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Risk of Suicide and Self-harm Is Increased After Bariatric Surgery—a Systematic Review and Meta-analysis

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Abstract

Background

Bariatric surgery is endorsed by multiple societies as the most effective treatment for obesity. Psychosocial functioning has also been noted to improve for most patients after bariatric surgery. However, some studies have shown an increase in post-operative suicide risk. The aim of this study was to review the published literature and evaluate the association of bariatric surgery with suicide events and suicide/self-harm attempts in patients who have undergone weight loss surgery.

Methods

MEDLINE and Embase were searched from inception through January 2018 for retrospective or prospective studies reporting mortality outcomes and self-harm or suicide rates after bariatric procedures. The primary outcome was the pooled event rate with 95% confidence interval (95% CI) for suicide. Secondary outcomes were suicide/self-harm attempts after bariatric surgery compared to same population prior to surgery and to matched control subjects, with the respective calculated odds ratios (OR) and 95% CI.

Results

From 227 citations, 32 studies with 148,643 subjects were eligible for inclusion. The patients were predominantly females (76.9%). Roux-en-Y gastric bypass (RYGB) was the most commonly performed procedure (58.9%). The post-bariatric suicide event rate was 2.7/1000 patients (95% CI 0.0019–0.0038), while the suicide/self-harm attempt event rate was 17/1000 patients (95% CI 0.01–0.03). The self-harm/suicide attempt risk was higher after bariatric surgery within the same population with OR of 1.9 (95% CI 1.23–2.95), and compared to matched control subjects, OR 3.8 (95% CI, 2.19–6.59).

Conclusions

Post-bariatric surgery patients had higher self-harm/suicide attempt risk compared to age-, sex-, and BMI-matched controls. Various pre- and post-surgical psychosocial, pharmacokinetic, physiologic, and medical factors may be involved.

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Acknowledgments

Violeta B. Popov has received research support from Spatz and Apollo Endosurgery. Christopher C. Thompson has received research support and/or works as a consultant for Boston Scientific, Medtronic, USGI Medical, Olympus, Apollo Endosurgery, GI Windows, Aspire Bariatrics, Fractyl, Spatz, EndoTAGSS, and GI Dynamics.

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  1. Daniel Castaneda and Violeta B. Popov contributed equally to this work.

Authors and Affiliations

  1. Digestive Disease Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Daniel Castaneda

  2. Division of Gastroenterology, New York VA Harbor Healthcare, NYU School of Medicine, 423 E 23rd St., New York, NY, 10010, USA

    Violeta B. Popov

  3. Department of Gastroenterology, Northshore Long Island Jewish Hospital, 300 Community Drive, Manhaseet, New York, NY, 11030, USA

    Praneet Wander

  4. Division of Gastroenterology, Harvard School of Medicine, Brigham & Women’s Hospital, 75 Francis St., Boston, MA, 02115, USA

    Christopher C. Thompson

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Correspondence to Christopher C. Thompson.

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Conflict of Interest

Authors 1 and 3 do not have any compelling conflict of interest. Author 2 has received a grant and non-financial support from Apollo Endosurgery and research support from Spatz. Author 4 is a consultant for Boston Scientific, Medtronic, Fractyl, Olympus, USGI Medical, Apollo, and GI Dynamics; has received research support from Olympus; has received grants from USGI Medical, Apollo Endosurgery, Aspire Bariatrics, and Spatz; and has ownership interest in GI Windows and EndoTAGSS.

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Castaneda, D., Popov, V.B., Wander, P. et al. Risk of Suicide and Self-harm Is Increased After Bariatric Surgery—a Systematic Review and Meta-analysis. OBES SURG 29, 322–333 (2019). https://doi.org/10.1007/s11695-018-3493-4

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