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Mediators of suicidality 12 years after bariatric surgery relative to a nonsurgery comparison group

  • Jacob G. Mabey
    Correspondence
    Correspondence: Jacob G. Mabey, B.S., Department of Exercise Sciences, Brigham Young University, 271 Smith Fieldhouse, Provo, UT 84604, USA.
    Affiliations
    Department of Exercise Sciences, Brigham Young University, Provo, Utah
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  • Ronette L. Kolotkin
    Affiliations
    Quality of Life Consulting, Durham, North Carolina

    Duke Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina

    Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway

    Centre of Health Research, Førde Hospital Trust, Førde, Norway

    Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
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  • Ross D. Crosby
    Affiliations
    Sanford Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota

    Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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  • Sheila E. Crowell
    Affiliations
    Department of Psychology, University of Utah, Salt Lake City, Utah

    Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah

    Department of Obstetrics & Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
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  • Steven C. Hunt
    Affiliations
    Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar

    Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
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  • Lance E. Davidson
    Affiliations
    Department of Exercise Sciences, Brigham Young University, Provo, Utah
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Published:August 31, 2020DOI:https://doi.org/10.1016/j.soard.2020.08.026

      Abstract

      Background

      Individuals undergoing bariatric surgery report higher levels of suicidality than the general population, but it is unknown what mediates this phenomenon or how this compares with individuals with severe obesity not receiving surgery.

      Objectives

      We evaluated suicidality in 131 individuals 12 years post surgery compared with 205 individuals with severe obesity who did not undergo surgery. Changes in health-related quality of life (HRQOL) and metabolic health were assessed as mediators of suicidality.

      Setting

      University.

      Methods

      Suicidality was assessed with the Suicide Behaviors Questionnaire-Revised at 12 years. Metabolic health and HRQOL (Short Form-36 [SF-36] Mental Component Summary score, Physical Component Summary score, and Impact of Weight on Quality of Life-Lite) were assessed at baseline and 2 and 6 years. The effects of bariatric surgery on suicidality at 12 years were assessed through univariate and multivariate sequential moderated mediation models, with changes in metabolic health and HRQOL from 0–2 years and 2–6 years as mediators.

      Results

      Suicidality was higher in the surgery group versus the nonsurgery group (estimate [est.] = .708, SE = .292, P < .05). Only the indirect pathways at 2 years after surgery for SF-36 Mental Component Summary in the univariate models (est. = −.172, SE = .080, P < .05) and for SF-36 Physical Component Summary in the multivariate model (est. = .593, SE = .281, P < .05) were significant.

      Conclusion

      Individuals undergoing bariatric surgery reported higher levels of suicidality at 12 years, which was mediated by less improvement in the mental and physical components of HRQOL in the first 2 years after surgery, suggesting the need for additional clinical monitoring.

