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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 19, Issue 1, 2016. Pages: 21-31
Published Online: 1 March 2016

Copyright © 2016 ICMPE.


 

Body Weight and Suicidal Behavior in Adolescent Females: The Role of Self-Perceptions

Travis Minor,1 Mir M. Ali,2 John A. Rizzo3

1Ph.D., Center for Food Safety & Applied Nutrition Food & Drug Administration, College Park, MD, USA.
2Ph.D.,Center for Behavioral Health Statistics & Quality, Substance Abuse & Mental Health Services Administration, Rockville, MD, USA
3Ph.D.,Department of Economics and Department of Preventive Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA

* Correspondence to: Travis Minor, Ph.D., Center for Food Safety & Applied Nutrition Food & Drug Administration, 5100 Paint Branch Parkway, College Park, MD 20910, USA.
Tel.: +1-301-436 2951
Fax: +1-301-436 2637
E-mail: Travis.Minor@fda.hhs.gov

Source of Funding: None declared.

Abstract

This study examines the relationship between body weight and suicidal behaviors using a nationally-representative sample of female adolescents. Specifically, we explore the relationship, not only between actual weight status and suicidal behaviors, but also between self-perception of weight and suicidal behaviors. 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. Additionally, endogeneity bias is shown to be of concern, and failing to account for this bias is likely to understate any estimated effect. 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.

 

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.

Aim of the Study: 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.

Method: 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.

Implications for Health Policy: 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.

Implications for Future Research: 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.

Received 22 January 2015; accepted 5 February 2016

Copyright 2016 ICMPE