Suicide attempts requiring hospitalization in patients with eating disorders: A retrospective cohort study

Charlotte Cliffe*, Hitesh Shetty, Hubertus Himmerich, Ulrike Schmidt, Robert Stewart, Rina Dutta

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)
441 Downloads (Pure)



Suicide attempts requiring hospitalization are known to be common in patients who are diagnosed with eating disorders. Attempting suicide is a major indicator for those at risk of completed suicide. Both the specific eating disorder diagnosis and the influence of psychiatric comorbidities on suicide attempts requiring hospitalization were investigated, with demographic and socioeconomic variables as confounders, over a 10‐year observation period from January 2007 to March 2017.


Anonymized health‐record data from the South London and Maudsley NHS Foundation Trust (SLaM) were retrieved through the Clinical Record Interactive Search (CRIS) data resource; this is linked to national Hospital Episode Statistics (HES) data. These data include all diagnoses for inpatient admissions. Hazard ratios, with 95% confidence intervals (CIs), were calculated from cox regression analyses and the effects of a number of confounders were estimated by performing multivariable analyses.


In total, 4,895 patients were diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder otherwise not specified (EDNOS). Of these, 331 (6.7%) had attempted suicide requiring hospitalization and 21 (0.04%) completed suicide. The eating disorder category associated with the highest risk of a suicide attempt was AN (HR: 1.43, 95%CI: 1.08–1.89, p = .01). The risk was significantly increased further if the patient had a comorbid diagnosis of personality disorder, depression, bipolar affective disorder, and substance misuse.


Suicide attempts requiring hospitalization have a high incidence rate among patients with eating disorders, and the risk is significantly increased in AN. Comorbid psychiatric illness and suicidal ideation should be carefully assessed in all eating disorder patients.

Original languageEnglish
Pages (from-to)458-465
Number of pages8
JournalInternational Journal of Eating Disorders
Issue number5
Early online date11 Feb 2020
Publication statusPublished - 1 May 2020


  • anorexia nervosa
  • bulimia nervosa
  • eating disorder
  • self-harm
  • suicide
  • suicide attempt


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