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Published in: Environmental Health and Preventive Medicine 1/2017

Open Access 01-12-2017 | Research article

Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study

Authors: Qiguo Lian, Xiayun Zuo, Yanyan Mao, Shan Luo, Shucheng Zhang, Xiaowen Tu, Chaohua Lou, Weijin Zhou

Published in: Environmental Health and Preventive Medicine | Issue 1/2017

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Abstract

Background

Although there is much literature on adolescent suicide, combined effects of depression and anorexia nervosa on suicide were rarely investigated. The aims of this study are to examine the association between anorexia nervosa and suicidal thoughts and explore the interaction between anorexia nervosa and depression.

Methods

This is a cross-sectional study, in the study, a sample of 8,746 Chinese adolescents was selected by multistage stratified method in 2012/2013 from 20 middle schools in 7 provinces across China Mainland. Multilevel logistic model was introduced to explore association between anorexia nervosa and suicidal thoughts. And subgroup analyses were conducted on participants with or without depression.

Results

Multilevel logistic model revealed that demographic variables, including academic achievement, were not the predictive risk factors of suicidal thoughts. Those who suffered from worse severity of perceived anorexia nervosa were at increased risk of thinking about suicide. The interaction between depression and anorexia nervosa was significant, however, subgroup analyses showed that the associations were significant only among the adolescents without depression.

