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Risk of suicide and non-fatal self-harm after bariatric surgery: results from two matched cohort studies
Karolinska Inst, Clin Epidemiol Unit, Dept Med, Stockholm, Sweden.
Karolinska Inst, Clin Epidemiol Unit, Dept Med, Stockholm, Sweden.
Univ Gothenburg, Sahlgrenska Acad, Inst Med, Gothenburg, Sweden.
Univ Gothenburg, Sahlgrenska Acad, Inst Med, Gothenburg, Sweden.
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2018 (English)In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 6, no 3, p. 197-207Article in journal (Refereed) Published
Abstract [en]

Background Bariatric surgery reduces mortality, but might have adverse effects on mental health. We assessed the risk of suicide and self-harm after bariatric surgery compared with non-surgical obesity treatment. Methods Suicide and non-fatal self-harm events retrieved from nationwide Swedish registers were examined in two cohorts. The non-randomised, prospective Swedish Obese Subjects (SOS) study compared bariatric surgery (n=2010; 1369 vertical-banded gastroplasty, 376 gastric banding, and 265 gastric bypass) with usual care (n=2037; recruitment 1987-2001). The second cohort consisted of individuals from the Scandinavian Obesity Surgery Registry (SOReg; n=20 256 patients who had gastric bypass) matched to individuals treated with intensive lifestyle modification (n=16 162; intervention 2006-13) on baseline BMI, age, sex, education level, diabetes, cardiovascular disease, history of self-harm, substance misuse, antidepressant use, anxiolytics use, and psychiatric health-care contacts. Findings During 68 528 person-years (median 18; IQR 14-21) 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, 95% CI 1.23-2.57; p=0.0021); of these events, nine and three were suicides, respectively (3.06, 0.79-11.88; p=0.11). In analyses by primary procedure type, increased risk of suicide or non-fatal self-harm was identified for gastric bypass (3.48, 1.65-7.31; p=0.0010), gastric banding (2.43, 1.23-4.82; p=0.011), and vertical-banded gastroplasty (2.25, 1.37-3.71; p=0.0015) compared with controls. Out of nine deaths by suicide in the SOS surgery group, five occurred after gastric bypass (two primary and three converted procedures). During 149 582 person-years (median 3.9; IQR 2.8-5.2), more suicides or non-fatal self-harm events were reported in the SOReg gastric bypass group (n=341) than in the intensive lifestyle group (n=84; aHR 3.16, 2.46-4.06; p<0.0001); of these events, 33 and five were suicides, respectively (5.17, 1.86-14.37; p=0.0017). In SOS, substance misuse during follow-up was recorded in 48% (39/81) of patients treated with surgery and 28% (13/47) of controls with non-fatal self-harm events (p=0.023). Correspondingly, substance misuse during follow-up was recorded in 51% (162/316) of participants in the SOReg gastric bypass group and 29% (23/80) of participants in the intensive lifestyle group with non-fatal self-harm events (p=0.0003). The risk of suicide and self-harm was not associated with poor weight loss outcome. Interpretation Bariatric surgery was associated with suicide and non-fatal self-harm. However, the absolute risks were low and do not justify a general discouragement of bariatric surgery. The findings indicate a need for thorough preoperative psychiatric history assessment along with provision of information about increased risk of self-harm following surgery. Moreover, the findings call for postoperative surveillance with particular attention to mental health.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 6, no 3, p. 197-207
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-354368DOI: 10.1016/S2213-8587(17)30437-0ISI: 000425719400019PubMedID: 29329975OAI: oai:DiVA.org:uu-354368DiVA, id: diva2:1222363
Funder
Swedish Research CouncilAvailable from: 2018-06-21 Created: 2018-06-21 Last updated: 2018-06-21Bibliographically approved

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