Mental health service use appears to increase after bariatric surgery

Over an average follow-up of 5 years, one in 10 patients who underwent bariatric surgery used mental health service afterwards, according to findings published in JAMA Psychiatry.

“Several recent studies have highlighted a concern that bariatric surgery may exacerbate psychiatric conditions, especially deliberate self-harm and suicide,” David J. R. Morgan, MBBS, of St. John of God Subiaco Hospital in Perth, Australia, and colleagues wrote. “In response to this, major professional bariatric societies currently recommend that potential surgical candidates should have either no active severe [psychopathology] or drug dependency problems and/or have undergone psychological assessment before surgery.”

Researchers conducted a longitudinal cohort study to better understand the link between bariatric surgery and broader mental health outcomes, such as the incidence of outpatient, ED and inpatient mental health service use. They examined data on patients undergoing their first bariatric surgery in Western Australia over a 10-year period to determine the incidence and predictors for mental health presentations, deliberate self-harm and suicide associated with the timing of bariatric surgery.

Overall, 24,766 patients (77.3% women) underwent bariatric surgery. In total, 3,979 patients (16.1%) used at least one mental health service. Of these, 1,401 patients (35.2%) presented only before surgery, 1,025 (25.8%) presented both before and after surgery, and 1,550 patients (39%) presented only after surgery.

After bariatric surgery, Morgan and colleagues reported an increase in outpatient clinic attendance (incidence rate ratio [IRR] = 2.3; 95% CI, 2.3-2.4), ED attendance (IRR = 3; 95% CI, 2.8-3.2) and psychiatric hospitalization (IRR = 3; 95% CI, 2.8-3.1).

The results also showed that presentations to the ED due to deliberate self-harm increased nearly 5-fold after surgery (IRR = 4.7; 95% CI, 3.8-5.7). Overall, suicides accounted for about 10% of post-operative deaths.

Some risk factors of self-harm or suicidal ideation after first bariatric surgery included younger age; higher socioeconomic status; self-harm, suicidal ideation, mental disorders due to psychoactive substance abuse, or mood disorders before their surgery. Complications after index surgery requiring further surgical intervention were also associated with later mental health presentations.

“Our findings question the hypothesis that weight reduction by bariatric surgery will improve mental health in patients with obesity,” the investigators wrote. “Whether using a preoperative psychological assessment, as recommended by the current guidelines, can identify those at risk and improve their mental health outcomes, to our knowledge, remains scientifically unproven.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.