medwireNews: Obese patients who undergo bariatric surgery are more likely to self-harm or die by suicide than those who undergo nonsurgical management, but the absolute risk is low, suggests an analysis of two Scandinavian cohorts.
“The findings indicate a need for thorough preoperative psychiatric history assessment along with provision of information about increased risk of self-harm following surgery,” say Martin Neovius (Karolinska Institutet, Stockholm, Sweden) and study co-authors.
As reported in The Lancet Diabetes & Endocrinology, the team analyzed data from the Swedish Obese Subjects (SOS) cohort – a nonrandomized study of obese patients undergoing bariatric surgery compared with matched subjects receiving usual care who were recruited between 1987 and 2001 and followed up until 2013 – and the Scandinavian Obesity Surgery Registry (SOReg) study of patients who received gastric bypass or intensive lifestyle modification between 2006 and 2013.
In the SOS cohort, 4.3% of 2008 patients in the surgery group and 2.4% of 2037 patients receiving usual care died by suicide or had a self-harm event, giving a hazard ratio (HR) of 1.78 after adjustment for age, sex, BMI, and history of self-harm. A total of nine suicides occurred in the surgery group, compared with three in the control group (HR=3.06).
Similarly, rates of suicide or self-harm were 1.68% among the 20,256 patients who underwent gastric bypass in the SOReg cohort, compared with 0.52% for the 16,162 participants receiving lifestyle modification, giving an adjusted HR of 3.16. In all, 33 people died by suicide in the surgery group versus five in the control group (HR=5.17).
The researchers note that the increased risk observed among those undergoing surgery was not related to weight loss outcome; patients who died by suicide or had a self-harm event in the SOS cohort had comparable or lower bodyweight over the follow-up period than those who did not.
These results “are the strongest and clearest evidence to date of an association between bariatric surgery and suicidal behavior,” write Matthew Spittal (University of Melbourne, Victoria, Australia) and Gema Frühbeck (Universidad de Navarra, Pamplona, Spain) in an accompanying editorial.
However, “[t]hese important findings should not deter patients from benefiting from the plentiful positive effects of bariatric surgery, but rather highlight the challenges it poses,” they comment.
Neovius and colleagues agree, emphasizing that although surgery was associated with “a substantially increased relative risk” for suicide or self-harm, “the absolute risks were low and do not justify a general discouragement of bariatric surgery.”
And the commentators conclude: “Multidisciplinary teams treating patients need to remain aware of the constellation of pathophysiological, psychosocial, and support factors that mutually interact and potentially negatively affect a patient’s postoperative course.”
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