title: Associations between body mass index and suicide in the veterans affairs health system.
abstract: OBJECTIVE
  Associations between BMI and suicide risks and methods for individuals receiving care in the Veterans Health Administration (VHA) health system were evaluated.
  
  
  METHODS
  For 4,005,640 patients in fiscal years 2001-2002, multivariable survival analyses assessed associations between BMI and suicide, through FY2009. Covariates included demographics, psychiatric, and nonpsychiatric diagnoses, receipt of VHA mental health encounters, and regional network. Among suicide decedents, multivariable Generalized Estimating Equations (GEE) regression examined associations between BMI and suicide method.
  
  
  RESULTS
  1.3% of patients were underweight, 24.3% normal weight, 40.6% overweight, and 33.8% obese. Underweight was associated with increased suicide risk (adjusted hazard ratio [AHR] = 1.17, 95% CI: 1.01, 1.36) compared to normal. Overweight and obese status were associated with lower risk (AHR = 0.78, 95% CI: 0.74, 0.82; AHR = 0.63, 95% CI: 0.60, 0.66, respectively). Among suicide decedents, high lethality methods were most common among underweight and least common among obese individuals. Adjusting for covariates, BMI was not associated with method lethality, yet some associations were observed between BMI and specific methods.
  
  
  CONCLUSIONS
  Among VHA patients, BMI was negatively associated with suicide risks. These differences may partly relate to choice of suicide method. Low BMI offers an additional resource for clinical suicide risk assessments.
authors.affiliation: US Department of Veterans Affairs (VA), Office of Mental Health Operations (OMHO), Washington, District of Columbia, USA; VA OMHO Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan, USA; VA Center for Clinical Management Research, Washington, District of Columbia, USA; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ilgen
authors.forename: Karen
authors.initials: K
authors.lastname: Austin
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.forename: Ira R
authors.initials: IR
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000523:psychology; D050177:Overweight / Q000523:psychology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000523:psychology*; D013851:Thinness / Q000523:psychology; D014728:Veterans / Q000523:psychology*; D055815:Young Adult