Increased Mental Health Service Use After Bariatric Surgery

Utilization of mental health services was found to increase following bariatric surgery, according to research published in JAMA Psychiatry, challenging the notion that weight loss surgery may improve psychiatric well-being in patients with obesity.

Investigators explored medical record data from the Western Australia Department of Health Data Linkage Branch pertaining to individuals who underwent their first bariatric surgery between January 2007 and December 2016. The primary outcome measure was incidence of mental health service use before and after bariatric surgery. Mental health care use included psychiatric outpatient clinic attendance, inpatient hospitalization, and presentation to an emergency department with a psychiatric diagnosis. Multivariable logistic regression was used to determine the risk factors for postoperative mental health service use, expressed as odds ratios (ORs). Regression analyses were adjusted for date of surgery and years of follow-up.

A total of 24,766 patients (77.3% women; mean age 42.5±11.7 years) underwent index bariatric surgery during the 10-year study period. At least 1 mental health service presentation was observed in 3976 patients (16.1%):1401 (35.2%) presented before surgery only, 1025 (25.8%) presented before and after surgery, and 1550 (39.0%) presented after surgery only. The incidence rate ratios (IRRs) for outpatient clinic attendance, emergency department attendance, and psychiatric hospitalizations were 2.3 (95% CI, 2.3-2.4), 3.0 (95% CI, 2.8-3.2), and 3.0 (95% CI, 2.8-3.1), respectively.

A 5-fold increase in presentation to an emergency department with deliberate self-harm was observed after surgery (IRR, 3.7; 95% CI, 3.8-5.7), and 9.6% of deaths in the postoperative period were due to suicide. Risk factors for postsurgery mental health service use included a history of psychiatric care (adjusted OR [aOR] range, 1.62-3.73) and complications after bariatric surgery requiring further surgical intervention (aOR range, 1.23-1.45). Presentation with deliberate self-harm after surgery was associated with younger age, higher socioeconomic status, presurgery experience with self-harm or suicidal ideation, and having had a sleeve gastrectomy or a bypass procedure. Post-surgery suicide attempt was associated with presurgery hospitalization for self-harm and prior experience with mental and behavioral disorders.

A significant increase in mental health service use was observed in patients who underwent bariatric surgery, with the risk particularly high in patients with prior psychiatric illness or bariatric surgery complications. The investigators wrote, “Our findings question the hypothesis that weight reduction by bariatric surgery will improve mental health in patients with obesity.” However, the researchers mention that greater service use may also signify increased scrutiny after surgery.

Reference

Morgan DJR, Ho KM, Platell C. Incidence and determinants of mental health service use after bariatric surgery [published online September 25, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.2741