title: Self-image and suicide in a Swedish national eating disorders clinical register.
abstract: OBJECTIVE
  Using a prospective design, to examine the relation between self-image (assessed using the Structural Analysis of Social Behavior) and suicide attempts/completions in women with anorexia nervosa-restricting type (ANR), anorexia nervosa-binge/purge type (ANBP), bulimia nervosa (BN), binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS); and to assess whether these self-image variables add unique predictive value to suicide when considering other baseline predictors.
  
  
  METHODS
  Women (N=2269) aged 12 to 45 (M=22.1) presenting to specialist eating disorders clinics in Sweden between 2005 and 2009 were identified through the Stepwise Eating Disorders Quality Register. Data on age, body mass index, eating disorder severity (Eating Disorder Examination-Questionnaire scores), psychiatric comorbidity, global assessment of functioning, and self-image were abstracted from Stepwise and included as baseline predictors or covariates. Suicide information (prior attempt and attempt/completion after Stepwise registration) was obtained from the National Patient Register and Cause of Death Register.
  
  
  RESULTS
  Prevalence of detected suicide attempts/completions over the study period was 9.2%. Negative self-image variables were associated with prior suicide attempts in ANR and EDNOS and later suicide attempts/completions in women with BN. In a stepwise Cox proportional hazards model, only low self-affirmation predicted time to suicide attempts/completions in women with BN when accounting for age and prior suicide attempt.
  
  
  CONCLUSIONS
  Assessing self-image might assist with identifying women with BN at elevated risk for suicide.
authors: Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
authors: Cristin D
authors: CD
authors: Runfola
authors: Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
authors: Laura M
authors: LM
authors: Thornton
authors: Department of Psychology, University of North Carolina, Chapel Hill, NC, USA.
authors: Emily M
authors: EM
authors: Pisetsky
authors: Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA; Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA. Electronic address: cbulik@med.unc.edu.
authors: Cynthia M
authors: CM
authors: Bulik
authors: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors: Andreas
authors: A
authors: Birgegård
mesh_terms: D000293:Adolescent; D000328:Adult; D001828:Body Image; D002648:Child; D001068:Feeding and Eating Disorders / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012649:Self Concept; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D013548:Sweden; D055815:Young Adult