Risk of completed suicide after bariatric surgery: a systematic review

Abstract

Bariatric surgery is one of the most effective treatments for morbid obesity, and a large body of research indicates significant long-term weight loss. While overall mortality decreases in patients who received bariatric surgery, a number of studies have shown that suicide rates are higher in bariatric patients than in control groups. The objective of this study was to present a systematic review of suicide mortality after bariatric surgery and calculate an estimate for the suicide rate. Literature researches of the databases PubMed, Web of Knowledge, PsychInfo, ScienceDirect and Google Scholar were conducted. Thirty studies concerning bariatric surgery and completed suicides met the inclusion criteria. We included 28 studies in the estimation of a suicide rate for the bariatric population. Only one study (Tindle et al.) put a main focus on suicide after bariatric surgery; this was therefore chosen as an adequate reference figure for comparison. The other 27 chosen studies were compared with World Health Organization data and the suicide rate reported by Tindle et al. Twenty-three thousand eight hundred eighty-five people were included in the analysis. In the literature, we found a total of 95 suicides when examining 190,000 person-years of post-bariatric surgery data. Little information was provided describing the reasons for suicide and the time-point of these events after surgery. We estimated a suicide rate of 4.1/10,000 person-years (95% confidence interval [3.2, 5.1]/10,000 person-years). A comparison with Tindle et al. demonstrates that their rate is significantly higher than our estimate (P = 0.03). Bariatric surgery patients show higher suicide rates than the general population. Therefore, there is a great need to identify persons at risk and post-operative psychological monitoring is recommended.

The effectiveness of bariatric surgery on long term psychosocial quality of life – A systematic review

“…There may also be a role for enhanced psychological support to address postoperative mental health issues. More recently, studies have reported elevated suicide rates following bariatric surgery [74][75] in BS groups when compared to control groups [76].…”

Management of the post-bariatric surgery patient – what an internist needs to know

“…However, a lot of patients continue to suffer from emotional disturbances, mainly due to unrealistic pre-surgical expectations concerning weight loss and difficulties associated with the necessity of post-bariatric life style changes. Several studies have reported increased suicide incidence in patients after bariatric surgery, with an estimated suicide rate of 3.9/10 000, compared with 1.0/10 000 in the general population [55]. The most common reason found is depression, but the spectrum of mental disorders linked to suicidal ideation and attempts is wide.…”

Living with Hemoglobin of 3.7 After Bariatric Surgery! Follow-up is Key to Preventing Adverse Outcomes

“…A recent study noted suicide rates after bariatric surgery to be five times that of general population [35]. The need for post-surgery follow-up specifically for depression should be emphasized [25,36].…”