Suicide attempts, self-harm and suicidal ideation among Norwegian university students with eating disorders and disordered eating: the SHoT study 2018 and 2022

BACKGROUND: Eating disorders (EDs) and disordered eating (DE) are associated with elevated risk for suicide attempts, self-harm and suicidal ideation. Still, gender-specific knowledge about the frequency and association of EDs and DE with these outcomes among university students is limited. This study examines gender-stratified frequencies and associations between EDs and DE, and suicide attempts, self-harm and suicidal ideation. METHODS: We pooled data from the students` Health and Wellbeing Study (SHoT) collected in 2018 and 2022, including Norwegian fulltime students aged 18-35 (N: 98 925). Participants completed self-report measures assessing EDs (including subtypes) and symptoms of DE (EDS-5), suicide attempts, self-harm and suicidal ideation during the last 12 months. Statistical analyses included logistic regression to assess associations between EDs, DE and suicide attempts, self-harm, and suicidal ideation. Further, a single item analysis of the EDS-5 was performed for the same outcomes. RESULTS: We found that female, male and gender diverse students with EDs had substantially elevated odds of suicide attempts, self-harm and suicidal ideation, and for DE, moderately elevated odds, compared to students without these conditions. We found the strongest associations among males with EDs, but precision was limited in several subgroup analyses because of small cell counts. Particularly items "comfort eating" and "feeling guilty about eating" on EDS-5 were closely associated with reports of suicide attempts, self-harm and suicidal ideation. CONCLUSIONS: We found consistently high rates of suicide attempts, self-harm and suicidal ideation among students with EDs and DE across genders, and robust associations between EDs and DE, and suicide attempts, self-harm and suicidal ideation. These findings underscore the importance of considering gender-specific patterns and targeted items to enhance assessment practices in student health settings. TRIAL REGISTRATION: Identifier: NCT05731102.