The roles of weight stigma, emotion dysregulation, and eating pathology in suicide risk

Multiple marginalization, discrimination, and disordered eating among youth aged 10-11

OBJECTIVE

Although rates of weight discrimination are on-par with racial, ethnic, and gender discrimination, comparatively less work has examined impacts of weight-based discrimination in youth, including on disordered eating. Knowing whether experiences of weight-based discrimination, including in youth with multiply-marginalized identities, are associated with disordered eating could identify vulnerable youth and inform intervention efforts.

METHOD

Youth (N = 11,875) ages 10-11 were recruited through the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions using cross-sectional data examined discrimination experiences (weight, perceived sexual orientation, race/ethnicity, national origin) and disordered eating (binge-eating, vomiting, weight-gain fear, weight self-worth). Models included race/ethnicity, age, sex, parental income, and degree of elevated weight. Raked poststratification weights were used.

RESULTS

Rates of weight-based discrimination (6.2%) were similar to rates of race/ethnicity (4.4%) and sexual orientation discrimination (4.5%). Weight-based discrimination was associated with more disordered eating. Youth reporting multiple experiences of discrimination had significantly increased disordered eating compared to youth who did not report discrimination.

DISCUSSION

Weight-based discrimination is common in youth and associated with disordered eating. Youth with elevated weight are more likely to be multiply marginalized and experience disordered eating. These findings suggest discrimination, including weight-based discrimination, is a critical intervention target to prevent and treat eating disorders.

PUBLIC SIGNIFICANCE

Experiences of discrimination contribute to poorer health; however, weight-based discrimination is relatively understudied. Data from a large sample of youth ages 10-11 showed that youth with elevated weight reported experiencing multiple types of discrimination, and multiply-marginalized youth had increased odds of disordered eating with each additional type of discrimination. Together, this suggests that weight-based discrimination is a critical target to prevent and treat eating disorders, especially in multiply-marginalized youth.

Mediation of the association between screen time and suicidality by overweight/obesity and perceived overweight: results from the youth risk behavior surveillance system of the United States

Aim

Adolescent suicide is a major public health concern, and modifiable risk factors associated with adolescent suicide remain poorly understood. This study aimed to assess the association between screen time and overweight/obesity and self-perceived overweigh and suicidality in adolescents.

Methods

Adolescents from the United States Youth Risk Behavior Surveillance System (YRBSS) between 2013 and 2019 were included in this cross-sectional study. The outcome was suicidality, including considered suicide, made a suicide plan, attempted suicide, and injurious suicide attempt. Multivariable logistic regression model was used to investigate the associations between screen time, overweight/obesity, self-perceived overweight, and suicidality, and expressed as odds ratio (OR) and 95% confidence interval (CI). Mediation analysis was used to explore the role of overweight/obesity and self-perceived overweight on the association between screen time and suicidality.

Results

A total of 30,731 adolescents were included, of which 6,350 (20.65%) had suicidality, including 5,361 (17.45%) with considered suicide, 4,432 (14.42%) with made a suicide plan, 2,300 (7.45%) with attempted suicide, and 677 (2.21%) with injurious suicide attempt. Adolescents with screen time ≥3h were related to higher odds of suicidality (OR=1.35, 95%CI: 1.23-1.46), overweight/obesity (OR=1.27, 95%CI: 1.19-1.38), and self-perceived overweight (OR=1.38, 95%CI: 1.30-1.48) after adjusting confounders. Adolescents with overweight/obesity (OR=1.30, 95%CI: 1.19-1.43) and self-perceived overweight (OR=1.54, 95%CI: 1.39-1.70) were associated with higher odds of suicidality. The association between screen time and suicidality was 4.67% mediated by overweight/obesity and 9.66% mediated by self-perceived overweight. Moreover, the mediating role of overweight/obesity was observed only in females, whereas there were no sex differences in the mediating effect of self-perceived overweight.

Conclusion

Both overweight/obesity and self-perceived overweight mediated the association between screen time and suicidality.

