BACKGROUND Although studies have suggested a high risk of suicide in people with eating disorders, most studies have focused on suicidal ideation and attempts. There is little research on the characteristics of people with eating disorders who died by suicide, nor investigation of trends over time. We aimed to compare the characteristics of patients with eating disorders who died by suicide versus patients with other mental health diagnoses who died by suicide in England and to examine the trends in rates. METHODS In this national retrospective cohort study, data on all people (aged ≥10 years) who died by suicide in England, UK, between Jan 1, 1997, and Dec 31, 2021, while under the care (within the previous 12 months) of mental health services were obtained from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), in which clinical information is collected via a questionnaire completed by the mental health professional responsible for the patient's care. Incidence of suicide in, and demographic, clinical, and treatment characteristics of, patients with a diagnosis of eating disorder (as recorded by the treating clinician) who died by suicide were compared with patients with other mental health diagnoses who died by suicide within the same timeframe using univariable logistic regression analysis. People with related lived experience were involved in the study design, implementation, interpretation, and writing of the manuscript. FINDINGS Of 119 446 people for whom NCISH were notified of dying by suicide in England, 30 795 were under the recent care of mental health services, of whom 30 246 had known diagnoses and were included in analyses. Of these individuals, 10 373 (34%) were female and 19 873 (66%) were male; 2236 (8%) were of minority ethnicity; 382 (1%) had a diagnosis of eating disorder and 29 864 (99%) had another mental health diagnosis. Compared with patients with other mental health diagnoses who died by suicide, patients with eating disorders were younger (median age 33 years [range 15-90] vs 45 years [10-100]), more often female (343 [90%] female and 39 [10%] male in the eating disorders group; 10 030 [34%] female and 19 834 [66%] male in the other diagnoses group), and less likely to have evidence of conventional risk factors for suicide such as living alone (odds ratio [OR] 0·68, 95% CI 0·55-0·84). 22 (6%) of 382 were from a minority ethnic group. Patients with an eating disorder were characterised by a greater clinical complexity (eg, self-harm [OR 2·31, 95% CI 1·78-3·00], comorbidity [9·79, 6·81-14·1], and longer duration of illness [1·95, 1·56-2·43]), and were more likely to have died following overdoses (2·00, 1·62-2·45) than patients with other diagnoses. Childhood abuse (52 [37%] of 140) and domestic violence (18 [20%] of 91) were common in patients with eating disorders. Similar to patients with other diagnoses, most (244 [75%] of 326) of those with eating disorders who died by suicide were rated as low risk by clinicians at last contact. The number of suicide deaths in patients with eating disorders rose between 1997 and 2021 (incidence rate ratio [IRR] 1·03, 95% CI 1·02-1·05; p<0·0001), but rates fell when accounting for the greater number of patients entering mental health services (IRR 0·97, 0·95-1·00; p=0·033). INTERPRETATION This study was focused on people who sought help from mental health services. It did not consider subtypes of eating disorders or include a control group, but it does highlight possible areas for intervention. The comprehensive provision of evidence-based treatment for eating disorders and underlying conditions to address the clinical complexity in these patients might help to reduce suicide. Recognising limitations in clinical risk assessment, addressing early life experiences and current adversities, and appropriate prescribing might also be of benefit. Suicide prevention must remain a priority for eating disorder services and mental health care more widely. FUNDING The Healthcare Quality Improvement Partnership.

中文翻译：

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在英格兰寻求心理健康治疗的饮食失调患者的自杀：一项全国回顾性队列研究。


背景虽然研究表明饮食失调患者自杀的风险很高，但大多数研究都集中在自杀意念和尝试上。关于因自杀而死亡的饮食失调患者的特征的研究很少，也没有对随时间变化的趋势进行调查。我们的目的是比较英格兰因饮食失调而自杀的患者与因其他心理健康诊断而自杀的患者的特征，并研究比率趋势。方法 在这项全国性回顾性队列研究中，收集了 1997 年 1 月 1 日至 2021 年 12 月 31 日期间（过去 12 个月内）在英国英格兰自杀身亡的所有人员（年龄≥10 岁）的数据心理健康服务的数据来自国家心理健康自杀和安全保密调查 (NCISH)，其中临床信息是通过负责患者护理的心理健康专业人员填写的调查问卷收集的。将诊断为饮食失调（由治疗临床医生记录）的自杀死亡患者的自杀发生率以及人口统计学、临床和治疗特征与同一时间内死于自杀的其他精神健康诊断患者进行比较。使用单变量逻辑回归分析的时间范围。有相关生活经验的人参与了研究设计、实施、解释和手稿的撰写。调查结果 在英格兰，NCISH 接到自杀死亡通知的 119 446 人中，有 30 795 人最近正在接受精神卫生服务机构的护理，其中 30 246 人已知诊断并纳入分析。 其中，10 373 人（34%）为女性，19 873 人（66%）为男性； 2236 名（8%）为少数民族； 382 人 (1%) 被诊断为饮食失调，29 864 人 (99%) 被诊断为精神健康问题。与自杀身亡的其他心理健康诊断患者相比，饮食失调患者更年轻（中位年龄 33 岁 [范围 15-90] vs 45 岁 [10-100]），且女性较多（343 名 [90%] 女性饮食失调组有 39 名男性（10%）；其他诊断组有 10 030 名女性（34%）和 19 834 名男性（66%），并且不太可能有自杀的传统危险因素（例如生活）。单独使用（比值比 [OR] 0·68，95% CI 0·55-0·84）。 382 人中有 22 人（6%）来自少数民族。饮食失调患者的特点是临床复杂性较高（例如，自残 [OR 2·31, 95% CI 1·78-3·00]、合并症 [9·79, 6·81-14·1] ，病程较长 [1·95, 1·56-2·43]），并且比其他诊断的患者更有可能因服药过量而死亡（2·00, 1·62-2·45）。饮食失调患者中常见童年虐待（140 人中的 52 人[37%]）和家庭暴力（91 人中的 18 人[20%]）。与其他诊断的患者类似，大多数（326 名饮食失调患者中的 244 名[75%]）因自杀而死亡的患者在最后一次接触时被临床医生评为低风险。 1997 年至 2021 年间，饮食失调患者的自杀死亡人数有所增加（发病率比 [IRR] 1·03，95% CI 1·02-1·05；p<0·0001），但考虑到自杀因素，自杀率有所下降进入心理健康服务的患者数量越多（IRR 0·97、0·95-1·00；p=0·033）。解释 这项研究的重点是向心理健康服务寻求帮助的人。 它没有考虑饮食失调的亚型，也没有包括对照组，但它确实强调了可能进行干预的领域。针对饮食失调和潜在疾病提供全面的循证治疗以解决这些患者的临床复杂性可能有助于减少自杀。认识到临床风险评估的局限性、解决早期生活经历和当前的逆境以及适当的处方也可能有益。预防自杀必须仍然是饮食失调服务和更广泛的心理保健的优先事项。为医疗保健质量改进合作伙伴关系提供资金。