Prediction of Suicide and Nonfatal Self-harm After Bariatric Surgery: A Risk Score Based on Sociodemographic Factors, Lifestyle Behavior, and Mental Health: A Nonrandomized Controlled Trial.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
pubmed:
19
12
2019
medline:
15
9
2021
entrez:
19
12
2019
Statut:
ppublish
Résumé
To identify preoperative sociodemographic and health-related factors that predict higher risk of nonfatal self-harm and suicide after bariatric surgery. Evidence is emerging that bariatric surgery is related to an increased risk of suicide and self-harm, but knowledge on whether certain preoperative characteristics further enhance the excess risk is scarce. The nonrandomized, prospective, controlled Swedish Obese Subjects study was linked to 2 Nationwide Swedish registers. The bariatric surgery group (N = 2007, per-protocol) underwent gastric bypass, banding or vertical banded gastroplasty, and matched controls (N = 2040) received usual care. Participants were recruited from 1987 to 2001, and information on the outcome (a death by suicide or nonfatal self-harm event) was retrieved until the end of 2016. Subhazard ratios (sub-HR) were calculated using competing risk regression analysis. The risk for self-harm/suicide was almost twice as high in surgical patients compared to control patients both before and after adjusting for various baseline factors [adjusted sub-HR = 1.98, 95% confidence interval (CI) = 1.34-2.93]. Male sex, previous healthcare visits for self-harm or mental disorders, psychiatric drug use, and sleep difficulties predicted higher risk of self-harm/suicide in the multivariate models conducted in the surgery group. Interaction tests further indicated that the excess risk for self-harm/suicide related to bariatric surgery was stronger in men (sub-HR = 3.31, 95% CI = 1.73-6.31) than in women (sub-HR = 1.54, 95% CI = 1.02-2.32) (P = 0.007 for adjusted interaction). A simple-to-use score was developed to identify those at highest risk of these events in the surgery group. Our findings suggest that male sex, psychiatric disorder history, and sleep difficulties are important predictors for nonfatal self-harm and suicide in postbariatric patients. High-risk patients who undergo surgery might require regular postoperative psychosocial monitoring to reduce the risk for future self-harm behaviors.
Sections du résumé
OBJECTIVE
To identify preoperative sociodemographic and health-related factors that predict higher risk of nonfatal self-harm and suicide after bariatric surgery.
BACKGROUND
Evidence is emerging that bariatric surgery is related to an increased risk of suicide and self-harm, but knowledge on whether certain preoperative characteristics further enhance the excess risk is scarce.
METHODS
The nonrandomized, prospective, controlled Swedish Obese Subjects study was linked to 2 Nationwide Swedish registers. The bariatric surgery group (N = 2007, per-protocol) underwent gastric bypass, banding or vertical banded gastroplasty, and matched controls (N = 2040) received usual care. Participants were recruited from 1987 to 2001, and information on the outcome (a death by suicide or nonfatal self-harm event) was retrieved until the end of 2016. Subhazard ratios (sub-HR) were calculated using competing risk regression analysis.
RESULTS
The risk for self-harm/suicide was almost twice as high in surgical patients compared to control patients both before and after adjusting for various baseline factors [adjusted sub-HR = 1.98, 95% confidence interval (CI) = 1.34-2.93]. Male sex, previous healthcare visits for self-harm or mental disorders, psychiatric drug use, and sleep difficulties predicted higher risk of self-harm/suicide in the multivariate models conducted in the surgery group. Interaction tests further indicated that the excess risk for self-harm/suicide related to bariatric surgery was stronger in men (sub-HR = 3.31, 95% CI = 1.73-6.31) than in women (sub-HR = 1.54, 95% CI = 1.02-2.32) (P = 0.007 for adjusted interaction). A simple-to-use score was developed to identify those at highest risk of these events in the surgery group.
CONCLUSIONS
Our findings suggest that male sex, psychiatric disorder history, and sleep difficulties are important predictors for nonfatal self-harm and suicide in postbariatric patients. High-risk patients who undergo surgery might require regular postoperative psychosocial monitoring to reduce the risk for future self-harm behaviors.
Identifiants
pubmed: 31850987
pii: 00000658-202108000-00024
doi: 10.1097/SLA.0000000000003742
pmc: PMC7283001
mid: NIHMS1587115
doi:
Types de publication
Controlled Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
339-345Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK105948
Pays : United States
Informations de copyright
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: L.M.S.C. has received consulting and lecture fees from Johnson & Johnson and AstraZeneca. All other authors report no conflicts of interest.
Références
Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med 2012; 367:695–704.
Ricci C, Gaeta M, Rausa E, et al. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg 2015; 25:397–405.
Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA 2012; 307:56–65.
Kwok CS, Pradhan A, Khan MA, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol 2014; 173:20–28.
Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357:753–761.
Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357:741–752.
Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA 2015; 313:62–70.
Bhatti JA, Nathens AB, Thiruchelvam D, et al. Self-harm emergencies after bariatric surgery: a population-based cohort study. JAMA Surg 2016; 151:226–232.
Lagerros YT, Brandt L, Hedberg J, et al. Suicide, self-harm, and depression after gastric bypass surgery: a nationwide cohort study. Ann Surg 2017; 265:235–243.
Morgan DJ, Ho KM. Incidence and risk factors for deliberate self-harm, mental illness, and suicide following bariatric surgery: a state-wide population-based linked-data cohort study. Ann Surg 2017; 265:244–252.
Neovius M, Bruze G, Jacobson P, et al. Risk of suicide and non-fatal self-harm after bariatric surgery: results from two matched cohort studies. Lancet Diabetes Endocrinol 2018; 6:197–207.
Castaneda D, Popov VB, Wander P, et al. Risk of suicide and self-harm is increased after bariatric surgery: a systematic review and meta-analysis. Obes Surg 2019; 29:322–333.
Tindle HA, Omalu B, Courcoulas A, et al. Risk of suicide after long-term follow-up from bariatric surgery. Am J Med 2010; 123:1036–1042.
Courcoulas A. Who, why, and how? Suicide and harmful behaviors after bariatric surgery. Ann Surg 2017; 265:253–254.
Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics 1975; 31:103–115.
Keating C, Neovius M, Sjoholm K, et al. Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study. Lancet Diabetes Endocrinol 2015; 3:855–865.
Lindroos AK, Lissner L, Sjostrom L. Validity and reproducibility of a self-administered dietary questionnaire in obese and non-obese subjects. Eur J Clin Nutr 1993; 47:461–481.
Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res 1985; 29:71–83.
Davies AR, Sherbourne CR, Peterson JR, et al. Scoring Manual: Adult Health Status and Patient Satisfaction Measures Used in RAND's Health Insurance Experiment. Santa Monica, CA: RAND Corporation; 1988.
Sjoberg L, Svensson E, Persson LO. The measurement of mood. Scand J Psychol 1979; 20:1–18.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67:361–370.
Bergner M, Bobitt RA, Carter WB, et al. The sickness impact profile: development and final revision of a health status measure. Med Care 1981; 19:787–805.
Karlsson J, Taft C, Sjostrom L, et al. Psychosocial functioning in the obese before and after weight reduction: construct validity and responsiveness of the Obesity-related Problems scale. Int J Obes Relat Metab Disord 2003; 27:617–630.
Hinz A, Brahler E. Normative values for the hospital anxiety and depression scale (HADS) in the general German population. J Psychosom Res 2011; 71:74–78.
Dawes AJ, Maggard-Gibbons M, Maher AR, et al. Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA 2016; 315:150–163.
Mitchell JE, Crosby R, De Zwaan M, et al. Possible risk factors for increased suicide following bariatric surgery. Obesity (Silver Spring) 2013; 21:665–672.
Spittal MJ, Fruhbeck G. Bariatric surgery: many benefits, but emerging risks. Lancet Diabetes Endocrinol 2018; 6:161–163.
Gordon KH, King WC, White GE, et al. A longitudinal examination of suicide-related thoughts and behaviors among bariatric surgery patients. Surg Obes Relat Dis 2019; 15:269–278.
Schrijvers DL, Bollen J, Sabbe BG. The gender paradox in suicidal behavior and its impact on the suicidal process. J Affect Disord 2012; 138:19–26.
Franklin JC, Ribeiro JD, Fox KR, et al. Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull 2017; 143:187–232.
Bernert RA, Kim JS, Iwata NG, et al. Sleep disturbances as an evidence-based suicide risk factor. Curr Psychiatry Rep 2015; 17:554.
Geiker NRW, Astrup A, Hjorth MF, et al. Does stress influence sleep patterns, food intake, weight gain, abdominal obesity and weight loss interventions and vice versa? Obes Rev 2018; 19:81–97.
Belsher BE, Smolenski DJ, Pruitt LD, et al. Prediction models for suicide attempts and deaths: a systematic review and simulation. JAMA Psychiatry 2019; 76:642–651.
Passos IC, Ballester P. Positive predictive values and potential success of suicide prediction models. JAMA Psychiatry 2019; [Epub ahead of print], doi: 10.1001/jamapsychiatry.2019.1507.
doi: 10.1001/jamapsychiatry.2019.1507