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Suicide, Self-harm, and Depression After Gastric Bypass Surgery

A Nationwide Cohort Study

Lagerros, Ylva Trolle MD, PhD; Brandt, Lena MSc; Hedberg, Jakob MD, PhD; Sundbom, Magnus MD, PhD; Bodén, Robert MD, PhD

doi: 10.1097/SLA.0000000000001884

Objective: The aim of this study was to examine risk of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery (GBP).

Summary of Background Data: Concerns regarding severe adverse psychiatric outcomes after GBP have been raised.

Methods: This nationwide, longitudinal, self-matched cohort encompassed 22,539 patients who underwent GBP during 2008 to 2012. They were identified through the Swedish National Patient Register, the Prescribed Drug Register, and the Causes of Death Register. Follow-up time was up to 2 years. Main outcome measures were hazard ratios (HRs) for post-surgery self-harm or hospitalization for depression in patients with presurgery self-harm and/or depression compared to patients without this exposure; and standardized mortality ratio (SMR) for suicide post-surgery.

Results: A diagnosis of self-harm in the 2 years preceding surgery was associated with an HR of 36.6 (95% confidence interval [CI] 25.5–52.4) for self-harm during the 2 years of follow up, compared to GBP patients who had no self-harm diagnosis before surgery. Patients with a diagnosis of depression preceding GBP surgery had an HR of 52.3 (95% CI 30.6–89.2) for hospitalization owing to depression after GBP, compared to GBP patients without a previous diagnosis of depression. The SMR for suicide after GBP was increased among females (n = 13), 4.50 (95% CI 2.50–7.50). The SMR among males (n = 4), was 1.71 (95% CI 0.54–4.12).

Conclusions: The increased risk of post-surgery self-harm and hospitalization for depression is mainly attributable to patients who have a diagnosis of self-harm or depression before surgery. Raised awareness is needed to identify vulnerable patients with history of self-harm or depression, which may be in need of psychiatric support after GBP.

*Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden

Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Stockholm, Sweden

Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

§Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.

Reprints: Dr. Ylva Trolle Lagerros, MD, PhD, Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, T2, SE 171 76 Stockholm, Sweden. E-mail:

Y.T.L. is an associate professor, L.B. is a biostatistician, J.H. is an associated professor, M.S. is an associate professor, and R.B. is an associate professor.

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.

This research was funded by the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet (YTL), funding from Serafimerlasarettet (YTL) and unrestricted research grants from Nasvell Foundation (RB) and Uppsala County Council (RB). YTL reports receiving consulting fees from Novo Nordisk and JH reports receiving consulting fees from AstraZeneca. For the remaining authors none were declared.

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