Conclusions

Our results indicate that all levels of anorexia nervosa serve as predictable indicators of suicidal thoughts in Chinese adolescents, and the effects of anorexia nervosa are modified by depression status.
Literature
2.
go back to reference Hawton K, Saunders KE, O'Connor RC. Self-harm and suicide in adolescents. Lancet. 2012;379:2373–82.CrossRefPubMed Hawton K, Saunders KE, O'Connor RC. Self-harm and suicide in adolescents. Lancet. 2012;379:2373–82.CrossRefPubMed
3.
go back to reference Wolff J, Frazier EA, Esposito-Smythers C, Burke T, Sloan E, Spirito A. Cognitive and social factors associated with NSSI and suicide attempts in psychiatrically hospitalized adolescents. J Abnorm Child Psychol. 2013;41:1005–13.CrossRefPubMedPubMedCentral Wolff J, Frazier EA, Esposito-Smythers C, Burke T, Sloan E, Spirito A. Cognitive and social factors associated with NSSI and suicide attempts in psychiatrically hospitalized adolescents. J Abnorm Child Psychol. 2013;41:1005–13.CrossRefPubMedPubMedCentral
4.
go back to reference Lian Q, Zuo X, Lou C, Gao E, Cheng Y. Sexual orientation and risk factors for suicidal ideation and suicide attempts: a multi-centre cross-sectional study in three Asian cities. J Epidemiol. 2015;25:155–61.CrossRefPubMedPubMedCentral Lian Q, Zuo X, Lou C, Gao E, Cheng Y. Sexual orientation and risk factors for suicidal ideation and suicide attempts: a multi-centre cross-sectional study in three Asian cities. J Epidemiol. 2015;25:155–61.CrossRefPubMedPubMedCentral
5.
go back to reference Chen YY, Wu KC, Yousuf S, Yip PS. Suicide in Asia: opportunities and challenges. Epidemiol Rev. 2012;34:129–44.CrossRefPubMed Chen YY, Wu KC, Yousuf S, Yip PS. Suicide in Asia: opportunities and challenges. Epidemiol Rev. 2012;34:129–44.CrossRefPubMed
6.
go back to reference Blum R, Sudhinaraset M, Emerson MR. Youth at risk: suicidal thoughts and attempts in Vietnam, China, and Taiwan. J Adolesc Health. 2012;50:S37–44.CrossRefPubMed Blum R, Sudhinaraset M, Emerson MR. Youth at risk: suicidal thoughts and attempts in Vietnam, China, and Taiwan. J Adolesc Health. 2012;50:S37–44.CrossRefPubMed
7.
go back to reference Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192:98–105.CrossRefPubMedPubMedCentral Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192:98–105.CrossRefPubMedPubMedCentral
8.
go back to reference Badiee J, Moore DJ, Atkinson JH, Vaida F, Gerard M, Duarte NA, Franklin D, Gouaux B, McCutchan JA, Heaton RK, et al. Lifetime suicidal ideation and attempt is common among HIV+ individuals. J Affect Disord. 2012;136:993–9.CrossRefPubMed Badiee J, Moore DJ, Atkinson JH, Vaida F, Gerard M, Duarte NA, Franklin D, Gouaux B, McCutchan JA, Heaton RK, et al. Lifetime suicidal ideation and attempt is common among HIV+ individuals. J Affect Disord. 2012;136:993–9.CrossRefPubMed
9.
go back to reference Kostro K, Lerman JB, Attia E. The current status of suicide and self-injury in eating disorders: a narrative review. J Eat Disord. 2014;2:1–9.CrossRef Kostro K, Lerman JB, Attia E. The current status of suicide and self-injury in eating disorders: a narrative review. J Eat Disord. 2014;2:1–9.CrossRef
10.
go back to reference Mekori E, Halevy L, Ziv SI, Moreno A, Enoch-Levy A, Weizman A, Stein D: Predictors of short-term outcome variables in hospitalised female adolescents with eating disorders. International Journal of Psychiatry in Clinical Practice. 2017;21:41–49. Mekori E, Halevy L, Ziv SI, Moreno A, Enoch-Levy A, Weizman A, Stein D: Predictors of short-term outcome variables in hospitalised female adolescents with eating disorders. International Journal of Psychiatry in Clinical Practice. 2017;21:41–49.
11.
go back to reference Pompili M, Mancinelli I, Girardi P, Ruberto A, Tatarelli R. Suicide in anorexia nervosa: a meta-analysis. Int J Eat Disord. 2004;36:99–103.CrossRefPubMed Pompili M, Mancinelli I, Girardi P, Ruberto A, Tatarelli R. Suicide in anorexia nervosa: a meta-analysis. Int J Eat Disord. 2004;36:99–103.CrossRefPubMed
12.
go back to reference Wade TD, Fairweather-Schmidt AK, Zhu G, Martin NG: Does shared genetic risk contribute to the co-occurrence of eating disorders and suicidality? International Journal of Eating Disorders. 2015;48:684-91. Wade TD, Fairweather-Schmidt AK, Zhu G, Martin NG: Does shared genetic risk contribute to the co-occurrence of eating disorders and suicidality? International Journal of Eating Disorders. 2015;48:684-91.
13.
go back to reference Ruuska J, Kaltiala-Heino R, Rantanen P, Koivisto AM. Psychopathological distress predicts suicidal ideation and self-harm in adolescent eating disorder outpatients. Eur Child Adolesc Psychiatry. 2005;14:276–81.CrossRefPubMed Ruuska J, Kaltiala-Heino R, Rantanen P, Koivisto AM. Psychopathological distress predicts suicidal ideation and self-harm in adolescent eating disorder outpatients. Eur Child Adolesc Psychiatry. 2005;14:276–81.CrossRefPubMed
14.