      Keywords

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      References

        • Flum D.R.
        • Belle S.H.
        • et al.
        • Longitudinal Assessment of Bariatric Surgery Consortium
        Perioperative safety in the longitudinal assessment of bariatric surgery.
        N Engl J Med. 2009; 361: 445-454
        • Sjostrom L.
        • Lindroos A.
        • Peltonen M.
        • et al.
        Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.
        N Engl J Med. 2004; 351: 2683-2693
        • Adams T.D.
        • Pendleton R.C.
        • Strong M.B.
        • et al.
        Health outcomes of gastric bypass patients compared to nonsurgical, nonintervened severely obese.
        Obesity (Silver Spring). 2010; 18: 121-130
        • Cummings D.E.
        • Arterburn D.E.
        • Westbrook E.O.
        • et al.
        Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial.
        Diabetologia. 2016; 59: 945-953
        • Sjostrom L.
        Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery.
        J Intern Med. 2013; 273: 219-234
        • Adams T.D.
        • Davidson L.E.
        • Litwin S.E.
        • et al.
        Weight and metabolic outcomes 12 years after gastric bypass.
        N Engl J Med. 2017; 377: 1143-1155
        • Magallares A.
        • Schomerus G.
        Mental and physical health-related quality of life in obese patients before and after bariatric surgery: a meta-analysis.
        Psychol Health Med. 2015; 20: 165-176
        • Hachem A.
        • Brennan L.
        Quality of life outcomes of bariatric surgery: a systematic review.
        Obes Surg. 2016; 26: 395-409
        • Masheb R.M.
        • White M.A.
        • Toth C.M.
        • et al.
        The prognostic significance of depressive symptoms for predicting quality of life 12 months after gastric bypass.
        Compr Psychiatry. 2007; 48: 231-236
        • Alabi F.
        • Guilbert L.
        • Villalobos G.
        • et al.
        Depression before and after bariatric surgery in low-income patients: the utility of the Beck Depression Inventory.
        Obes Surg. 2018; 28: 3492-3498
        • Ribeiro G.
        • Giapietro H.B.
        • Belarmino L.B.
        • Salgado-Junior W.
        Depression, anxiety, and binge eating before and after bariatric surgery: problems that remain [in Portuguese].
        Arq Bras Cir Dig. 2018; 31: e1356
        • Vangoitsenhoven R.
        • Frederiks P.
        • Gijbels B.
        • et al.
        Long-term effects of gastric bypass surgery on psychosocial well-being and eating behavior: not all that glitters is gold.
        Acta Clin Belg. 2016; 71: 395-402
        • Aasprang A.
        • Andersen J.R.
        • Vage V.
        • Kolotkin R.L.
        • Natvig G.K.
        Five-year changes in health-related quality of life after biliopancreatic diversion with duodenal switch.
        Obes Surg. 2013; 23: 1662-1668
        • Kolotkin R.L.
        • Kim J.
        • Davidson L.E.
        • et al.
        12-year trajectory of health-related quality of life in gastric bypass patients versus comparison groups.
        Surg Obes Relat Dis. 2018; 14: 1359-1365
        • Andersen J.R.
        • Aasprang A.
        • Karlsen T.I.
        • et al.
        Health-related quality of life after bariatric surgery: a systematic review of prospective long-term studies.
        Surg Obes Relat Dis. 2015; 11: 466-473
        • Lent M.R.
        • Avakoff E.
        • Hope N.
        • et al.
        Clinical characteristics of Roux-en-Y gastric bypass patients with death from accidental overdose or intentional self-harm: a descriptive study.
        Obes Surg. 2018; 28: 3531-3537
        • Bhatti J.A.
        • Nathens A.B.
        • Thiruchelvam D.
        • et al.
        Self-harm emergencies after bariatric surgery: a population-based cohort study.
        JAMA Surg. 2016; 151: 226-232
        • Gordon K.H.
        • King W.C.
        • White G.E.
        • et al.
        A longitudinal examination of suicide-related thoughts and behaviors among bariatric surgery patients.
        Surg Obes Relat Dis. 2019; 15: 269-278
        • Adams T.D.
        • Gress R.
        • Smith S.C.
        • et al.
        Long-term mortality after gastric bypass surgery.
        N Engl J Med. 2007; 357: 753-761
        • Davidson L.E.
        • Adams T.D.
        • Kim J.
        • et al.
        Association of patient age at gastric bypass surgery with long-term all-cause and cause-specific mortality.
        JAMA Surg. 2016; 151: 631-637
        • Omalu B.I.
        • Ives D.G.
        • Buhari A.M.
        • et al.
        Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004.
        Arch Surg. 2007; 142 (discussion 9): 923-928
        • Tindle H.A.
        • Omalu B.
        • Courcoulas A.
        • et al.
        Risk of suicide after long-term follow-up from bariatric surgery.
        Am J Med. 2010; 123: 1036-1042
        • Mitchell J.E.
        • Crosby R.
        • de Zwaan M.
        • et al.
        Possible risk factors for increased suicide following bariatric surgery.
        Obesity (Silver Spring). 2013; 21: 665-672
