Studies have shown that patients who undergo bariatric surgery have a suicide rate up to four times greater than the general population. In addition, higher rates of self-harm, mental health intervention, and substance abuse have also been reported. Interestingly, restrictive bariatric procedures such as adjustable gastric banding and vertical banded gastroplasty have lower mental health incidences compared to gastric bypass. Sleeve gastrectomy, which is now the most common bariatric procedure, has had very little examination regarding the mental health repercussions of the procedure.
To fill this gap in knowledge, Priya Sumithran, MBBS (Hons), FRACP, PhD, and colleagues conducted a longitudinal retrospective cohort study that examined the rates of suicide and mental health–based hospitalizations after sleeve gastrectomy compared with gastric bypass and restrictive procedures, such as gastric banding and gastroplasty. Over 120,000 bariatric surgery patients were tracked for up to 19 years; all these patients underwent surgery between July 2001 and December 2020.
The results of this study were published in Obesity. Dr. Sumithran discussed the findings and their implications with Physician’s Weekly. In the published record of this study’s findings, Dr. Sumithran and colleagues remind practitioners that current clinical practice guidelines recommend a complete psychological evaluation by a qualified healthcare professional before a patient can secure clearance for a bariatric procedure.
Why did this topic warrant study?
We know that although most people experience improvement in health and well-being after bariatric surgery, some people have a deterioration in mental health. This is mostly known from studies of gastric bypass, but we knew relatively little about mental health after sleeve gastrectomy, which is now the most common bariatric surgery type. So, this study was done to look at mental health outcomes after sleeve gastrectomy and compare them with other surgery types.
What are the most important findings from the study?
The main findings are that rates of admission to the hospital with mental health diagnoses were different after (compared with before) bariatric surgery and that these changes varied by type of surgery (Table). As an example, people had higher rates of hospitalization with anxiety after sleeve gastrectomy and gastric bypass, and with a substance use disorder after any type of bariatric surgery.
Will these findings impact practice?
These findings won’t yet change clinical practice, and it is important to emphasize that only a small minority of people will experience a decline in mental health, whereas overall, most will experience benefits after surgery.
What would you like future research to be focused on?
There are many potential reasons why mental health may improve or deteriorate after a major event like bariatric surgery. The most interesting finding from this study is that changes in mental health aren’t the same across all types of surgery. It will be important to try to identify the people who are most likely to experience a deterioration in mental health so that we can provide better support to them and so that we can find out whether there is something related to the surgery itself that we could change to reduce these risks.
