A Swedish study published in The Lancet Diabetes & Endocrinology reported that the risk for suicide and non-fatal self-harm was increased after bariatric surgery. Martin Neovius, MSc, PhD, professor in the Department of Medicine, Solna Clinical Epidemiology Unit at the Karolinska Institutet in Stockholm, Sweden, and colleagues explored the association between bariatric surgery and suicide or non-fatal self-harm in 2 cohorts in the nonrandomized prospective Swedish Obese Subjects (SOS) study.
The first cohort compared bariatric surgery (n=2010), including 1368 vertical-banded gastroplasties, 376 gastric bandings, and 265 gastric bypasses, with usual care (n=2037). The second cohort looked at 20,256 individuals from the Scandinavian Obesity Surgery Registry (SOReg) who had undergone a gastric bypass matched for baseline body mass index (BMI), age, sex, education level, diabetes, cardiovascular disease, history of self-harm, substance misuse, antidepressant use, anxiolytics use, and psychiatric healthcare contacts to 16,162 individuals treated with intensive lifestyle modification.
The investigators noted that during 68,528 person-years in the SOS study, suicides or non-fatal self-harm events were higher in the surgery group (n=87) than in the control group (n=49; adjusted hazard ratio [aHR] 1.78; P =.0015). Of these events, 9 and 3 were suicides, respectively (aHR 3.06; P =.11).
The incidence of these events varied by procedure type, with an increased risk for suicide or non-fatal self-harm identified in the gastric bypass (aHR 3.48; P =.0010), gastric banding (aHR 2.43; P =.011), and vertical-banded gastroplasty (aHR 2.25; P =.0015) groups compared with controls. Of the 9 suicides identified in the SOS surgery group, 5 occurred after gastric bypass. During 149,582 person-years, more suicides or non-fatal self-harm events occurred in the SOReg gastric bypass group (n=341) than in the intensive lifestyle group (n=84; aHR 3.16; P <.0001). Of these events, 33 were suicides in the gastric bypass group compared with 5 in the intensive lifestyle group (aHR 5.17; P =.0017). In patients experiencing events, substance abuse was more common in the surgery group. Poor weight loss results was not a risk factor for suicide or self-harm.
The researchers concluded that the absolute risks were low and do not warrant limiting bariatric surgery. However, these results do indicate the need for thorough preoperative psychiatric history assessment in patients considering bariatric surgery, as well as postoperative surveillance.
Neovius M, Bruze F, Jacobson P, et al. Risk of suicide and non-fatal self-harm after bariatric surgery: results from two matched cohort studies [published online January 9, 2018]. Lancet Diabetes Endocrinol. doi:10.1016/S2213.8587(17)30437-0