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Suicide is the second leading cause of death among adolescents aged 10-24. Previous studies have examined the effect of actual and perceived weight status on adolescent suicidal behaviors, however, few investigated the influence of weight (mis)perception profiles, which characterizes the discrepancy between actual and perceived weight, on suicidal behaviors, presumably through social stigma of weight. Although prior research has documented gender differences—higher risks of suicide among females perceiving themselves as overweight than males, whether such differential associations also exist across age and racial/ethnicity are unknown. Understanding the prevalence and impact of weight (mis)perception is important to underline weight stigma prevalent among adolescents. It also addresses promising next steps for developing suicide prevention strategies integrating health education on weight status.
Using a nationally representative sample of US adolescents, this study aims to a) identify the weight (mis)perception profiles, b) examine the associations between weight (mis)perception profiles and suicidal behaviors, c) investigate whether associations between weight (mis)perception profiles and suicidal behaviors vary across demographic characteristics (i.e., gender, race/ethnicity, age).
Methods
Data and samples: Data were derived from the 2017 Youth Risk Behavior Survey (YRBS), a school-based survey administered to a nationally representative sample of students in grades 9 through 12 (n = 14,638).
Measures: Weight (mis)perception profiles were constructed by actual weight (obesity, overweight, normal, underweight; classified using body mass index) and perceived weight (very underweight, slightly underweight, about the right weight, slightly overweight, very overweight; self-evaluated). Suicidal behaviors were self-reported suicidal ideation, plan, attempts, and injury. Covariates included demographics, depression, and health behavior indicators (e.g., eating breakfast, exercise).
Analysis: Hierarchical multivariable logistic regression adjusting for complex survey design was used to examine the associations between weight (mis)perception profiles and suicidal behaviors. Interaction terms of weight (mis)perception profiles and demographic characteristics were included to explore the potential moderating roles of age, gender, and race/ethnicity.
Results
Approximately 42.7% adolescents had weight (mis)perception, 29.7% students over-perceived (actual<perceived) and 13.0% under-perceived (actual>perceived) weight. Black and Hispanic students were more likely to over-perceive weight, while Asian, girls, and adolescents aged 12-14 were more likely to under-perceive their weight than their counterparts (p < 0.05).
Bivariate analyses revealed that both over- and under-perceptions of weight status were associated with higher suicidal behaviors. After adjusting for covariates, only under-perceived weight was significantly associated with greater adjusted odds of suicidal ideation (OR=1.37, 95%CI=[1.11-1.70), suicide plan (OR=1.62 [1.28-2.06]), suicide attempt (OR=1.43 [1.01-2.02]), and injury by attempt (OR=1.59 [1.05-2.41]). Significant moderating effects of gender and race/ethnicity were found. Male, Asian, and Hispanic adolescents under-perceiving their weight showed stronger risks of suicidal thoughts, plan, and injuries.
Conclusions and Implications
More than two-fifths of adolescents misperceived their body weight statuses. Weight (mis)perception, especially under-perception, was associated with higher risks of suicidal behaviors. Significant moderating effects of gender and race/ethnicity addresses higher risks of male, Asian, and Hispanic adolescents who had under-perception of actual weight. Assessing weight (mis)perception may facilitate detecting at-risk youth. Tailored suicide interventions for different gender and racial/ethnic groups addressing body weight perception could effectively reduce suicidal behaviors.