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Mental health and surgery

Increase in psychiatric illness presentations after bariatric surgery

The most important associations with subsequent mental health presentations after surgery were complications after bariatric surgery requiring further surgical intervention and a history of mental health service provision before surgery

Researchers from Australia have reported an increase in mental health service presentations after bariatric surgery, particularly among those who had prior psychiatric illnesses or developed surgical complications requiring further surgery.

The paper, ‘Incidence and Determinants of Mental Health Service Use After Bariatric Surgery’, published in JAMA Psychiatry, by investigators from St John of God Subiaco Hospital, the University of Western Australia and Murdoch University, Perth, Western Australia, sought to determine the association of bariatric surgery with the incidence of outpatient, emergency department (ED) and inpatient mental health service use. It is known that obesity is associated with an increased prevalence of psychiatric disorders however, the association of bariatric surgery with mental health outcomes is poorly understood.

The statewide, mirror-image, longitudinal cohort study used data from Western Australian Department of Health Da£ ns gbp vs ta Linkage Branch records from all patients undergoing primary bariatric surgery in Western Australia over a ten-year period (January 2007-December 2016), with mean (SD) follow-up periods of 10.2 (2.9) years before and 5.2 (2.9) years after bariatric surgery. The data analysis was performed between November 2018 and March 2019. Specifically, they examined the incidence and predictors for mental health presentations, deliberate self-harm and suicide in association with the timing of bariatric surgery.

A total of 24, 766 patients underwent index bariatric surgery; of these, the mean (SD) age was 42.5 (11.7) years and 19,144 (77.3%) were women. At least one mental health service occurred in 3,976 patients (16.1%), with 1,401 patients (35.2%) presenting only before surgery, 1,025 (25.8%) presenting before and after surgery, and 1,550 patients (39.0%) presenting only after surgery.

The researchers noted that there was an increase in psychiatric illness presentations after bariatric surgery for outpatient clinic attendance, ED attendance and psychiatric hospitalisation. They also noted a five-fold increase in deliberate self-harm presentations to an ED after surgery and 25 of 261 post-operative deaths (9.6%) due to suicide.

The researchers noted that “the current professional bariatric surgery guidelines recommending preoperative psychological assessments and the deferment of surgery in patients with active psychiatric conditions may be either ineffectual or inconsistently adhered to.” The add that patients should be routinely assessed and informed pre-operatively about the potential associations of bariatric surgery with mental health outcomes.

The most important associations with subsequent mental health presentations after surgery were complications after bariatric surgery requiring further surgical intervention and a history of mental health service provision before surgery. The main associations with subsequent deliberate self-harm or suicide after surgery were deliberate self-harm and mental and behavioural disorders due to psychoactive substance use before bariatric surgery.

“We observed an increase in mental health service presentations after bariatric surgery, particularly among those who had prior psychiatric illnesses or developed surgical complications requiring further surgery,” the authors concluded. “These findings caution the hypothesis that weight reduction by bariatric surgery will improve mental health in patients with obesity.”

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