Disclosures: The authors declare no conflicts of interest.
Article first published online: 25 MAY 2013
Copyright © 2012 The Obesity Society
Volume 21, Issue 4, pages 665–672, April 2013
How to Cite
Mitchell, J. E., Crosby, R., de Zwaan, M., Engel, S., Roerig, J., Steffen, K., Gordon, K. H., Karr, T., Lavender, J. and Wonderlich, S. (2013), Possible risk factors for increased suicide following bariatric surgery. Obesity, 21: 665–672. doi: 10.1002/oby.20066
Funding agencies: James E. Mitchell is supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant RO1 DK84979, UO1 DK66471, and RO1 DK75119. Ross Crosby is supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant RO1 DK75119. Scott Engel and Kristine Steffen are supported by the National Institute of Alcoholism and Alcohol Abuse grant RO3 AA19513, and Kristine Steffen is supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK85066. Trisha Karr and Jason Lavender are supported by the National Institute of Mental Health grant T32 NIMH82761.
- Issue published online: 25 MAY 2013
- Article first published online: 25 MAY 2013
- Accepted manuscript online: 3 OCT 2012 05:16PM EST
- Manuscript Accepted: 2 AUG 2012
- Manuscript Received: 15 MAR 2012
- National Institute of Diabetes and Digestive and Kidney Diseases. Grant Numbers: RO1 DK84979, UO1 DK66471, RO1 DK75119
- National Institute of Diabetes and Digestive and Kidney Diseases. Grant Number: RO1 DK75119
- National Institute of Alcoholism and Alcohol Abuse. Grant Number: RO3 AA19513
- National Institute of Diabetes and Digestive and Kidney Diseases. Grant Number: K23 DK85066
- National Institute of Mental Health. Grant Number: T32 NIMH82761
There is a growing research literature suggesting that there may be elevated risk of suicide following bariatric surgery. Most of the data reported thus far has been cross-sectional and observational, and very little is known about the possible specific causal variables involved.
Design and Methods:
The purpose of this report is to review this literature and to review possible risk factors for increased suicidal risk following bariatric surgery, to delineate future research directions.
First a variety of medical, biological, and genetic factors, including the persistence or recurrence of medical comorbidities after bariatric surgery, the disinhibition and impulsivity secondary to changes in the absorption of alcohol, hypoglycemia, as well as pharmacokinetic changes that may affect the absorption of various medications including antidepressant medications are reviewed. Also reviewed are possible mediating factors involving changes in various peptidergic systems such as GLP-1 and Ghrelin. A number of psychosocial issues that might be involved are discussed, including lack of improvement in quality of life after surgery, continued or recurrent physical mobility restrictions, persistence or recurrence of sexual dysfunction and relationship problems, low self-esteem, and a history of child maltreatment. Inadequate weight loss or weight regain are also discussed.
A number of possible contributing factors have been identified. Possible theoretical models involved and directions for research are suggested.