Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery

Bäckman, Olof; Stockeld, Dag; Rasmussen, Finn; Näslund, Erik; Marsk, Richard

doi:10.1002/bjs.10258

Cited by 103 publications

(83 citation statements)

References 28 publications

(37 reference statements)

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“…Our finding of an increased use of hypnotics and/or sedatives after gastric bypass is consistent with that from an uncontrolled 2-year follow-up study of 165 Norwegian patients (22) and from a Swedish study comparing 3,139 gastric bypass patients with 31,390 general population controls over 4 years of follow-up (23). Note that the Swedish study did not match for baseline BMI.…”

Section: Discussionsupporting

confidence: 87%

Change in Use of Sleep Medications After Gastric Bypass Surgery or Intensive Lifestyle Treatment in Adults with Obesity

Peeters

Näslund

et al. 2017

Obesity

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ObjectiveTo examine the change in use of hypnotics and/or sedatives after gastric bypass surgery or intensive lifestyle modification in adults with obesity.MethodsAdults with obesity who underwent gastric bypass surgery or initiated intensive lifestyle modification between 2007 and 2012 were identified through the Scandinavian Obesity Surgery Registry and a Swedish commercial weight loss database. The two cohorts were matched on BMI, age, sex, education, history of hypnotics and/or sedatives use, and treatment year (surgery n = 20,626; lifestyle n = 11,973; 77% women, mean age 41 years, mean BMI 41 kg/m2). The proportion of participants with filled hypnotics and/or sedatives prescriptions was compared yearly for 3 years.ResultsIn the matched treatment cohorts, 4% had filled prescriptions for hypnotics and/or sedatives during the year before treatment. At 1 year follow‐up, following an average weight loss of 37 kg and 18 kg in the surgery and intensive lifestyle cohorts, respectively, this proportion had increased to 7% in the surgery cohort but remained at 4% in the intensive lifestyle cohort (risk ratio 1.7; 95% CI: 1.4‐2.1); at 2 years, the proportion had increased to 11% versus 5% (risk ratio 2.0; 95% CI: 1.7‐2.4); and at 3 years, it had increased to 14% versus 6% (risk ratio 2.2; 95% CI: 1.9‐2.6).ConclusionsGastric bypass surgery was associated with increased use of hypnotics and/or sedatives compared with intensive lifestyle modification.

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Section: Discussionsupporting

confidence: 87%

Change in Use of Sleep Medications After Gastric Bypass Surgery or Intensive Lifestyle Treatment in Adults with Obesity

Peeters

Näslund

et al. 2017

Obesity

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“…2,5,6 However, findings from longitudinal studies of AUD-related outcomes prior to and following bariatric surgery are inconsistent 3-5 and few studies have long-term follow-up or evaluation of non-alcohol SUD, 3,4 such that we have little understanding of whether the risk of AUD or non-alcohol SUD changes over time and the proportion of post-surgical patients that are ultimately affected. Recent literature reviews of AUD or SUD and bariatric surgery concluded there is a need for large, prospective, longitudinal studies that extend beyond two years, separate alcohol from other drug use, use standardized assessments, account for type of bariatric surgical procedure and identify risk factors for development of post-surgery AUD.…”

Section: Introductionmentioning

confidence: 99%

Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

King

Chen

Courcoulas

et al. 2017

Surgery for Obesity and Related Diseases

227

156

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Background Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) following bariatric surgery is limited. Objective To report SUD-related outcomes following RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes. Setting Ten US hospitals. Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to seven years through January 2015. Results Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95%CI, 18.5-23.3), 7.5% (95%CI, 6.1-9.1), and 3.5% (95%CI, 2.6-4.8), respectively, post-RYGB, and 11.3% (95%CI, 8.5-14.9), 4.9% (95%CI, 3.1-7.6), and 0.9% (95%CI, 0.4-2.5) post-LAGB. Undergoing RYGB vs. LAGB was associated with higher risk of incident AUD symptoms (AHR=2.08 [95%CI, 1.51-2.85]), illicit drug use (AHR=1.76 [95%CI, 1.07-2.90]) and SUD treatment (AHR=3.56 [95%CI, 1.26-10.07]). Conclusions Undergoing RYGB vs. LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.

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“…5-7 Recent populationbased observational studies have identified an increased risk of suicide and self-harm among patients who underwent surgery, compared to non-surgically treated individuals and the general population.Moreover, longitudinal studies have demonstrated that the risk of self-harm increases following treatment in those patients who choose to undergo surgery. [8][9][10][11][12] Despite these reports, there is sparse evidence from randomized trials assessing the risk of suicidality and self-harm following bariatric Alejandro Szmulewicz, Kerollos N. Wanis and Ashley Gripper contributed equally to this work.…”

mentioning

confidence: 99%

Mental health quality of life after bariatric surgery: A systematic review and meta‐analysis of randomized clinical trials

et al. 2018

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Recent literature has raised concerns regarding the risk of adverse psychiatric events among bariatric surgery patients. However, the relationship between weight loss therapy and psychiatric outcomes is confounded by baseline psychosocial characteristics in observational studies. To understand the impact of bariatric surgery on the risk of adverse mental health outcomes, we conducted a systematic review and meta‐analysis of randomized controlled trials that compared surgical and non‐surgical treatments and assessed mental health quality of life (QoL). We evaluated the PubMed, EMBASE, Web of Science PsycINFO, http://clinicaltrials.gov and Cochrane databases through 7 March 2018. Pooled standardized mean differences (SMDs) for mental health QoL scores were estimated using random effects models. Eleven randomized trials with 731 participants were included in the final analyses. Surgery was not associated with an improvement in mental health QoL from baseline as compared to non‐surgical intervention (SMD: 0.02, 95% confidence interval [CI] −0.22 to 0.25). Final mental health QoL scores were similar for surgically and non‐surgically treated patients (SMD: 0.37, 95% CI −0.07 to 0.81). Subgroup analyses assessing the effect of specific surgical interventions, and varying lengths of follow‐up did not identify a beneficial effect of bariatric surgery on mental health QoL outcomes. These results, in conjunction with the fact that individuals who choose bariatric surgery tend to have high‐risk baseline characteristics, suggest that intensive mental health follow‐up following surgery should be routinely considered.

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Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery

Abstract: Patients who have undergone RYGB are at an increased risk of being diagnosed with alcohol and substance use, with an increased rate of attempted suicide compared with a non-obese general population cohort.

Cited by 103 publications

References 28 publications

Change in Use of Sleep Medications After Gastric Bypass Surgery or Intensive Lifestyle Treatment in Adults with Obesity

Change in Use of Sleep Medications After Gastric Bypass Surgery or Intensive Lifestyle Treatment in Adults with Obesity

Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

Mental health quality of life after bariatric surgery: A systematic review and meta‐analysis of randomized clinical trials

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