• David J R Morgan and Kwok M Ho.
• *Department of Intensive Care Medicine, St John of God Hospital Subiaco, Subiaco, Western Australia, Australia †School of Population Health, University of Western Australia, Nedlands, Western Australia, Australia ‡School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia.
• Ann. Surg. 2017 Feb 1; 265 (2): 244-252.

ObjectiveAssess the incidence and determinants of hospitalization for deliberate self-harm and mental health disorders, and suicide after bariatric surgery.BackgroundLimited recent literature suggests an increase in deliberate self-harm following bariatric surgery.MethodsA state-wide, population-based, self-matched, longitudinal cohort study over a 5-year period between 2007 and 2011. Utilizing the Western Australian Department of Health Data Linkage Unit records, all patients undergoing bariatric surgery (n = 12062) in Western Australia were followed for an average 30.4 months preoperatively and 40.6 months postoperatively.ResultsThere were 110 patients (0.9%) hospitalized for deliberate self-harm, which was higher than the general population [incidence rate ratio (IRR) 1.47, 95% confidence interval (CI) 1.11-1.94, P = 0.005]. Compared with before surgery, there was no significant increase in deliberate self-harm hospitalizations (IRR 0.79, 95% CI 0.54-1.16; P = 0.206) and a reduction in overall mental illness related hospitalizations (IRR 0.76, 95% CI 0.63-0.91; P = 0.002) after surgery. Younger age, no private-health insurance cover, a history of hospitalizations due to depression before surgery, and gastrointestinal complications after surgery were predictors for deliberate self-harm hospitalizations after bariatric surgery. Three suicides occurred during the follow-up period, a rate comparable to the general population during the same time period (IRR 0.61, 95% CI 0.11-2.27, P = 0.444).ConclusionsHospitalization for deliberate self-harm in bariatric patients was more common than the general population, but an increased incidence of deliberate self-harm after bariatric surgery was not observed. Hospitalization for depression before surgery and major postoperative gastrointestinal complications after bariatric surgery are potentially modifiable risk factors for deliberate self-harm after bariatric surgery.

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