Association between body mass index and suicidal behaviors: a systematic review protocol

Abstract

BackgroundSuicide is among the leading causes of death worldwide. Suicide attempts and suicidal ideation are more common than completed suicide and are associated with psychological distress. These behaviors are considered risk factors of completed suicide. Considering the psychosocial stigma and medical comorbidities associated with obesity, an accumulating body of studies have investigated body mass index (BMI) as a potential risk factor of suicide. However, several cohort studies have demonstrated an inverse relationship between BMI and completed suicide, suggesting a protective effect of increasing BMI against completed suicide. The association between BMI and attempted suicide is more equivocal, with several studies reporting both positive and negative relationships between BMI and attempted suicide. The primary objective of this study is to systematically review the literature to determine the association between BMI and suicidal behavior (including completed suicide, attempted suicide, suicidal ideation) in an adult population (18 years and older). The secondary objective is to explore whether sex, age, and the method used in suicide modify the relationship between BMI and suicidal behavior.Methods/designAn electronic search will be conducted using PubMed/MEDLINE, PsycINFO, CINAHL, and EMBASE using a predefined search strategy; databases will be searched from their inception. Two authors (SP and RE) will independently screen articles using predefined inclusion and exclusion criteria and will extract pertinent data using a pilot tested extraction form. At all levels of screening, discrepancies between the two authors will be resolved by consensus, and in the case of disagreement, by consulting a third author (ZS). The primary outcomes include the association between BMI and completed suicide, attempted suicide, and suicidal ideation. If appropriate, a meta-analysis will be conducted. Risk of bias and quality of evidence will be assessed.DiscussionThe results of this systematic review will inform health care professionals and researchers about whether BMI has a significant role in suicidal behavior and psychological well-being.Systematic review registrationPROSPERO CRD42014014739.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0038-y) contains supplementary material, which is available to authorized users.

Night noise exposure and risk of death by suicide in adults living in metropolitan areas

“…Excess body mass is a known risk factor for chronic illnesses, but the association between BMI and suicidal behavior has not yet been clarified (Perera et al, 2015). Excess body mass is a known risk factor for chronic illnesses, but the association between BMI and suicidal behavior has not yet been clarified (Perera et al, 2015).…”

Body Mass Index Is an Important Predictor for Suicide: Results from a Systematic Review and Meta‐Analysis

“…The methods of this systematic review were published in an a priori designed protocol (Perera et al., ) that was registered with PROSPERO. We provide a summary of the methods below.…”

“…No language restrictions were applied. A medical librarian (NB) assisted with the development of the search strategy (see Table of the published protocol; Perera et al., ). We also hand‐searched the reference lists of included articles and past reviews.…”

“…Some research has similarly demonstrated an inverse relationship between BMI and attempted suicide (Gao, Juhaeri, Reshef, & Dai, ; Sörberg et al., ); however, several positive (Brunner et al., ; Dong, Li, Li, & Price, ; Wagner, Klinitzke, Brähler, & Kersting, ) and nonsignificant (Smith, White, Hadden, & Marriott, ) associations have been reported. The impact of body weight on suicidal ideation remains unclear (Perera et al., ).…”

Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know?

“…In recent years, an increasing number of studies have revealed a consistent, longitudinal, and positive association between obesity and symptoms of depression (Mather et al 2009;Luppino et al 2010;Faith et al 2011). However, focusing on the complex link between obesity and suicidality, Klinitzke et al (2012) and Perera (2015) independently demonstrated in systematic overviews, that the current literature supports a significant inverse relationship between obesity and suicide. Therefore, the current progress in the field of bariatric surgery and its impact on self-harm behavior and suicidality is of growing relevance.…”