Hospitalization risks for psychiatric disorders vary for adults after bariatric surgery
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Key takeaways:
- Rates of death from suicide did not differ between three bariatric surgery procedures.
- The risk of psychiatric hospitalizations varied following sleeve gastrectomy, gastric bypass and restrictive surgery.
Hospitalization rates for psychiatric disorders vary by procedure type and psychiatric diagnosis for adults with obesity who undergo bariatric surgery, according to a study published in Obesity.
“There are many potential reasons why mental health may improve, or deteriorate, after a major event like bariatric surgery,” Priya Sumithran, MBBS, PhD, associate professor and researcher at Monash University in Melbourne, Australia, told Healio. “The most interesting finding from this study is that changes in mental health aren’t the same after all types of surgery. It will be important to try to identify the people who are most likely to experience a deterioration in mental health so we can support them better, and to find out whether there is something related to the surgery itself that we could change to reduce these risks.”
Sumithran and colleagues conducted a retrospective population-based cohort study of adults who underwent bariatric surgery in New South Wales or Queensland, Australia, from July 2001 to December 2020. Hospital admissions were obtained from the admitted patient data collections in each state. Deaths were collected from the state’s registries of births, deaths and marriages. Surgery types were classified as restrictive, sleeve gastrectomy or gastric bypass. The study’s primary outcome was death due to suicide. Hospital admissions for other psychiatric diagnoses were analyzed as secondary outcomes.
There were 121,203 adults who underwent bariatric surgery, of whom 76% were women and 90% were aged 20 to 59 years. Of the study group, 85% underwent a sleeve gastrectomy. The mean follow-up time was 4.5 years after surgery.
There were 77 suicides that occurred during follow-up. Suicide rates were similar for restrictive surgery, sleeve gastrectomy and gastric bypass.
Rates for hospitalizations due to psychiatric diagnoses varied by surgery type. Adults who had a restrictive procedure performed had a lower risk of hospitalization due to self-harm (RR = 0.64; 95% CI, 0.47-0.88), mood disorders (RR = 0.63; 95% CI, 0.53-0.75), any psychiatric diagnosis (RR = 0.78; 95% CI, 0.68-0.89) and admission as a psychiatric inpatient (RR = 0.77; 95% CI, 0.64-0.93) after surgery compared with before surgery. Adults had a lower risk of hospitalization due to self-harm after a sleeve gastrectomy compared with before surgery (RR = 0.88; 95% CI, 0.81-0.95). All three surgery types were associated with an increased risk for substance use after surgery compared with before surgery. Adults who had a gastric bypass had a higher risk of hospitalization due to mood disorders after surgery compared with before surgery (RR = 1.24; 95% CI, 1.07-1.44). Both sleeve gastrectomy and gastric bypass increased the risk of hospitalization due to anxiety disorders, any psychiatric diagnosis and admission as a psychiatric patient after surgery compared with before surgery.
“These findings won’t yet change clinical practice, and it is important to emphasize that only a small minority of people will experience a decline in mental health,” Sumithran said. “Overall, most will experience benefits after surgery.”
The researchers wrote that research investigating the mechanisms of the associations observed in the study may help in the creation of evidence-based psychiatric management strategies.
For more information:
Priya Sumithran, MBBS, PhD, can be reached at priya.sumithran@monash.edu.
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