Nationwide Children's Hospital, Columbus, Ohio

    Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio
    Search for articles by this author
  • Takeshi Yokoo
    Affiliations
    Department of Radiology, University of Texas Southwestern, Dallas, Texas
    Search for articles by this author
  • Sarah E. Messiah
    Affiliations
    Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas

    Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, Texas
    Search for articles by this author

      Abstract

      Background

      Adolescents with obesity are more likely to exhibit suicide behaviors, but this association may be confounded by psychosocial stigma related to obesity. We examined whether the obesity is independently associated with suicide behaviors among United States adolescents, after adjusting for the psychosocial factors.

      Methods

      We analyzed data from 2019 Youth Risk Behavior Survey data (N = 13,871 United States adolescents) on recent (past year) suicide behavior (attempt, ideation, and plan); demographics (age, sex, and race/ethnicity); and psychosocial factors (feeling sad/hopeless, alcohol and illegal drug use, being bullied, and sexually abused). Participants were classified as having obesity (Y/N) per standardized percentiles. Logistic regression was employed to examine the association between obesity and suicide attempt, ideation, and plan, while adjusting for psychosocial covariates.

      Results

      The prevalence of suicide attempt, ideation, and plan was 8.90%, 18.75%, and 15.71%, respectively. Obesity prevalence was 15.5%. The odds of suicide attempt, ideation, and plan were 1.65 (1.30–2.11), 1.31 (0.89–1.61), and 1.27 (1.02–1.57), respectively, among those with obesity versus without obesity.