        • Adams T.D.
        • Avelar E.
        • Cloward T.
        • et al.
        Design and rationale of the Utah obesity study. A study to assess morbidity following gastric bypass surgery.
        Contemp Clin Trials. 2005; 26: 534-551
        • Williams R.R.
        • Hunt S.C.
        • Barlow G.K.
        • et al.
        Health family trees: a tool for finding and helping young family members of coronary and cancer prone pedigrees in Texas and Utah.
        Am J Public Health. 1988; 78: 1283-1286
        • Adams T.D.
        • Davidson L.E.
        • Litwin S.
        • et al.
        Health benefits of gastric bypass surgery after 6 years.
        JAMA. 2012; 308: 1122-1131
        • Ware Jr., J.E.
        • Gandek B.
        Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project.
        J Clin Epidemiol. 1998; 51: 903-912
        • Ware Jr., J.E.
        • Snow K.K.
        • Kosinski M.
        • Gandek B.
        SF-36 health survey: manual and interpretation guide.
        Health Institute, New England Medical Center, Boston1993
        • Brazier J.E.
        • Harper R.
        • Jones N.M.
        • et al.
        Validating the SF-36 health survey questionnaire: new outcome measure for primary care.
        BMJ. 1992; 305: 160-164
        • Corica F.
        • Corsonello A.
        • Apolone G.
        • et al.
        Construct validity of the Short Form-36 Health Survey and its relationship with BMI in obese outpatients.
        Obesity (Silver Spring). 2006; 14: 1429-1437
        • Kolotkin R.L.
        • Crosby R.D.
        Psychometric evaluation of the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-lite) in a community sample.
        Qual Life Res. 2002; 11: 157-171
        • Kolotkin R.L.
        • Crosby R.D.
        • Kosloski K.D.
        • Williams G.R.
        Development of a brief measure to assess quality of life in obesity.
        Obes Res. 2001; 9: 102-111
        • Osman A.
        • Bagge C.L.
        • Gutierrez P.M.
        • et al.
        The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples.
        Assessment. 2001; 8: 443-454
        • Batterham P.J.
        • Ftanou M.
        • Pirkis J.
        • et al.
        A systematic review and evaluation of measures for suicidal ideation and behaviors in population-based research.
        Psychol Assess. 2015; 27: 501-512
        • Smith S.C.
        • Edwards C.B.
        • Goodman G.N.
        • Halversen R.C.
        • Simper S.C.
        Open vs laparoscopic Roux-en-Y gastric bypass: comparison of operative morbidity and mortality.
        Obes Surg. 2004; 14: 73-76
        • Smith S.C.
        • Goodman G.N.
        • Edwards C.B.
        Roux-en-Y gastric bypass: a 7-year retrospective review of 3,855 patients.
        Obes Surg. 1995; 5: 314-318
        • Kolotkin R.L.
        • Crosby R.D.
        • Gress R.E.
        • Hunt S.C.
        • Adams T.D.
        Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls.
        Surg Obes Relat Dis. 2009; 5: 250-256
        • Kolotkin R.L.
        • Davidson L.E.
        • Crosby R.D.
        • Hunt S.C.
        • Adams T.D.
        Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups.
        Surg Obes Relat Dis. 2012; 8: 625-633
        • Hayes A.F.
        Introduction to mediation, moderation, and conditional process analysis: a regression-based approach.
        Guilford Press, New York2013
        • Chen E.Y.
        • Fettich K.C.
        • McCloskey M.S.
        Correlates of suicidal ideation and/or behavior in bariatric-surgery-seeking individuals with severe obesity.
        Crisis. 2012; 33: 137-143
        • Windover A.K.
        • Merrell J.
        • Ashton K.
        • Heinberg L.J.
        Prevalence and psychosocial correlates of self-reported past suicide attempts among bariatric surgery candidates.
        Surg Obes Relat Dis. 2010; 6: 702-706
        • Karmali S.
        • Brar B.
        • Shi X.
        • et al.
        Weight recidivism post-bariatric surgery: a systematic review.
        Obes Surg. 2013; 23: 1922-1933
        • Courcoulas A.P.
        • King W.C.
        • Belle S.H.
        • et al.
        Seven-year weight trajectories and health outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study.
        JAMA Surg. 2018; 153: 427-434
      1. Freire CC, Zanella MT, Segal A, et al. Associations between binge eating, depressive symptoms and anxiety and weight regain after Roux-en-Y gastric bypass surgery. Eat Weight Disord. Epub 2020 Jan 2.

        • Jones-Corneille L.R.
        • Wadden T.A.
        • Sarwer D.B.
        Risk of depression and suicide in patients with extreme obesity who seek bariatric surgery.
        Obes Manag. 2007; 3: 255-260
        • Polovina S.
        • Micic D.
        Lifestyle, depression and metabolic/bariatric surgery.
        J Depress Anxiety. 2019; S13 (https://doi.org/10.35248/2167-1044.19.S13-001): 1-3
        • Wnuk S.
        • Parvez N.
        • Hawa R.
        • Sockalingam S.
        Predictors of suicidal ideation one-year post-bariatric surgery: results from the Toronto Bari-Psych Cohort Study.
        Gen Hosp Psychiatry. 2020; 63: 39-45