title: Body Weight and Suicidal Behavior in Adolescent Females: The Role of Self-Perceptions.
abstract: BACKGROUND
  Suicide is the third leading cause of death among adolescents and recent data indicate that the suicide rate, particularly for young girls, is increasing. Excess body weight among adolescents has also been documented widely over the last two decades and is considered one of the most pressing public health concerns today. Previous literature has examined the relationship between actual body weight and suicidal behavior, but there is little evidence on self-perception of weight and suicidal behaviors.
  
  
  OBJECTIVE
  This study examines the relationship between body weight and suicidal behaviors using a rich longitudinal data set of a large nationally-representative sample of female adolescents to account for a number of confounding factors. The study explores the relationship, not only between actual weight status and suicidal behaviors, but also between self-perception of weight and suicidal behaviors.
  
  
  METHODS
  Using data from a nationally-representative sample of adolescents in the United States, the study ascertains the effect of body weight status on suicidal behaviors by estimating endogeneity-corrected models including school-level fixed effects to account for bi-directionality and unobserved confounders. Actual body weight status was calculated using interviewer-measured height and weight. The study also used a measure of self-perceived weight status to compare how actual versus self-perceived weight status affects suicidal behavior. Thinking about committing suicide and attempting to commit suicide in the past 12 months were utilized as dichotomous measures of suicidal behaviors. Potential mediators between suicidal behaviors and weight status such as family history of suicide, participation in risky health behaviors and parental characteristics were also controlled for in the analysis. The analytical sample consists of 5,430 adolescent females aged 11 to 18.
  
  
  RESULTS
  The results suggest that both self-perceived and measured weight status (overweight or obese) increase a female adolescent's probability of suicidal ideation, with self-perceived weight status causing a larger increase in suicidal ideation. There is some evidence that body weight status affects suicide attempts, but these results are much less robust. Finally, endogeneity bias is shown to be of concern in all estimates, and failing to account for this bias is likely to understate any estimated effect.
  
  
  CONCLUSIONS
  The results have important implications for the design of public health programs to prevent adolescent suicide, especially among female adolescents. Understanding the mechanisms through which adolescents are motivated to take such dire actions will help to allocate resources into the treatment areas which are most effective in stemming the rise of suicidal behaviors. This study identifies one key factor, self-perception of weight, which may be an avenue for mental health care providers to continue exploring.
  
  
  CONCLUSIONS
  Further research on this topic could include not only studying the impact of body weight on suicidal behaviors, but also examining the relationships between body weight and other important mental health outcomes such as psychological distress and major depressive episodes.
authors.affiliation: Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5100 Paint Branch Parkway, College Park, MD 20910, USA, Travis.Minor@fda.hhs.gov.
authors.forename: Travis
authors.initials: T
authors.lastname: Minor
authors.forename: Mir M
authors.initials: MM
authors.lastname: Ali
authors.forename: John A
authors.initials: JA
authors.lastname: Rizzo
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001828:Body Image / Q000523:psychology*; D001835:Body Weight; D002648:Child; D005260:Female; D006801:Humans; D009765:Obesity / Q000453:epidemiology / Q000523:psychology*; D050177:Overweight / Q000453:epidemiology / Q000523:psychology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology