Clinical research study
Risk of Suicide after Long-term Follow-up from Bariatric Surgery

https://doi.org/10.1016/j.amjmed.2010.06.016Get rights and content

Abstract

Purpose

Bariatric surgery is recognized as the treatment of choice for class III obesity (body mass index ≥40) and has been increasingly recommended for obese patients. Prior research has suggested an excess of deaths due to suicide following bariatric surgery, but few large long-term follow-up studies exist. We examined postbariatric surgery suicides by time since operation, sex, age, and suicide death rates as compared with US suicide rates.

Methods

Medical data following bariatric operations performed on Pennsylvania residents between January 1, 1995 and December 31, 2004 were obtained from the Pennsylvania Health Care Cost and Containment Council. Matching mortality data from suicides between September 1, 1996 and December 28, 2006 were obtained from the Division of Vital Records, Pennsylvania State Department of Health.

Results

There were 31 suicides (16,683 operations), for an overall rate of 6.6/10,000; 13.7 per 10,000 among men and 5.2 per 10,000 among women. About 30% of suicides occurred within the first 2 years following surgery, with almost 70% occurring within 3 years. For every age category except the youngest, suicide rates were higher among men than women. Age- and sex-matched suicide rates in the US population (ages 35-64 years) were 2.4/10,000 (men) and 0.7/10,000 (women).

Conclusions

Compared with age and sex-matched suicide rates in the US, there was a substantial excess of suicides among all patients who had bariatric surgery in Pennsylvania during a 10-year period. These data document a need to develop more comprehensive longer-term surveillance and follow-up methods in order to evaluate factors associated with postbariatric surgery suicide.

Section snippets

Methods

Data were obtained from the following 2 sources: the Pennsylvania Health Care Cost and Containment Council database,44 to identify patients hospitalized for bariatric surgery, and the Division of Vital Records, Pennsylvania State Department of Health, to determine suicides (as judged by the coroner or medical examiner) and obtain copies of death certificates.

The Pennsylvania Health Care Cost and Containment Council collects data in the state of Pennsylvania, including all hospital discharges

Results

There were 31 total suicides. Mean age of the deceased was 45 years, and they were primarily female (65%, Table 1) and white (94%). Mean time to death was about 3 years after surgery, with 10% occurring in the first year, 29% within the first 2 years, and 68% within 3 years after surgery (Table 2). The distribution of suicides by year of bariatric surgery is shown in Table 3. The incidence of suicide was 6.6 per 10,000 person-years. Men had higher rates of suicide in each age category except

Discussion

We examined all suicides occurring between 1996 and 2006 among postbariatric surgery patients residing in Pennsylvania. There were 31 total suicides in this population, for an overall rate of 13.7 per 10,000 among men and 5.2 per 10,000 among women. It is very likely that suicide deaths were also underestimated because some of the deaths were listed as drug overdose, rather than suicide, on the death certificate. In this case, the suicide rate postbariatric surgery would be even higher than

Acknowledgment

The authors gratefully acknowledge Ms. Monica Love for preparing this manuscript for publication, and Mr. Alhaji Buhari for statistical support.

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    Funding: This publication was made possible by a grant from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research (KL2 RR024154-05, Dr. Tindle). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.

    Conflict of Interest: There are no conflicts of interest to report.

    Author: All authors had access to the data and had a role in writing the manuscript.

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