Weight-loss surgery linked to increased suicide risk

Last Updated: 2015-10-07

By Lisa Rapaport

NEW YORK (Reuters Health) - Patients may be more likely to harm themselves or attempt suicide after weight-loss surgery, a Canadian study suggests.

Researchers followed nearly 8,800 patients for three years before and after bariatric surgeries, which involved gastric bypass in most cases.

During the first three years after surgery, 111 patients (1.3%) received emergency care for 158 self-inflicted injuries.

Overall, self-harm emergencies significantly increased after surgery compared with before (3.63 vs 2.33 per 1000 patient-years; rate ratio, 1.54; p=0.007).

People over 35 were significantly more likely to be treated for a self-inflicted emergency after surgery than before (RR, 1.76; P=0.03), and the risk more than doubled for low-income patients (RR,2.09; P=0.01).

Rural patients had more than a six-fold greater risk of receiving emergency care for self-inflicted harm after their weight-loss operations than before (RR6.49; P=0.02).

Almost three in four of the self-inflicted injuries were intentional drug overdoses.

Most of the time, patients who harmed themselves had been diagnosed with a mental health disorder at some point in the five years preceding surgery.

Most incidents of self-inflicted harm happened one to three years after the surgeries, suggesting that patients may need more long-term behavioral health care than they're getting, said Dr. Amir Ghaferi, a bariatric surgeon at the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System.

"Unfortunately, long-term postoperative follow-up for bariatric patients is not ideal," said Dr. Ghaferi, who wrote an editorial accompanying the study online October 7 in JAMA Surgery.

"This study should not dissuade patients with mental health problems from seeking bariatric surgery," Dr. Ghaferi added. Instead, it should encourage health care providers to target these patients for improved follow-up care, he said.

These procedures also come with a risk of overdosing on alcohol or drugs because patients' resected gastrointestinal tract may no longer be able to tolerate the same quantity of libations or medications.

One limitation of the study, however, is its use of billing data to identify drug overdoses, which might not be an accurate indicator of whether the act was intentional or accidental, the authors acknowledge.

Even so, the findings add to a growing body of evidence linking bariatric surgery to an increased risk of suicide, lead author Dr. Junaid Bhatti of the Institute for Clinical Evaluative Sciences and the Sunnybrook Research Institute in Toronto told Reuters Health by email.

"These findings suggest that more effort may be needed to improve access to mental health care services in these patients should they need them," Dr. Bhatti said.

The Canadian Institutes of Health Research, the Canada Research Chair in Medical Decision Sciences, and the Da Souza Chair in Trauma Research supported this research.

SOURCE: http://bit.ly/1Om9YH6 and http://bit.ly/1L078DA

JAMA Surg 2015.