Incidence and Determinants of Mental Health Service Use After Bariatric Surgery | Bariatric Surgery | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.175.212.130. Please contact the publisher to request reinstatement.
1.
Scott  KM, McGee  MA, Wells  JE, Oakley Browne  MA.  Obesity and mental disorders in the adult general population.  J Psychosom Res. 2008;64(1):97-105. doi:10.1016/j.jpsychores.2007.09.006PubMedGoogle ScholarCrossref
2.
Wardle  J, Cooke  L.  The impact of obesity on psychological well-being.  Best Pract Res Clin Endocrinol Metab. 2005;19(3):421-440. doi:10.1016/j.beem.2005.04.006PubMedGoogle ScholarCrossref
3.
Kubik  JF, Gill  RS, Laffin  M, Karmali  S.  The impact of bariatric surgery on psychological health.  J Obes. 2013;2013:837989. doi:10.1155/2013/837989PubMedGoogle Scholar
4.
Puhl  R, Brownell  KD.  Bias, discrimination, and obesity.  Obes Res. 2001;9(12):788-805. doi:10.1038/oby.2001.108PubMedGoogle ScholarCrossref
5.
Romain  AJ, Marleau  J, Baillot  A.  Impact of obesity and mood disorders on physical comorbidities, psychological well-being, health behaviours and use of health services.  J Affect Disord. 2018;225:381-388. doi:10.1016/j.jad.2017.08.065PubMedGoogle ScholarCrossref
6.
Australian Bureau of Statistics. National health survey: first results, 2017-18. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001. Accessed February 8, 2019.
7.
Chang  S-H, Stoll  CRT, Song  J, Varela  JE, Eagon  CJ, Colditz  GA.  The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012.  JAMA Surg. 2014;149(3):275-287. doi:10.1001/jamasurg.2013.3654PubMedGoogle ScholarCrossref
8.
Flum  DR, Belle  SH, King  WC,  et al; Longitudinal Assessment of Bariatric Surgery (LABS) Consortium.  Perioperative safety in the longitudinal assessment of bariatric surgery.  N Engl J Med. 2009;361(5):445-454. doi:10.1056/NEJMoa0901836PubMedGoogle ScholarCrossref
9.
Morgan  DJ, Ho  KM, Armstrong  J, Litton  E.  Long-term clinical outcomes and health care utilization after bariatric surgery: a population-based study.  Ann Surg. 2015;262(1):86-92. doi:10.1097/SLA.0000000000000972PubMedGoogle ScholarCrossref
10.
Dawes  AJ, Maggard-Gibbons  M, Maher  AR,  et al.  Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis.  JAMA. 2016;315(2):150-163. doi:10.1001/jama.2015.18118PubMedGoogle ScholarCrossref
11.
Szmulewicz  A, Wanis  KN, Gripper  A,  et al.  Mental health quality of life after bariatric surgery: a systematic review and meta-analysis of randomized clinical trials.  Clin Obes. 2019;9(1):e12290. doi:10.1111/cob.12290PubMedGoogle Scholar
12.
Morgan  DJ, Ho  KM.  Incidence and risk factors for deliberate self-harm, mental illness, and suicide following bariatric surgery: a state-wide population-based linked-data cohort study.  Ann Surg. 2017;265(2):244-252. doi:10.1097/SLA.0000000000001891PubMedGoogle ScholarCrossref
13.
Bhatti  JA, Nathens  AB, Thiruchelvam  D, Grantcharov  T, Goldstein  BI, Redelmeier  DA.  Self-harm emergencies after bariatric surgery: a population-based cohort study.  JAMA Surg. 2016;151(3):226-232. doi:10.1001/jamasurg.2015.3414PubMedGoogle ScholarCrossref
14.
International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Are you a candidate? https://www.ifso.com/are-you-a-candidate/. Accessed March 17, 2019.
15.
Australian New Zealand Metabolic Obesity Surgery Society. Am I a candidate? https://anzmoss.com.au/obesity/am-i-a-candidate/. Accessed April 12, 2019.
16.
American Society of Metabolic and Bariatric Surgery. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. https://asmbs.org/app/uploads/2016/06/2016-Psych-Guidelines-published.pdf. Accessed March 2019.
17.
The National Institute for Health and Care Excellence. Obesity: identification, assessment and management. https://www.nice.org.uk/guidance/cg189/chapter/1-Recommendations#assessment. Accessed April 12, 2019.
18.
Smith  FJ, Holman  CDJ, Moorin  RE, Fletcher  DR.  Incidence of bariatric surgery and postoperative outcomes: a population-based analysis in Western Australia.  Med J Aust. 2008;189(4):198-202.PubMedGoogle ScholarCrossref
19.
The Australian Bureau of Statistics. Australian historical population statistics. http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3105.0.65.001. Accessed January 26, 2019.
20.
Western Australian Department of Health. Data linkage Western Australia [database]. http://www.datalinkage-wa.org.au/. Accessed November 12, 2018.
21.
Holman  CDJ, Bass  AJ, Rouse  IL, Hobbs  MS.  Population-based linkage of health records in Western Australia: development of a health services research linked database.  Aust N Z J Public Health. 1999;23(5):453-459. doi:10.1111/j.1467-842X.1999.tb01297.xPubMedGoogle ScholarCrossref
22.
Government of Western Australia Mental Health Commission. Suicide prevention 2020. https://www.mhc.wa.gov.au/media/1220/suicide-prevention-2020-strategy-final.pdf. Accessed February 12, 2019.
23.
Müller  A, Claes  L, Smits  D, Schag  K, de Zwaan  M.  Lifetime self-harm behaviors are not more prevalent in bariatric surgery candidates than in community controls with obesity.  Obes Facts. 2018;11(2):109-115. doi:10.1159/000486484PubMedGoogle ScholarCrossref
24.
Prescott  HC, Costa  DK.  Improving long-term outcomes after sepsis.  Crit Care Clin. 2018;34(1):175-188. doi:10.1016/j.ccc.2017.08.013PubMedGoogle ScholarCrossref
25.
Dimitriadis  GK, Randeva  MS, Miras  AD.  Potential hormone mechanisms of bariatric surgery.  Curr Obes Rep. 2017;6(3):253-265. doi:10.1007/s13679-017-0276-5PubMedGoogle ScholarCrossref
26.
Clapp  M, Aurora  N, Herrera  L, Bhatia  M, Wilen  E, Wakefield  S.  Gut microbiota’s effect on mental health: the gut-brain axis.  Clin Pract. 2017;7(4):987. doi:10.4081/cp.2017.987PubMedGoogle ScholarCrossref
27.
Tabasi  M, Ashrafian  F, Khezerloo  JK,  et al.  Changes in gut microbiota and hormones after bariatric surgery: a bench-to-bedside review.  Obes Surg. 2019;29(5):1663-1674. doi:10.1007/s11695-019-03779-7PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    EXPAND ALL
    potential determinant of mental health service use not mentioned in study
    Marcia Kaplan, MD | University of Cincinnati Dept. of Psychiatry
    I would like to suggest a determinant of mental health status and service use after bariatric surgery that was not mentioned or measured by the authors: the potential emotional distress experienced by subjects accustomed to binge-eating as a means of managing psychic distress who can no longer use this mechanism due to the smaller pouch. I have treated patients post-bariatric surgery who became alcoholic in order to substitute oral gratification of some sort. Surgery may reduce appetite but does not allow for development of new coping mechanisms. If this is a widespread phenomenon post-surgery, it would argue for compelling group therapy for subjects before and after the procedure.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Original Investigation
    September 25, 2019

