Heightened suicide risk after weight-loss surgery

Heightened suicide risk after weight-loss surgery

This isn't new news, it's a new study.  This topic has been discussed before, and it's true.  WLS'ers off themselves more often AFTER undergoing WLS than before.

We can only hope to see MORE studies, information and support for our peers and ourselves.

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From Reuters -

NEW YORK (Reuters Health) - Severely obese people who undergo weight-loss surgery may have a higher-than-average risk of suicide in the years following the procedure, a new study finds.

But, "most of the suicides among individuals in this study occurred later than the time post-surgical follow up usually ends," Tindle said.

The report, in The American Journal of Medicine, adds to evidence that patients who have bariatric surgery to lose weight have an increased risk of suicide compared with the general population.

But the reasons for the pattern, researchers say, remain unknown.

A number of studies have found that while the absolute rate of suicide among bariatric surgery patients is quite low, it is still higher than the norm for the general population.

The benefits of weight-loss surgery are well-documented. The procedures, which alter the digestive tract to limit food intake and nutrient absorption, can help severely obese individuals shed a substantial amount of weight. They can also reverse obesity-related health problems like type 2 diabetes and high blood pressure.

The latest study, which tracked deaths among Pennsylvania residents who underwent bariatric surgery, examined a longer period than previous research -- up to 10 years following the procedure.

Among 16,683 who had bariatric surgery between 1995 and 2004, 31 committed suicide by the end of 2006, the researchers found. The data translate into a suicide rate of nearly 14 per 10,000 men per year, and five per 10,000 women each year.

Those numbers are substantially higher than the suicide rates among Pennsylvanians in the same 35-to-64 age range, during the same period. Among all men in the state, the suicide rate in 2005 was 2.5 per 10,000, while the rate among women was 0.6 per 10,000.

Overall, 30 percent of suicides in the surgery group occurred within two years of the procedure, and 70 percent occurred within three years.

For now, the reasons for the higher suicide risk are unclear, according to lead researcher Dr. Hilary A. Tindle of the University of Pittsburgh in Pennsylvania. Her group's study, based on death certificate data, could not examine details surrounding the individual suicides.

But the study does not imply that bariatric surgery itself leads to suicides -- something that is "critical" for patients to understand, she told Reuters Health in an e-mail.

Rather, she said, it may be that some bariatric surgery patients have depression or other mental health problems before the procedure -- or develop them afterward -- and that, in turn, increases their overall suicide risk.

Depression is common among severely obese adults, including those who seek weight-loss surgery, Tindle and her colleagues point out. One study of surgery candidates found that two-thirds had, at some point in their lives, experienced a so-called "Axis I" disorder, a group of mental health conditions that includes depression, anxiety disorders, eating disorders and substance abuse.

Bariatric surgery candidates do undergo screening to see whether the operation is appropriate for them, and that includes a mental health evaluation. But a history of depression or other psychiatric conditions does not necessarily preclude a person from having the surgery.

Instead, Tindle explained, a team of health professionals -- including the surgeon, a dietitian, a psychologist and, often, an exercise physiologist -- try to determine whether an individual is medically and psychologically ready for surgery, and if not, they attempt to address any underlying problems.

More research, according to Tindle's team, is needed to understand why bariatric surgery patients show an increased suicide risk. If there are pre-surgery characteristics connected to a higher risk, then some suicides might be prevented by more careful monitoring and treatment, the researchers say.

Also unclear is whether suicide risk depends on how much weight a person loses after surgery. It's possible, Tindle's team speculates, that any pre-existing psychological distress could be exacerbated if patients have disappointing weight-loss results -- or if their overall quality of life does not improve as they had hoped.

According to Tindle, the findings indicate a general need for longer term monitoring of patients after surgery.

Bariatric surgery centers across the U.S. do post-surgery monitoring, with the recommended follow-up being six months.

But, "most of the suicides among individuals in this study occurred later than the time post-surgical follow up usually ends," Tindle said.

About 225,000 Americans are now having bariatric surgery each year, according to the American Society for Metabolic and Bariatric Surgery. Given those numbers, Tindle said, it will become increasingly important to understand the factors that contribute to patients' heightened suicide risk.

SOURCE: link.reuters.com/mah85p

The American Journal of Medicine, online September 14, 2010.

 

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I don't buy that. I think the numbers would be the same for any group.

Having worked with many suicidal clients, I can see why this would be true. Many people go through a period after the surgery where they (temporarily) regret having the surgery. Many also express disappointment that the surgery didn't "fix" things in their life other than their weight. We know that the depression risk is also higher after WLS, and this is likely exacerbated by the hormone dump that happens as the weight is lost. While the rate of suicide is still relatively low, it is always something to be mindful of and to educate people about. Thanks to Melting Mama for highlighting this issue!

Tonia

I can definitely see that this would be true. While I am not suicidal by any means, I have been very depressed since surgery. I think it has a lot to do with my raging hormones, as the previous poster said.

Actually, me having WLS was a major concern for my husband as his mother committed suicide and she had WLS. It was about 25 years between her surgery and her suicide; however, I have to agree that one had to do with the other. Like so many people, over time they don't think they need to continue the vitamins, and she was in severe need of B12 and iron. After I had surgery, I had felt the effects of very low B12 (I went into surgery with low levels) and found myself tired and quite depressed. It then dawned on me that my MIL went through this every day and I could totally understand that if I felt that way for as long as she did that I would likely end up in the same place.  I truly believe that her vitamin deficiencies pushed her over the edge. She was absolutely an incredible person and we wish we had know this before it was too late. 

Fascinating. And actually, not that surprising. (At least to me.)
We talk a lot here about "emotional eating", "head hunger", and I've always considered over-eating a form of self-medication. Some people over-eat to relieve stress, some to deaden feelings which may be too intense or painful... nobody seems to doubt that much obesity is emotionally driven.  So why would I be surprised that, when that "medication" is suddenly gone, some may find themselves bereft?
But it's also a good reminder to stay on top of our own emotional outlooks, and try to keep them as healthy as we are our bodies.  It's just too easy to be dragged down.  It can sneak up on you.
Like an ice cream sandwich.

Absolutely IS medication.

Case - My DH.  Stressful day - comes home with two donuts.  Eats half by half until it's gone over night.  Or, a half stack of saltines, compulsively.  Carbs ARE his medicine.  Always have been.

I sugar manage myself when I need to.

I also caffeine manage myself as well.



And there are times others do this FOR me.

Having the surgery is a major life chnage,  Everything that you have been doing needsto be changed,  I would think that if they compared this group with peopke that were recenly laid off, lost some significant to them, got a divorce, or faced a financial set back the results would be pretty close to the same.

I have a friend whose mother committed suicide after having WLS.  Another friend and I speculated that nutritional deficiencies may have lead to depression.  All of this went untreated (presumably)... and she ended up killing herself.  I wonder if menopause may have also played a role.  At this point it's all just speculation.

I suspect that depression is higher among those who have WLS (both pre- and post-op) than in the general population.  It would be interesting to compare apples to apples... that is, compare the percentage of suicides of diagnosed, clinically depressed folks in the general population to those who have WLS.