• Lagerros Ylva Trolle YT *Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden †Department of Endocrinology, Metabolism and Diabete, Lena Brandt, Jakob Hedberg, Magnus Sundbom, and Robert Bodén.
• *Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden †Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Stockholm, Sweden ‡Department of Surgical Sciences, Uppsala University, Uppsala, Sweden §Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
• Ann. Surg. 2017 Feb 1; 265 (2): 235-243.

ObjectiveThe aim of this study was to examine risk of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery (GBP).Summary Of Background DataConcerns regarding severe adverse psychiatric outcomes after GBP have been raised.MethodsThis nationwide, longitudinal, self-matched cohort encompassed 22,539 patients who underwent GBP during 2008 to 2012. They were identified through the Swedish National Patient Register, the Prescribed Drug Register, and the Causes of Death Register. Follow-up time was up to 2 years. Main outcome measures were hazard ratios (HRs) for post-surgery self-harm or hospitalization for depression in patients with presurgery self-harm and/or depression compared to patients without this exposure; and standardized mortality ratio (SMR) for suicide post-surgery.ResultsA diagnosis of self-harm in the 2 years preceding surgery was associated with an HR of 36.6 (95% confidence interval [CI] 25.5-52.4) for self-harm during the 2 years of follow up, compared to GBP patients who had no self-harm diagnosis before surgery. Patients with a diagnosis of depression preceding GBP surgery had an HR of 52.3 (95% CI 30.6-89.2) for hospitalization owing to depression after GBP, compared to GBP patients without a previous diagnosis of depression. The SMR for suicide after GBP was increased among females (n = 13), 4.50 (95% CI 2.50-7.50). The SMR among males (n = 4), was 1.71 (95% CI 0.54-4.12).ConclusionsThe increased risk of post-surgery self-harm and hospitalization for depression is mainly attributable to patients who have a diagnosis of self-harm or depression before surgery. Raised awareness is needed to identify vulnerable patients with history of self-harm or depression, which may be in need of psychiatric support after GBP.

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