Background: Eating disorders are associated with an increased risk of suicide.

Objective: To examine suicidal behavior and depression in adolescents with eating disorders, and to identify risk factors associated with suicidal ideation and attempted suicide.

Methods: Forty-six Israeli adolescent girls with anorexia nervosa or bulimia nervosa completed a self-report battery at the time of assessment or treatment. Suicide attempts and suicidal ideation were investigated in relation to clinical (e.g. body mass index, purging) and psychological (e.g. body dissatisfaction) features of the eating disorders, as well as depression. Twenty-four percent of the subjects had attempted suicide, and 65% reported suicidal thoughts. Fifty-eight percent were moderately to severely depressed.

Results: The risk of attempted suicide was associated with depression, a history of sexual abuse and longer duration of illness, but it was moderated by hospital treatment. Suicidal ideation was related only to depression.

Conclusions: The results of this study emphasize the importance of treating aggressively depression in adolescents with eating disorders. Depression seems to amplify illness severity. Currently, strategies for treating eating disorders focus more on the eating disorder behaviors and less on depression. We suggest investing more resources in detecting and treating the co-morbid depression.