American Journal of Epidemiology Advance Access originally published online on February 17, 2007
American Journal of Epidemiology 2007 165(7):846-847; doi:10.1093/aje/kwk121
American Journal of Epidemiology Copyright © 2007 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
THE AUTHORS REPLY
Paul J. Villeneuve1,2,
Eric J. Holowaty3,
Jacques Brisson4,
Lin Xie1,
Anne-Marie Ugnat1,
Louis Latulippe4 and
Yang Mao1
1 Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada K1A 0K9
2 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada M5T 3M7
3 Informatics Research and Development, Cancer Care Ontario, Toronto, Ontario, Canada M5G 2L7
4 Department of Social and Preventive Medicine, Laval University, Laval, Quebec, Canada G1K 7P4
(e-mail: Yang_Mao{at}hc-sc.gc.ca)
We thank Didie and Phillips (1) for their interest in our work (2) and their comment on the relevance of body dysmorphic disorder (BDD) among women who receive breast implants for cosmetic reasons. We agree that mental disorders, such as BDD, may have contributed to our observation of increased suicide rates among both the breast implant and other plastic surgery patients in our cohort. Although the prevalence of BDD in the general population is estimated to be between 1 percent and 2 percent (3–5), the review by Crerand et al. (6) suggests that the prevalence of BDD among patients who present for cosmetic procedures is between 7 percent and 15 percent. Moreover, their review of the literature suggests that patients with BDD do not benefit from receiving cosmetic procedures. We share the view of Didie and Phillips (1) that future cohort studies of breast implant patients should endeavor to collect information on their mental health at baseline. However, there are important methodological considerations to evaluating BDD as a risk factor for suicide in such patient populations. In particular, sample size is a critical consideration. In our study of 24,558 women with breast implants, there were only a total 58 suicides. Therefore, even had baseline data been collected on mental disorders in our patient population, with an anticipated BDD prevalence of 7–15 percent, we would have relatively poor statistical power to characterize suicide risk.
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ACKNOWLEDGMENTS
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Conflict of interest: none declared.
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References
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- Didie ER and Phillips KA. (2007) Re: "Mortality among Canadian women with cosmetic breast implants." (Letter). Am J Epidemiol 165:000.
- Villeneuve PJ, Holowaty EJ, Brisson J, et al. (2006) Mortality among Canadian women with cosmetic breast implants. Am J Epidemiol 164:334–41.[Abstract/Free Full Text]
- Rief W, Buhlmann U, Wilhelm S, et al. (2006) The prevalence of body dysmorphic disorder: a population-based survey. Psychol Med 36:877–85.[CrossRef][Web of Science][Medline]
- Faravelli C, Salvatori S, Galassi F, et al. (1997) Epidemiology of somatoform disorders: a community survey in Florence. Soc Psychiatry Psychiatr Epidemiol 32:24–9.[CrossRef][Web of Science][Medline]
- Otto MW, Wilhelm S, Cohen LS, et al. (2001) Prevalence of body dysmorphic disorder in a community sample of women. Am J Psychiatry 158:2061–3.[Abstract/Free Full Text]
- Crerand CE, Franklin ME, Sarwer DB. (2006) Body dysmorphic disorder and cosmetic surgery. Plast Reconstr Surg 118:167e–80e.[CrossRef][Medline]
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