Possible link between bariatric surgery, increased suicide risk emerges

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A Canadian study involving 8,815 adults from Ontario has found a possible link between bariatric surgery and increased risk of self-harm including suicide.

Researchers from Sunnybrook Research Institute, Toronto, including Junaid A. Bhatti, M.B.B.S., M.Sc., Ph.D., studied a total of 8,815 adults from Ontario, who underwent weight-loss surgery and compared their risk of self-harm behaviour before and after the study. Researchers started monitoring the patients 3 years prior to surgery and continued the follow-up for 3 years after the surgery.

Researchers found that 111 patients had 158 self-harm emergencies during follow-up and while very few patients had such emergencies, the risk had increased substantially post surgery – in some cases by as much as 50 per cent. Researchers also revealed in the study that nearly all self-harm events occurred in patients who had a history of a mental health disorder. Intentional self-poisoning by medications was the most common mechanism of attempted suicide.

For the purpose of the study researchers categorised 4 distinct mechanisms of self-harm behaviors: medications, alcohol, poisoning by toxic chemicals, and physical trauma.

Though the researchers have been able to figure out whether self-harm behaviours are mitigated or aggravated by surgery, they were able to ascertain a few reasons why there is a possible link between bariatric surgery and the subsequent risk of self-harm. These include changes in alcohol metabolism after surgery; possible substitution of substance misuse for food; increased stress and anxiety in postoperative patients; and the effect of surgery on the levels of neurohormones, possible mediators of the likelihood of depression and suicidal behaviors.

“Findings from this study advocate a better understanding of these and other theories through future research of potential mechanisms of self-harm in patients undergoing bariatric surgery”, researchers note in the study.

The findings of the study should in no way deter obese patients with mental health condition to refrain from bariatric surgery, researchers say. However, the findings are useful for bariatric surgeons and emergency physicians in postoperative follow-up as they provide clues about increased risk of self-harm behaviour and what may be done to reduce those.

Amir A. Ghaferi, M.D., M.S., and Carol Lindsay-Westphal, Ph.D., of the Ann Arbor Veterans Administration Healthcare System, Ann Arbor, Michigan points out that the research has two important findings. The first being that preoperative incidence of self-harm emergencies in patients undergoing bariatric surgery is twice the population average and increases by an additional 50 percent in the postoperative period.

Secondly, most self-harm instances have occurred in the second and third postoperative years and there is no minimum standard for psychological follow-up. Although stringent criteria are in place for insurance and programmatic approval to undergo surgery, the postoperative follow-up rates in general have been poor.