Effects of Perceived and Actual Body Weight on Suicidal Ideation Among Adolescents: Findings from the 2015-2021 National Youth Risk Behavior Survey

Background and Objective: Suicidal ideation (SI) among adolescents is a significant public health concern, with one in five adolescents in the United States seriously considering suicide in the past year. Understanding the factors associated with SI, including demographic, behavioral, and psychological factors, is crucial for effective prevention strategies. While literature suggests a U-shaped relationship between body mass index (BMI) and SI, limited research has focused on the role of perceived body weight in this association. This study aims to investigate the cross-sectional association between perceived and actual body weight and SI among adolescents. We hypothesized that perceived body weight will have a stronger association with SI than actual body weight.

Methods: Using data from the Youth Risk Behavior Survey (YRBS) from 2015 to 2021, this study analyzed responses from 39,166 adolescents aged 14-18. SI in the past year was assessed as a binary variable, while perceived and actual body weight were evaluated using reported BMI and self-perceived weight status. Perceived overweight was based on responses indicating being "slightly overweight" or "very overweight," while actual overweight was determined by BMI > 85th percentile for age and sex. The main analysis was a binary logistic regression to examine the association between perceived and actual body weight and SI while simultaneously adjusting for demographic factors, bullying victimization, feelings of sadness or hopelessness, substance use, and physical activity.

Results: The study revealed that 19.8% of adolescents experienced SI, with notable disparities observed across demographic and other factors. Females were more likely than males to report SI, with 24.5% of females compared to 12.4% of males. Adolescents who perceived themselves as overweight presented with elevated odds of SI independent of their actual BMI. This association persisted even after adjusting for demographic variables and other covariates, with adolescents perceiving themselves as overweight and having BMI >85th percentile having 1.48 times higher odds of reporting SI (AOR=1.48, 95% CI=1.35-1.62), and those perceiving themselves as overweight but having BMI <85th percentile having 1.47 times higher odds of experiencing SI (AOR=1.47, 95% CI=1.27-1.70). Furthermore, adolescents victimized by bullying, experiencing sadness or hopelessness, and engaging in substance use were at increased risk of SI. Conversely, physical activity emerged as a protective factor against SI.

Conclusions: Adolescents who perceived themselves as overweight, regardless of their actual BMI, exhibited elevated odds of reporting SI, highlighting the potential impact of body image perceptions on mental health outcomes. The findings of this study suggests that the effect of body weight on SI may lie more in perceived body weight than actual BMI. These findings underscore the multifaceted nature of SI, with various demographic and behavioral factors contributing to its occurrence. Notably, sexual minority adolescents and those experiencing bullying or using substances were at heightened risk for SI. Such findings emphasize the importance of comprehensive interventions that address not only mental health challenges but also the broader social determinants of health.