Suicide, Self-harm, and Depression After Gastric Bypass Surgery

Lagerros, Ylva Trolle; Brandt, Lena; Hedberg, Jakob; Sundbom, Magnus; Bodén, Robert

doi:10.1097/sla.0000000000001884

Cited by 76 publications

(79 citation statements)

References 41 publications

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“…In this study, patient discussions about reviews by the surgeon were in reference to band management. Recent studies have reported that patients undergoing bariatric surgery were at increased risk of suicide and self‐harm . The unique GP–patient relationship may be pivotal in identifying patients at an increased risk of experiencing psychological distress.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study of the role of Australian general practitioners in the surgical management of obesity

et al. 2017

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General practitioners (GPs) are increasingly managing patients with class 2 and 3 obesity (body mass index [BMI] > 35 and 40 kg/m , respectively). Bariatric surgery is considered for patients with class 2 obesity and comorbidities or class 3 obesity where sustained weight loss using non-surgical interventions has not been achieved. In Australia, GPs facilitate access to surgery through referral processes, but the nature of GP involvement in bariatric pre- and post-surgery care is currently unclear. This qualitative study involved 10 in-depth interviews with GPs and 20 interviews with adults who had all undergone laparoscopic adjustable gastric banding (LAGB) for weight management in Tasmania, Australia. Interviews were transcribed and analysed thematically. Referrals for bariatric surgery commonly occurred at the patient's request or to manage comorbidity. Consistent with previous studies, for GPs, referral patterns were influenced by previous case experience and patients' financial considerations. Accessibility of surgery was also a consideration. Post-surgery, there was a lack of clarity about the role of GPs, with patients generally preferring the surgical team to manage the LAGB. In bariatric surgery, patient preference for surgery, access and comorbidity are key drivers for referral and post-surgical monitoring and support. Greater role clarity and enhanced collaboration between surgeons, GPs and patients following surgery is likely to enhance the experience and outcomes for patients.

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Section: Discussionmentioning

confidence: 99%

A qualitative study of the role of Australian general practitioners in the surgical management of obesity

et al. 2017

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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.…”

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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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“…However, recent advancements within this complex topic yielded rather heterogeneous results. Lagerros et al (2016) examined self-harm diagnoses and completed suicides in a recent patient register-based Swedish study comprising over 22,000 gastric bypass patients. The authors reported an increase in self-harm diagnosis from 0.38 per 100 person-years before to 0.59 per 100 person-years two years after surgery.…”

Section: Self-harm and Suicidalitymentioning

confidence: 99%

Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know?

Herpertz

Kessler

Jongen

2017

Zeitschrift für Psychosomatische Medizin und Psychotherapie

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ZusammenfassungPsychosoziale Fragen zur Adipositas-Chirurgie: was SummarySubject: In view of the epidemic increase in severe obesity and the ineffectiveness of conservative weight-loss interventions, bariatric surgery delivers compelling results for patients with class II (BMI ≥ 35 kg/m²) and class III obesity (BMI ≥ 40 kg/m²), not only in reducing weight over the long term, but also in reducing obesity-related somatic comorbidity and improving psychosocial functioning and quality of life. Investigations into the psychosocial aspects of obesity surgery have proliferated over the last 15 years, providing a huge amount of essential research data. Yet the results are partly contradictory and highly dependent on the duration of follow-up. Method: Based of a narrative review, this article provides an overview of the current status and recent developments of the reciprocal effects between bariatric surgery and psychosocial functioning. The review focused on eight domains representing important psychosomatic and psychosocial aspects of bariatric surgery. Results: Especially in cases of class II and III obesity, bariatric surgery is the only means to reduce bodyweight significantly and permanently, though they carry with them the associated risk factors of metabolic, cardiovascular, and oncological diseases. With regard to psychosocial and psychosomatic aspects, studies with a short-term catamnesis (approx. 3 years) speak in favor of an improvement in the quality of life including mental disorders. If we consider studies with longer follow-ups, however, the results are not as uniform. In particular, we observe an increase in harmful alcohol consumption, self-harm behavior, and suicide risk. Discussion: In light of mental well-being and thus also quality of life, bariatric surgery would appear to convey an elevated risk for a minority of patients. Yet identifying these patients before surgery has so far been insufficient.

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Suicide, Self-harm, and Depression After Gastric Bypass Surgery

Cited by 76 publications

References 41 publications

A qualitative study of the role of Australian general practitioners in the surgical management of obesity

A qualitative study of the role of Australian general practitioners in the surgical management of obesity

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

Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know?

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