      Discussion

      Obesity is significantly associated with a suicide attempt, ideation, and plan among United States adolescents, even after adjusting for confounding psychosocial factors. Further research on the temporality and causality of this association is needed.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control and Prevention
        Leading causes of death reports, 1999–2019.
        (Available at:)
        https://wisqars.cdc.gov/fatal-leading
        Date accessed: May 1, 2022
        • Curtin S.C.
        State suicide rates among adolescents and young adults aged 10-24: United States, 2000-2018.
        Natl Vital Stat Rep. 2020; 69: 1-10
        • World Health Organization
        Preventing suicide: a global imperative. World Health Organization, 2014: 40 (Available at:)
        https://apps.who.int/iris/handle/10665/131056
        Date accessed: January 10, 2023
        • Klonsky E.D.
        • Saffer B.Y.
        • Bryan C.J.
        Ideation-to-action theories of suicide: A conceptual and empirical update.
        Curr Opin Psychol. 2018; 22: 38-43
        • Klonsky E.D.
        • May A.M.
        Differentiating suicide attempters from suicide ideators: A critical frontier for suicidology research.
        Suicide Life Threat Behav. 2014; 44: 1-5
        • Nock M.K.
        • Green J.G.
        • Hwang I.
        • et al.
        Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the national comorbidity survey replication adolescent supplement.
        JAMA Psychiatry. 2013; 70: 300-310
        • Orri M.
        • Scardera S.
        • Perret L.C.
        • et al.
        Mental health problems and risk of suicidal ideation and attempts in adolescents.
        Pediatrics. 2020; 146: e20193823
        • Gili M.
        • Castellvi P.
        • Vives M.
        • et al.
        Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies.
        J Affect Disord. 2019; 245: 152-162
        • Mental Health America
        2019 Report on mental health in America.
        (Available at:)
        • Stone D.M.
        • Simon T.R.
        • Fowler K.A.
        • et al.
        Vital signs: Trends in state suicide rates - United States, 1999-2016 and circumstances contributing to suicide - 27 states, 2015.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 617-624
        • Zeller M.H.
        • Reiter-Purtill J.
        • Jenkins T.M.
        • Ratcliff M.B.
        Adolescent suicidal behavior across the excess weight status spectrum.
        Obesity (Silver Spring). 2013; 21: 1039-1045
        • Eaton D.K.
        • Lowry R.
        • Brener N.D.
        • et al.
        Associations of body mass index and perceived weight with suicide ideation and suicide attempts among US high school students.
        Arch Pediatr Adolesc Med. 2005; 159: 513-519
        • Minor T.
        • Ali M.M.
        • Rizzo J.A.
        Body weight and suicidal behavior in adolescent females: The role of self-perceptions.
        J Ment Health Policy Econ. 2016; 19: 21-31
        • Mannan M.
        • Mamun A.
        • Doi S.
        • Clavarino A.
        Prospective associations between depression and obesity for adolescent males and females- a systematic review and meta-analysis of longitudinal studies.
        PLoS One. 2016; 11: e0157240
        • Muhlig Y.
        • Antel J.
        • Focker M.
        • Hebebrand J.
        Are bidirectional associations of obesity and depression already apparent in childhood and adolescence as based on high-quality studies? A systematic review.
        Obes Rev. 2016; 17: 235-249
        • Girela-Serrano B.M.
        • Guerrero-Jimenez M.
        • Spiers A.D.V.
        • Gutierrez-Rojas L.
        Obesity and overweight among children and adolescents with bipolar disorder from the general population: A review of the scientific literature and a meta-analysis.
        Early Interv Psychiatry. 2022; 16: 113-125
        • Hu C.
        • Torres I.J.
        • Qian H.
        • et al.
        Trajectories of body mass index change in first episode of mania: 3-year data from the systematic treatment optimization program for early mania (STOP-EM).
        J Affect Disord. 2017; 208: 291-297
        • Shapiro J.
        • Mindra S.
        • Timmins V.
        • et al.
        Controlled study of obesity among adolescents with bipolar disorder.
        J Child Adolesc Psychopharmacol. 2017; 27: 95-100
        • Bioque M.
        • Garcia-Portilla M.A.P.
        • Garcia-Rizo C.
        • et al.
        Evolution of metabolic risk factors over a two-year period in a cohort of first episodes of psychosis.
        Schizophr Res. 2018; 193: 188-196
        • Holt M.K.
        • Vivolo-Kantor A.M.
        • Polanin J.R.
        • et al.
        Bullying and suicidal ideation and behaviors: A meta-analysis.
        Pediatrics. 2015; 135: e496-e509
        • Koyanagi A.
        • Oh H.
        • Carvalho A.F.
        • et al.
        Bullying victimization and suicide attempt among adolescents aged 12-15 years from 48 countries.
        J Am Acad Child Adolesc Psychiatry. 2019; 58: 907-918.e4
        • Zatti C.
        • Rosa V.