A systematic review of weight stigma and disordered eating cognitions and behaviors

Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing literature that has explored the relationship between weight stigma and disordered eating cognitions and behaviors. We specifically examined three dimensions of weight stigma - experienced, anticipated, and internalized - and adopted an inclusive conceptualization of outcomes related to disordered eating (including constructs such as binge eating, body dissatisfaction, and other cognitions and behaviors such as dietary restraint, unhealthy weight control behaviors, and drive for thinness). We searched PubMed, Embase, CINAHL, Web of Science, Sociological Abstracts, and PsycINFO for English-language, peer-reviewed articles and dissertations with quantitative methodology published through October 2023. The search resulted in 242 articles meeting inclusion criteria. A narrative review found a consistent relationship between greater weight stigma and more disordered eating cognitions and behaviors. Methodological and theoretical limitations are discussed, as are critical avenues for future research and potential clinical implications stemming from this body of research. Given the widespread nature and impact of weight stigma on disordered eating, it is imperative that we intervene to address weight stigma at all levels, from the structural to the intrapersonal.

Relationship between biological rhythm dysregulation and suicidal ideation in patients with major depressive disorder

BACKGROUND

Although the disturbance of circadian rhythms represents a significant clinical feature of major depressive disorder (MDD), the relationship between biological rhythm disturbances and the severity of suicidal ideation in individuals with MDD remains unclear. We aimed to explore the characteristics of different biological rhythm dimensions in MDD and their association with the severity of depressive symptoms and suicidal ideation.

METHODS

A total of 50 MDD patients and 50 healthy controls were recruited and their general information was collected. The severity of depressive symptoms was assessed with the 17-item Hamilton Depression Rating Scale (HDRS17). The intensity of suicidal ideation was evaluated with the Beck Scale for Suicide Ideation (BSS). The Chinese version of the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) scale was utilized to assess the participants' biological rhythm dysregulation. Multiple logistic regression analysis was conducted to explore the relationship between biological rhythm and the risk of MDD. Multiple linear regression analysis was performed in the MDD group to investigate the relationship between different biological rhythm dimensions and suicide ideation.

RESULTS

Significant differences were observed between the MDD group and the control group in total BRIAN score (Z=-5.41, P < 0.001) as well as scores for each dimension. After adjusting for confounding factors, multiple logistic regression analysis revealed a significant association between total BRIAN score and the presence of MDD (OR = 1.20, 95% CI = 1.10-1.29, P < 0.001), as well as between scores in different BRIAN dimensions and the presence of MDD (activity: OR = 1.47, 95% CI = 1.24-1.74, P < 0.001; sleep: OR = 1.52, 95% CI = 1.28-1.79, P < 0.001; social: OR = 1.80, 95% CI = 1.32-2.46, P < 0.001; eating pattern: OR = 1.34, 95% CI = 1.12-1.60, P = 0.001). In patients with MDD, linear regression analysis demonstrated a positive relationship between BSS scores and BRIAN eating pattern scores (β = 0.34, P = 0.022), even after adjusting for demographic factors and the severity of depression.

CONCLUSIONS

Patients with MDD exhibited significantly higher levels of dysregulation in all four biological rhythm dimensions compared to healthy controls and the degree of dysregulation was associated with the severity of depression. More importantly, dysregulation of eating pattern may increase the intensity of suicidal ideation in MDD, thus elevating the risk of suicide.

The Mental "Weight" of Discrimination: The Relationship between Perceived Interpersonal Weight Discrimination and Suicidality in the United States

Extant research has investigated the relationship between body weight and suicidality because obesity is highly stigmatized, leading to social marginalization and discrimination, yet has produced mixed results. Scholars have speculated that factors associated with body weight, such as weight discrimination, may better predict suicidality than body weight itself. We consider this possibility among a sample of 12,057 adult participants ages 33 to 43 in Wave V of the National Longitudinal Study of Adolescent to Adult Health through investigation of the relationships between weight discrimination and two dimensions of suicidality-suicide ideation and attempts. We also examine gender as a moderator of these relationships. We find that weight discrimination is positively associated with both suicide ideation and attempts, and this relationship is similar among men and women. Our findings underscore the need to address issues of weight discrimination in our society to better promote mental well-being.

