Depression and Suicide After Bariatric Surgery
Purpose of Review
Individuals with morbid obesity benefit from bariatric surgery with respect to weight loss and decreases in obesity-related somatic disorders. This paper focuses on psychosocial outcomes and provides a narrative review of recent meta-analyses and controlled studies concerning postoperative depression and suicide.
Considerable evidence shows short- and medium-term improvement in depressive symptoms after surgery. However, a subgroup of patients exhibits erosion of these improvements or new onset of depression in the long run. Some studies have found an increased risk for suicide among postoperative patients.
Prospective longitudinal examinations of factors contributing to the increased risk for postoperative depression and suicide and the interaction between these factors are warranted. The inclusion of mental health professionals in bariatric teams would help to monitor patients for negative psychosocial outcomes and to identify those patients who are vulnerable to depression, suicide, and any other forms of deliberated self-harm following surgery.
KeywordsBariatric surgery Obesity Depression Suicide
Compliance with Ethical Standards
Conflict of Interest
Astrid Müller reports a grant from Institute Danone Ernährung für Gesundheit e.V. (2015/6) and personal fees from Johnson & Johnson Medical GmbH Ethicon Germany and German Federal Ministry of Education and Research. Carolin Hase and Melanie Pommnitz each declare no potential conflicts of interest. Martina de Zwaan reports a grant from NovoNordisk and personal fees from Cheplapharm, Weight Watchers, and NovoNordisk.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42.Google Scholar
- 5.The Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring). 2014;22(1):5–13.Google Scholar
- 7.O'Brien PE, Hindle A, Brennan L, Skinner S, Burton P, Smith A, et al. Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 2019;29(1):3–14.PubMedGoogle Scholar
- 11.De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26(8):1659–96.PubMedPubMedCentralGoogle Scholar
- 16.Karlsson J, Taft C, Ryden A, Sjöström L, Sullivan M. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31(8):1248–61.Google Scholar
- 20.Sarwer DB, Allison KC, Wadden TA, Ashare R, Spitzer JC, McCuen-Wurst C, et al. Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. Surg Obes Relat Dis 2019.Google Scholar
- 23.Mitchell JE, Crosby R, de Zwaan M, Engel S, Roerig J, Steffen K, et al. Possible risk factors for increased suicide following bariatric surgery. Obesity (Silver Spring). 2013;21(4):665–72.Google Scholar
- 26.Mitchell JE, King WC, Chen JY, Devlin MJ, Flum D, Garcia L, et al. Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS-2) study. Obesity (Silver Spring). 2014;22(8):1799–806.Google Scholar
- 37.• Lu CW, Chang YK, Lee YH, Kuo CS, Chang HH, Huang CT, et al. Increased risk for major depressive disorder in severely obese patients after bariatric surgery - a 12-year nationwide cohort study. Ann Med. 2018;50(7):605–12. This is a large-scale 12-year cohort study from Taiwan that investigated the prevalence of major depressive disorder (MDD) in patients who received bariatric surgery. The findings suggest a higher risk of MDD in bariatric surgery recipients compared to controls, with patients who underwent malabsorptive procedures having a higher risk of MDD than those receiving restrictive procedures.PubMedGoogle Scholar
- 41.WHO. 2017 [Available from: https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/.
- 43.•• Castaneda D, Popov VB, Wander P, Thompson CC. Risk of suicide and self-harm is increased after bariatric surgery - a systematic review and meta-analysis. Obes Surg. 2019;29(1):322–33. This systematic review and meta-analysis found an increased risk for self-harm/suicide in patients who underwent bariatric surgery and summarizes potential biological and psychosocial factors that may be involved.Google Scholar
- 44.• Neovius M, Bruze G, Jacobson P, Sjöholm K, Johansson K, Granath F, et al. Risk of suicide and non-fatal self-harm after bariatric surgery: results from two matched cohort studies. Lancet Diabetes Endocrinol. 2018;6(3):197–207. This study provides results from the Scandinavian Obesity Surgery Registry (SOReg). During 149,582 person-years, there were 33 suicides in the surgery group and 5 suicides in the intensive lifestyle group (aHR 5.17, CI 1.86–14.4, p = .0017).PubMedPubMedCentralGoogle Scholar
- 47.• Wnuk S, Parvez N, Hawa R, Sockalingam S. Predictors of suicidal ideation one-year post-bariatric surgery: results from the Toronto Bari-Psych Cohort Study. Gen Hosp Psychiatry. 2019. This study showed that a history of suicidal ideation pre-surgery was the strongest predictor of suicidal ideation 1-year post-surgery. Google Scholar
- 51.Blum K, Bailey J, Gonzalez AM, Oscar-Berman M, Liu Y, Giordano J, et al. Neuro-genetics of reward deficiency syndrome (RDS) as the root cause of “addiction transfer”: a new phenomenon common after bariatric surgery. J Genet Syndr Gene Ther 2011;2012(1).Google Scholar
- 53.Conceição EM, Fernandes M, de Lourdes M, Pinto-Bastos A, Vaz AR, Ramalho S. Perceived social support before and after bariatric surgery: association with depression, problematic eating behaviors, and weight outcomes. Eat Weight Disord 2019.Google Scholar
- 54.• Hjelmesaeth J, Rosenvinge JH, Gade H, Friborg O. Effects of cognitive behavioral therapy on eating behaviors, affective symptoms, and weight loss after bariatric surgery: a randomized clinical trial. Obes Surg. 2019;29(1):61–9. This treatment study showed that presurgical group psychotherapy resulted in short-term reduction in depressive symptoms. The effect disappeared 4 years after surgery.PubMedGoogle Scholar
- 56.Beck NN, Johannsen M, Stoving RK, Mehlsen M, Zachariae R. Do postoperative psychotherapeutic interventions and support groups influence weight loss following bariatric surgery? A systematic review and meta-analysis of randomized and nonrandomized trials. Obes Surg. 2012;22(11):1790–7.PubMedGoogle Scholar