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Am J Epidemiol. 2012 Apr 15;175(8):804-15. doi: 10.1093/aje/kwr386. Epub 2012 Mar 16.

Adiposity, its related biologic risk factors, and suicide: a cohort study of 542,088 taiwanese adults.

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China Medical University Hospital, and Institute of Population Health Science, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 350, Taiwan.


Recent studies in Western nations have shown inverse associations between body mass index (BMI, measured as weight (kg)/height (m)(2)) and suicide. However, it is uncertain whether the association is similar in non-Western settings, and the biologic pathways underlying the association are unclear. The authors investigated these issues in a cohort of 542,088 Taiwanese people 20 years of age or older who participated in a health check-up program (1994-2008); there were 573 suicides over a mean 8.1 years of follow up. There was a J-shaped association between BMI and suicide risk (P for the quadratic term = 0.033) but limited evidence of a linear association (adjusted hazard ratio per 1-standard-deviation increase = 0.95 (95% confidence interval: 0.85, 1.06)); compared with individuals whose BMI was 18.5-22.9, adjusted hazard ratios for those with a BMI <18.5 or ≥35 were 1.56 (95% confidence interval: 1.07, 2.28) and 3.62 (95% confidence interval: 1.59, 8.22), respectively. A high waist-to-hip ratio was associated with an increased risk of suicide. There was some evidence for a reverse J-shaped association of systolic blood pressure and high density lipoprotein cholesterol with suicide and an association of higher triglyceride level with increased suicide risk; these associations did not appear to mediate the associations of BMI and waist-to-hip ratio with suicide.

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