        • Barros A.
        • et al.
        Childhood trauma and suicide attempt: A meta-analysis of longitudinal studies from the last decade.
        Psychiatry Res. 2017; 256: 353-358
        • Rupp K.
        • McCoy S.M.
        Bullying perpetration and victimization among adolescents with overweight and obesity in a nationally representative sample.
        Child Obes. 2019; 15: 323-330
        • Wen J.
        • Dong L.
        • Tian J.
        • et al.
        Fluorescent BINOL-based sensor for thorium recognition and a density functional theory investigation.
        J Hazard Mater. 2013; 263 Pt 2: 638-642
        • Isong I.A.
        • Rao S.R.
        • Bind M.A.
        • et al.
        Racial and ethnic disparities in early childhood obesity.
        Pediatrics. 2018; 141: e20170865
        • Hoffmann J.A.
        • Alegria M.
        • Alvarez K.
        • et al.
        Disparities in pediatric mental and behavioral health conditions.
        Pediatrics. 2022; 150e2022058227
        • Underwood J.M.
        • Brener N.
        • Thornton J.
        • et al.
        Overview and methods for the youth risk behavior surveillance system - United States, 2019.
        MMWR Suppl. 2020; 69: 1-10
        • Klonsky E.D.
        • May A.M.
        • Saffer B.Y.
        Suicide, suicide attempts, and suicidal ideation.
        Annu Rev Clin Psychol. 2016; 12: 307-330
        • Kuczmarski R.J.
        • Ogden C.L.
        • Guo S.S.
        • et al.
        2000 CDC Growth Charts for the United States: methods and development.
        Vital Health Stat 11. 2002; 246: 1-190
        • Merlo C.L.
        • Jones S.E.
        • Michael S.L.
        • et al.
        Dietary and physical activity behaviors among high school students - youth risk behavior survey, United States, 2019.
        MMWR Suppl. 2020; 69: 64-76
        • Ivey-Stephenson A.Z.
        • Demissie Z.
        • Crosby A.E.
        • et al.
        Suicidal ideation and behaviors among high school students - youth risk behavior survey, United States, 2019.
        MMWR Suppl. 2020; 69: 47-55
        • Streiner D.L.
        • Norman G.R.
        Mine is bigger than yours: Measures of effect size in research.
        Chest. 2012; 141: 595-598
        • Whitney D.G.
        • Peterson M.D.
        US national and state-level prevalence of mental health disorders and disparities of mental health care use in children.
        JAMA Pediatr. 2019; 173: 389-391
        • Bursac Z.
        • Gauss C.H.
        • Williams D.K.
        • Hosmer D.W.
        Purposeful selection of variables in logistic regression.
        Source Code Biol Med. 2008; 3: 17
        • Mangione C.M.
        • Barry M.J.
        • et al.
        • US Preventive Services Task Force
        Screening for depression and suicide risk in children and adolescents: US Preventive Services Task Force recommendation statement.
        JAMA. 2022; 328: 1534-1542
        • Horowitz L.M.
        • Bridge J.A.
        • Teach S.J.
        • et al.
        Ask suicide-screening questions (ASQ): A brief instrument for the pediatric emergency department.
        Arch Pediatr Adolesc Med. 2012; 166: 1170-1176
        • Gordon-Larsen P.
        • Adair L.S.
        • Nelson M.C.
        • Popkin B.M.
        Five-year obesity incidence in the transition period between adolescence and adulthood: The national longitudinal study of adolescent health.
        Am J Clin Nutr. 2004; 80: 569-575
        • Ogden C.L.
        • Fryar C.D.
        • Hales C.M.
        • et al.
        Differences in obesity prevalence by demographics and urbanization in US children and adolescents, 2013-2016.
        JAMA. 2018; 319: 2410-2418
        • Zhao K.
        • Zhou S.
        • Shi X.
        • et al.
        Potential metabolic monitoring indicators of suicide attempts in first episode and drug naive young patients with major depressive disorder: A cross-sectional study.
        BMC Psychiatry. 2020; 20: 387
        • Koponen H.
        • Kautiainen H.
        • Leppänen E.
        • et al.
        Association between suicidal behaviour and impaired glucose metabolism in depressive disorders.
        BMC Psychiatry. 2015; 15: 163
        • Goldman-Mellor S.J.
        • Caspi A.
        • Harrington H.
        • et al.
        Suicide attempt in young people: A signal for long-term health care and social needs.
        JAMA Psychiatry. 2014; 71: 119-127
        • Khanna D.
        • Khanna S.
        • Khanna P.
        • et al.
        Obesity: A chronic low-grade inflammation and its markers.
        Cureus. 2022; 14: e22711
        • Vasupanrajit A.
        • Jirakran K.
        • Tunvirachaisakul C.
        • et al.
        Inflammation and nitro-oxidative stress in current suicidal attempts and current suicidal ideation: A systematic review and meta-analysis.
        Mol Psychiatry. 2022; 27: 1350-1361
        • Miola A.
        • Dal Porto V.
        • Tadmor T.
        • et al.
        Increased C-reactive protein concentration and suicidal behavior in people with psychiatric disorders: A systematic review and meta-analysis.
        Acta Psychiatr Scand. 2021; 144: 537-552