Background: Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) has been linked to depression and the risk of suicide attempts and deaths in conflicting directions.
Methods: In a prospective cohort study of 46 755 men free of cancer enrolled in the Health Professionals Follow-up Study, participants reported their height, weight, diet, and physical activity on repeated occasions beginning in 1986 and were followed up until death or until February 2002. A subsample of 1829 men reported their mental health-related quality of life with the Mental Component Summary Scale of the 36-Item Short-Form Health Survey in 1998.
Results: A total of 131 men died from suicide during follow-up. A higher BMI was related to a graded decline in the suicide mortality rate, from 52 per 100 000 person-years among men with a BMI of less than 21 to 13 per 100 000 among men with a BMI of 30 or higher; the adjusted hazard ratio per 1-U BMI increment was 0.89 (95% confidence interval, 0.84-0.95; P<.001). The relationship was consistent when baseline or updated measures of BMI were used and with adjustment for medical illness, dietary factors, antidepressant use, physical activity, or social support. Height and physical activity were not strongly associated with risk. Analyses of mental health-related quality of life showed a similar positive relationship with BMI.
Conclusions: Among men, risk of death from suicide is strongly inversely related to BMI, but not to height or to physical activity. Although obesity cannot be recommended on the basis of its detrimental effects, further research into the mechanisms of lower risk among overweight and obese men may provide insights into effective methods of suicide prevention.