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

  • Jacob G. Mabey
    Correspondence: Jacob G. Mabey, B.S., Department of Exercise Sciences, Brigham Young University, 271 Smith Fieldhouse, Provo, UT 84604, USA.
    Department of Exercise Sciences, Brigham Young University, Provo, Utah
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  • Ronette L. Kolotkin
    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
    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
    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
    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
    Department of Exercise Sciences, Brigham Young University, Provo, Utah
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Published:August 31, 2020DOI:



      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.


      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.




      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.


      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.


      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.


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