Citation

Bhatti JA, Nathens AB, Thiruchelvam D, Grantcharov T, Goldstein BI, Redelmeier DA. JAMA Surg. 2015; 151(3): 226-232.

Affiliation

Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada2Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

Copyright

(Copyright © 2015, American Medical Association)

DOI

10.1001/jamasurg.2015.3414

PMID

26444444

Abstract

IMPORTANCE: Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery.

OBJECTIVE: To compare the risk of self-harm behaviors before and after bariatric surgery. DESIGN, SETTING, AND PARTICIPANTS: In this population-based, self-matched, longitudinal cohort analysis, we studied 8815 adults from Ontario, Canada, who underwent bariatric surgery between April 1, 2006, and March 31, 2011. Follow-up for each patient was 3 years prior to surgery and 3 years after surgery. MAIN OUTCOMES AND MEASURES: Self-harm emergencies 3 years before and after surgery.

RESULTS: The cohort included 8815 patients of whom 7176 (81.4%) were women, 7063 (80.1%) were 35 years or older, and 8681 (98.5%) were treated with gastric bypass. A total of 111 patients had 158 self-harm emergencies during follow-up. Overall, self-harm emergencies significantly increased after surgery (3.63 per 1000 patient-years) compared with before surgery (2.33 per 1000 patient-years), equaling a rate ratio (RR) of 1.54 (95% CI, RESULTS:  1.03-2.30; P = .007). Self-harm emergencies after surgery were higher than before surgery among patients older than 35 years (RR, 1.76; 95% CI, 1.05-2.94; P =.03), those with a low-income status (RR, 2.09; 95% CI, 1.20-3.65; P =.01), and those living in rural areas (RR, 6.49; 95% RESULTS: CI, 1.42-29.63; P =.02). The most common self-harm mechanism was an intentional overdose (115 [72.8%]). A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the 5 years before the surgery.

CONCLUSIONS AND RELEVANCE: In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.

Language: en