Identifying the Relationship between Eating Disorders, Non-Suicidal Self-Injury, and Suicidal Behavior in College-Enrolled Males

Background and Purpose: Eating disorders are complex mental health conditions with high rates of comorbidity, including non-suicidal self-injury (NSSI) and suicidal behavior. Among college-enrolled males, research has found that 3%-5.5% experience an eating disorder, 15% engage in NSSI, and 6% report suicidal ideation. Furthermore, in 2015, suicide was the second leading cause of death for college-aged males, and overall eating disorders have the highest mortality rate of any mental illness. Given the high rates of these harmful and potentially lethal behaviors, it is important to study their relationship. Previous research has found a positive association between eating disorders and these behaviors among women; however, they have not been studied exclusively in male populations. Therefore, this study aimed to explore the association between a self-reported 12-month history of NSSI, a self-reported 12-month history of suicidal ideation, and a self-reported 12-month history of a suicide attempt and screening positive for an eating disorder among college-enrolled males.

Methods: Data and Sample: A secondary data analysis was conducted using the 2017-2018 Healthy Minds Study. The analytic sample included a representative sample of over 11,500 cisgender males currently enrolled in college.

Statistical Analysis: The analysis was conducted using hierarchal logistic regression models to estimate the effects of screening positive for an eating disorder using the SCOFF scale and a self-reported 12-month history of NSSI, a self-reported 12-month history of suicidal ideation, and a self-reported 12-month history of a suicide attempt when controlling for age, race/ethnicity, sexual orientation, degree program, flourishing (Flourishing Scale), academic impact, sense of belonging, and residence.

Results: Findings indicate that college-enrolled cisgender males who screened positive for an eating disorder, compared to those who did not, had greater odds of a self-reported 12-month history of NSSI (OR=1.65, p<.001) and a self-reported 12-month history of suicidal ideation (OR=1.37, p<.001). There was no statistically significant relationship between screening positive for an eating disorder and a self-reported 12-month history of a suicide attempt. In both models analyzing NSSI and suicidal ideation, college-enrolled males who screened positive for an eating disorder, compared to those who did not, had significantly greater odds of identifying as a sexual minority, Hispanic, or Asian, screening positive for depression and anxiety, reporting illicit drug use in the previous 30 days, and were not flourishing. Age, degree program, residence, academic impact, sense of belonging, and alcohol use were not significantly associated with screening positive for an eating disorder in these models.

Conclusions and Implications: Findings from this study indicate that NSSI and suicidal ideation are positively associated with eating disorders among college-enrolled cisgender males. From these findings, social workers should simultaneously screen for eating disorders, NSSI, and suicidal ideation in college-enrolled cisgender males, particularly among those who identify as a sexual minority, Hispanic, or Asian, have depression or anxiety, report illicit drug use, and are not flourishing. A 12-month history of a suicide attempt was not significantly associated with a positive eating disorder screen, which is surprising given the high rates of suicide among college males and individuals with eating disorders.