Suicide and Self-Harm

Abstract

There is a growing concern that post-bariatric surgery patients may have an increased risk for completed suicide, attempted suicide, and self-harm compared to age-, sex-, and BMI-matched controls. Although the pathogenic mechanisms increasing the risk are not fully understood, there is evidence that various pre- and post-surgical psychosocial, pharmacokinetic, physiologic, and medical factors may be involved. Mental health problems are much more prevalent in patients undergoing bariatric surgery than in age, gender, and BMI-matched controls. The high prevalence of preexisting psychiatric disorders combined with surgery-related changes may cause an increased risk of suicide and self-harm. Lifetime history of suicide ideation and self-injurious behavior are most strongly associated with post-surgery risk. Therefore, pre-operative assessment conducted by an expert mental health professional is crucial for effective prevention of self-harm and suicide in bariatric patients. Pre-operative assessment is very important, but it should be combined with post-operative assessment. Most programs focus on the first year post surgery, but there is evidence to support the call for long-term follow-up, especially for patients with a history of major depression, personality disorder, and/or self-injurious behavior.