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The Pre-Existing Depressive Disorders, Substance Use Disorders Predicted the Suicidal Death of the Patients with Eating Disorders – A Preliminary Result of National Health Insurance Research Databases in a Chinese Population

Author(s): Chiu-Lan Yan, Jung-Chen Chang, Shu-Chuan Weng, Ming-Kung Yeh, Chin-Bin Yeh


Recent evidence suggests that additional psychiatric disorders in patients with eating disorders (ED) may contribute to suicide risk. The aim of our study was to investigate the association between eating disorders, its comorbidity and suicidal deaths by the analyzing the data from National Health Insurance Research Databases (NHIRD) and statistical reports on the causes of death.


We identified 19,648 patients with ED diagnoses from the Taiwan National Health Insurance Database between 2001 and 2012. The patients who had been diagnosed eating disorders ≥4 times at outpatient visits, or had ≥1 time of hospitalization were recruited as the group of ED (N=9974). The outcome of measurements was defined as the death of the group of eating disorders either by suicide (N=113), accidental death (N=35) or others (N=97). Cox regression was applied to investigate the relationship between psychiatry comorbidities and the suicidal death of the patients with ED.


Age of onset with Anorexia Nervosa (AN) was significantly younger than Bulimia Nervosa (BN) or Eating disorders, NOS (EDNOS) in patients with ED. The risk of suicide had 2.4-fold higher of preexisting (aHR=2.4; 95% CI=1.6-3.7) but not concurrent (aHR=1.0; 95% CI=0.7-1.5) or subsequent (aHR=0.8; 95% CI=0.4-1.3) any psychiatric comorbidity with ED patients than without psychiatric comorbidity. The risk of suicide was 1.8-fold higher in patients with previous major depressive disorder (aHR=1.8; 95% CI=1.2-2.7), and 2.6-fold higher in patients with prior substance use disorder (aHR=2.6; 95% CI=1.5-4.5). Patients with four or more psychiatric comorbidities had a 6.3- fold increased risk of suicide (aHR=6.3; 95% CI=3.1–12.8; p<0.05).


The previous psychiatric comorbidities including major depressive disorder and substance use disorder were associated with the suicidal death in patients with ED. The patients with more psychiatric comorbidities had a higher risk of suicide.

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