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Incidence and Risk Factors for Deliberate Self-harm, Mental Illness, and Suicide Following Bariatric Surgery

A State-wide Population-based Linked-data Cohort Study

Morgan, David J. R. MBBS, FACEM, FCICM; Ho, Kwok M. MBBS, FANZCA, FCICM, PhD

doi: 10.1097/SLA.0000000000001891

Objective: Assess the incidence and determinants of hospitalization for deliberate self-harm and mental health disorders, and suicide after bariatric surgery.

Background: Limited recent literature suggests an increase in deliberate self-harm following bariatric surgery.

Methods: A state-wide, population-based, self-matched, longitudinal cohort study over a 5-year period between 2007 and 2011. Utilizing the Western Australian Department of Health Data Linkage Unit records, all patients undergoing bariatric surgery (n = 12062) in Western Australia were followed for an average 30.4 months preoperatively and 40.6 months postoperatively.

Results: There were 110 patients (0.9%) hospitalized for deliberate self-harm, which was higher than the general population [incidence rate ratio (IRR) 1.47, 95% confidence interval (CI) 1.11–1.94, P = 0.005]. Compared with before surgery, there was no significant increase in deliberate self-harm hospitalizations (IRR 0.79, 95% CI 0.54–1.16; P = 0.206) and a reduction in overall mental illness related hospitalizations (IRR 0.76, 95% CI 0.63–0.91; P = 0.002) after surgery. Younger age, no private-health insurance cover, a history of hospitalizations due to depression before surgery, and gastrointestinal complications after surgery were predictors for deliberate self-harm hospitalizations after bariatric surgery. Three suicides occurred during the follow-up period, a rate comparable to the general population during the same time period (IRR 0.61, 95% CI 0.11–2.27, P = 0.444).

Conclusions: Hospitalization for deliberate self-harm in bariatric patients was more common than the general population, but an increased incidence of deliberate self-harm after bariatric surgery was not observed. Hospitalization for depression before surgery and major postoperative gastrointestinal complications after bariatric surgery are potentially modifiable risk factors for deliberate self-harm after bariatric surgery.

*Department of Intensive Care Medicine, St John of God Hospital Subiaco, Subiaco, Western Australia, Australia

School of Population Health, University of Western Australia, Nedlands, Western Australia, Australia

School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia.

Reprints: David J. R. Morgan, MBBS, FACEM, FCICM, Department of Intensive Care, St John of God Hospital Subiaco, 12 Salvado Road, Subiaco, Western Australia 6008, Australia. E-mail:

D.J.R.M is a staff specialist and PhD candidate, K.M.H is a staff specialist, clinical associate professor, adjunct associate professor and research fellow.

The authors and all staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

The prime author (DJRM) received a local St John of God Hospital Subiaco Research Grant. Sum value: AUD$2845.00 (∼USD$3004 in January 2013). This research grant was paid directly by St John of God Hospital Subiaco (the authors’ base hospital) to the Western Australian Department of Health covering the Data Linkage Branch data extraction fees. There were no contractual agreements between the authors and St John of God Hospital Subiaco or The Western Australian Department of Health that denied investigators the right to examine data independently or to submit a manuscript for publication without first obtaining the consent of the sponsor. The authors have no commercial associations that might be a conflict of interest in relation to this article. Dr KMH is supported by WA Department of Health and Raine Medical Research Foundation through the Raine Clinical Research Fellowship.

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