go back to reference Guillaume S, Jaussent I, Olie E, Genty C, Bringer J, Courtet P, Schmidt U. Characteristics of suicide attempts in anorexia and bulimia nervosa: a case-control study. PLoS One. 2011;6:e23578.CrossRefPubMedPubMedCentral Guillaume S, Jaussent I, Olie E, Genty C, Bringer J, Courtet P, Schmidt U. Characteristics of suicide attempts in anorexia and bulimia nervosa: a case-control study. PLoS One. 2011;6:e23578.CrossRefPubMedPubMedCentral
16.
go back to reference Garcia-Alba C. Anorexia and depression: depressive comorbidity in anorexic adolescents. Span J Psychol. 2004;7:40–52.CrossRefPubMed Garcia-Alba C. Anorexia and depression: depressive comorbidity in anorexic adolescents. Span J Psychol. 2004;7:40–52.CrossRefPubMed
17.
go back to reference Smith C, Steiner H. Psychopathology in anorexia nervosa and depression. J Am Acad Child Adolesc Psychiatry. 1992;31:841–3.CrossRefPubMed Smith C, Steiner H. Psychopathology in anorexia nervosa and depression. J Am Acad Child Adolesc Psychiatry. 1992;31:841–3.CrossRefPubMed
18.
go back to reference Kennedy SH, Kaplan AS, Garfinkel PE, Rockert W, Toner B, Abbey SE. Depression in anorexia nervosa and bulimia nervosa: discriminating depressive symptoms and episodes. J Psychosom Res. 1994;38:773–82.CrossRefPubMed Kennedy SH, Kaplan AS, Garfinkel PE, Rockert W, Toner B, Abbey SE. Depression in anorexia nervosa and bulimia nervosa: discriminating depressive symptoms and episodes. J Psychosom Res. 1994;38:773–82.CrossRefPubMed
19.
20.
go back to reference Koutek J, Kocourkova J, Dudova I. Suicidal behavior and self-harm in girls with eating disorders. Neuropsychiatr Dis Treat. 2016;12:787–93.PubMedPubMedCentral Koutek J, Kocourkova J, Dudova I. Suicidal behavior and self-harm in girls with eating disorders. Neuropsychiatr Dis Treat. 2016;12:787–93.PubMedPubMedCentral
21.
go back to reference Wade TD, Bulik CM, Neale M, Kendler KS. Anorexia nervosa and major depression: shared genetic and environmental risk factors. Am J Psychiatry. 2000;157:469–71.CrossRefPubMed Wade TD, Bulik CM, Neale M, Kendler KS. Anorexia nervosa and major depression: shared genetic and environmental risk factors. Am J Psychiatry. 2000;157:469–71.CrossRefPubMed
22.
go back to reference Aharoni R, Hertz MM. Disgust sensitivity and anorexia nervosa. Eur Eat Disord Rev. 2012;20:106–10.CrossRefPubMed Aharoni R, Hertz MM. Disgust sensitivity and anorexia nervosa. Eur Eat Disord Rev. 2012;20:106–10.CrossRefPubMed
23.
go back to reference Vahter L, Kreegipuu M, Talvik T, Gross-Paju K. One question as a screening instrument for depression in people with multiple sclerosis. Clin Rehabil. 2007;21:460–4.CrossRefPubMed Vahter L, Kreegipuu M, Talvik T, Gross-Paju K. One question as a screening instrument for depression in people with multiple sclerosis. Clin Rehabil. 2007;21:460–4.CrossRefPubMed
24.
go back to reference StataCorp. Stata Statistical Software: Release 14.2. College Station: StataCorp LP; 2016. StataCorp. Stata Statistical Software: Release 14.2. College Station: StataCorp LP; 2016.
25.
go back to reference Signorini A, De Filippo E, Panico S, De Caprio C, Pasanisi F, Contaldo F. Long-term mortality in anorexia nervosa: a report after an 8-year follow-up and a review of the most recent literature. Eur J Clin Nutr. 2007;61:119–22.CrossRefPubMed Signorini A, De Filippo E, Panico S, De Caprio C, Pasanisi F, Contaldo F. Long-term mortality in anorexia nervosa: a report after an 8-year follow-up and a review of the most recent literature. Eur J Clin Nutr. 2007;61:119–22.CrossRefPubMed
26.
go back to reference Latzer Y, Hochdorf Z. Dying to be thin: attachment to death in anorexia nervosa. Sci World J. 2005;5:820–7.CrossRef Latzer Y, Hochdorf Z. Dying to be thin: attachment to death in anorexia nervosa. Sci World J. 2005;5:820–7.CrossRef
27.
go back to reference Pompili M, Girardi P, Tatarelli G, Ruberto A, Tatarelli R. Suicide and attempted suicide in eating disorders, obesity and weight-image concern. Eat Behav. 2006;7:384–94.CrossRefPubMed Pompili M, Girardi P, Tatarelli G, Ruberto A, Tatarelli R. Suicide and attempted suicide in eating disorders, obesity and weight-image concern. Eat Behav. 2006;7:384–94.CrossRefPubMed
28.
go back to reference Sachs KV, Harnke B, Mehler PS, Krantz MJ. Cardiovascular complications of anorexia nervosa: a systematic review. Int J Eat Disord. 2016;49:238–48.CrossRefPubMed Sachs KV, Harnke B, Mehler PS, Krantz MJ. Cardiovascular complications of anorexia nervosa: a systematic review. Int J Eat Disord. 2016;49:238–48.CrossRefPubMed
29.
go back to reference Lamis DA, Ballard ED, May AM, Dvorak RD. Depressive symptoms and suicidal ideation in college students: the mediating and moderating roles of hopelessness, alcohol problems, and social support. J Clin Psychol. 2016;72(9):919–32.CrossRefPubMed Lamis DA, Ballard ED, May AM, Dvorak RD. Depressive symptoms and suicidal ideation in college students: the mediating and moderating roles of hopelessness, alcohol problems, and social support. J Clin Psychol. 2016;72(9):919–32.CrossRefPubMed