Relationship Between Emotion Regulation and Suicide Ideation and Attempt in Adults and Adolescents: A Systematic Review

INTRODUCTION

Suicide is one of the main causes of death in adults and adolescents, so research focused on identifying risk factors for suicidal behavior is needed. In recent years, emotion regulation, mainly the presence of difficulties regulating one's own negative emotions, has been associated with negative mental health outcomes.

OBJECTIVE

The purpose of this study was to systematically review the available evidence on the association between emotion regulation and suicide (ideation and attempt) in both adults and adolescents.

METHOD

A systematic search of scientific articles published in English and Spanish was carried out through the databases PsycINFO, MEDLINE, Scopus, and the Cochrane Library.

RESULTS

We identified 76 eligible studies, of which 70 reported that people with difficulties in emotion regulation reported higher levels of suicide ideation and more suicide attempts. The results were consistent in adolescents and adults, in clinical and general population samples, and when studies assessed both emotion regulation processes and strategies. However, few studies were longitudinal and most of them were with women.

CONCLUSIONS

We discuss the theoretical implications of the results, suggesting that actual psychological models might benefit from considering individual differences in ER in understanding why people engage in suicide behavior. Clinical implications are also discussed.HIGHLIGHTSDifficulties regulating one's emotions is associated with suicide behavior (SI and SA).Consistent results at all the ages and in the clinical and general population.Individual differences in ER could help researchers to understand suicide.

Prolonged Grief Symptoms among Suicide-Loss Survivors: The Contribution of Intrapersonal and Interpersonal Characteristics

BACKGROUND

Suicide-loss survivors (SLSs) are a population with unique characteristics that place them at increased risk for developing grief complications and painful feelings of guilt that may impact their supportive social environment. However, no studies to date have examined the role of intrapersonal and interpersonal variables that may contribute to prolonged grief symptoms (PGS) as outlined by the new DSM-5 criteria. The present study aimed to extend knowledge regarding the role of interpersonal variables, such as perceived burdensomeness, thwarted belongingness, and self-disclosure, in determining the impact of guilt on the development of PGS among SLSs.

METHOD

This study is part of a longitudinal study, though, in this study, we used a cross-sectional examination of the recently completed fourth measurement. Study participants included 152 SLSs aged 22 to 76 who completed questionnaires measuring guilt, depression, perceived burdensomeness, thwarted belongingness, self-disclosure, and PGS using the Prolonged Grief-Revised Inventory. Participants' demographics and loss-related characteristics, such as time since suicide and participant's age at the time of suicide, were examined.

RESULTS

Confirming the hypotheses, intrapersonal variables (i.e., guilt and depression), as well as interpersonal variables (i.e., perceived burdensomeness, thwarted belongingness, and self-disclosure), contributed significantly to PGS beyond sociodemographic and loss-related factors. Perceived burdensomeness significantly moderated the contribution of guilt to PGS: for participants with high burdensomeness levels, guilt contributed to PGS more strongly than for participants with low burdensomeness.

CONCLUSION

Guilt is an important contributor to PGS among SLSs, and perceived burdensomeness plays a critical role in moderating this contribution. In light of these findings, it can be suggested that SLSs with high levels of guilt should receive special attention and may benefit from therapeutic interventions focusing on reducing maladaptive cognitions that elicit intense guilt or perceived burden.

The relationship between obesity and suicide ideation among young adults in the United States

The prevalence of both obesity and suicide ideation has risen in the last several decades among young adults in the United States (U.S.). Obesity is highly stigmatized in the U.S. and leads to discrimination and societal rejection, which suggests that obesity may increase the risk of suicide ideation. However, no U.S. population-representative studies to date have investigated the relationship between body weight and suicide ideation among young adults. We make this contribution by analyzing data from Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Our results indicate obesity is not related to suicide ideation among young men or young women and overweight young men have lower odds of suicide ideation than normal weight young men. We speculate that these findings may be attributable to the very high U.S. overweight and obesity prevalence, which has made obesity more common despite stigmatization.

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First nationally representative study of young adults' weight and suicide ideation.

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Obesity is not associated with suicide ideation among U.S. young men and women.

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Overweight is associated with a lower risk of suicide ideation among young men.