30.
go back to reference Kaltiala-Heino R, Rimpelä M, Marttunen M, Rimpelä A, Rantanen P. Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. BMJ. 1999;319:348–51.CrossRefPubMedPubMedCentral Kaltiala-Heino R, Rimpelä M, Marttunen M, Rimpelä A, Rantanen P. Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. BMJ. 1999;319:348–51.CrossRefPubMedPubMedCentral
31.
go back to reference Klomek AB, Sourander A, Kumpulainen K, Piha J, Tamminen T, Moilanen I, Almqvist F, Gould MS. Childhood bullying as a risk for later depression and suicidal ideation among Finnish males. J Affect Disord. 2008;109:47–55.CrossRefPubMed Klomek AB, Sourander A, Kumpulainen K, Piha J, Tamminen T, Moilanen I, Almqvist F, Gould MS. Childhood bullying as a risk for later depression and suicidal ideation among Finnish males. J Affect Disord. 2008;109:47–55.CrossRefPubMed
32.
go back to reference Joffe BI, Van Lieshout RJ, Duncan L, Boyle MH. Suicidal ideation and behavior in adolescents aged 12-16 years: a 17-year follow-up. Suicide Life Threat Behav. 2014;44:497–509.CrossRefPubMed Joffe BI, Van Lieshout RJ, Duncan L, Boyle MH. Suicidal ideation and behavior in adolescents aged 12-16 years: a 17-year follow-up. Suicide Life Threat Behav. 2014;44:497–509.CrossRefPubMed
33.
go back to reference Hong L, Guo L, Wu H, Li P, Xu Y, Gao X, Deng J, Huang G, Huang J, Lu C. Bullying, depression, and suicidal ideation among adolescents in the fujian province of china: a cross-sectional study. Medicine (Baltimore). 2016;95:e2530.CrossRef Hong L, Guo L, Wu H, Li P, Xu Y, Gao X, Deng J, Huang G, Huang J, Lu C. Bullying, depression, and suicidal ideation among adolescents in the fujian province of china: a cross-sectional study. Medicine (Baltimore). 2016;95:e2530.CrossRef
34.
go back to reference Quiroga CV, Janosz M, Lyons JS, Morin AJS. Grade retention and seventh-grade depression symptoms in the course of school dropout among high-risk adolescents. Psychology. 2012;03:749–55.CrossRef Quiroga CV, Janosz M, Lyons JS, Morin AJS. Grade retention and seventh-grade depression symptoms in the course of school dropout among high-risk adolescents. Psychology. 2012;03:749–55.CrossRef
35.
go back to reference Troop NA, Murphy F, Bramon E, Treasure JL. Disgust sensitivity in eating disorders: a preliminary investigation. Int J Eat Disord. 2000;27:446–51.CrossRefPubMed Troop NA, Murphy F, Bramon E, Treasure JL. Disgust sensitivity in eating disorders: a preliminary investigation. Int J Eat Disord. 2000;27:446–51.CrossRefPubMed
36.
go back to reference McNamara C, Hay P, Katsikitis M, Chur-Hansen A. Emotional responses to food, body dissatisfaction and other eating disorder features in children, adolescents and young adults. Appetite. 2008;50:102–9.CrossRefPubMed McNamara C, Hay P, Katsikitis M, Chur-Hansen A. Emotional responses to food, body dissatisfaction and other eating disorder features in children, adolescents and young adults. Appetite. 2008;50:102–9.CrossRefPubMed
37.
go back to reference Choi SKY, Boyle E, Burchell AN, Gardner S, Collins E, Grootendorst P, Rourke SB, OCS Group. Validation of six short and ultra-short screening instruments for depression for people living with HIV in Ontario: results from the Ontario HIV treatment network cohort study. PLOS One. 2015;10:e0142706.CrossRefPubMedPubMedCentral Choi SKY, Boyle E, Burchell AN, Gardner S, Collins E, Grootendorst P, Rourke SB, OCS Group. Validation of six short and ultra-short screening instruments for depression for people living with HIV in Ontario: results from the Ontario HIV treatment network cohort study. PLOS One. 2015;10:e0142706.CrossRefPubMedPubMedCentral
38.
go back to reference Richardson LP, Rockhill C, Russo JE, Grossman DC, Richards J, McCarty C, McCauley E, Katon W. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics. 2010;125:e1097–1103.CrossRefPubMedPubMedCentral Richardson LP, Rockhill C, Russo JE, Grossman DC, Richards J, McCarty C, McCauley E, Katon W. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics. 2010;125:e1097–1103.CrossRefPubMedPubMedCentral
39.
go back to reference Le LC, Blum RW, Magnani R, Hewett PC, Do HM. A pilot of audio computer-assisted self-interview for youth reproductive health research in Vietnam. J Adolesc Health. 2006;38:740–7.CrossRefPubMed Le LC, Blum RW, Magnani R, Hewett PC, Do HM. A pilot of audio computer-assisted self-interview for youth reproductive health research in Vietnam. J Adolesc Health. 2006;38:740–7.CrossRefPubMed
Metadata
Title
Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study
Authors
Qiguo Lian
Xiayun Zuo
Yanyan Mao
Shan Luo
Shucheng Zhang
Xiaowen Tu
Chaohua Lou
Weijin Zhou
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Environmental Health and Preventive Medicine / Issue 1/2017
Print ISSN: 1342-078X
Electronic ISSN: 1347-4715
DOI
https://doi.org/10.1186/s12199-017-0639-2

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