    Incidence and Determinants of Mental Health Service Use After Bariatric Surgery

    Author Affiliations
    • 1Department of Intensive Care Medicine, St John of God Subiaco Hospital, Perth, Western Australia
    • 2University of Western Australia, Perth, Western Australia.
    • 3School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia.
    • 4Department of Surgery, St John of God Subiaco Hospital, Perth, Western Australia
    • 5School of Medicine, University of Western Australia, Perth, Western Australia.
    JAMA Psychiatry. 2020;77(1):60-67. doi:10.1001/jamapsychiatry.2019.2741
    Key Points

    Question  Is there an increase in mental health service use after bariatric surgery?

    Findings  In this cohort study, over a 10-year study period, 1 in 6 patients undergoing bariatric surgery (16.7%) used at least 1 perioperative episode of a mental health service. Compared with before surgery, outpatient, emergency department, and inpatient psychiatric presentations were all significantly more common after surgery.

    Meaning  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, and patients should be routinely assessed and informed preoperatively about the potential associations of bariatric surgery with mental health outcomes.

    Abstract

    Importance  Obesity is associated with an increased prevalence of psychiatric disorders. The association of bariatric surgery with mental health outcomes is poorly understood.

    Objective  To investigate the association of bariatric surgery with the incidence of outpatient, emergency department (ED), and inpatient mental health service use.

    Design, Setting, and Participants  This statewide, mirror-image, longitudinal cohort study used data from Western Australian Department of Health Data Linkage Branch records from all patients undergoing index (ie, first) bariatric surgery in Western Australia over a 10-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 index bariatric surgery. The data analysis was performed between November 2018 and March 2019.

    Exposures  Index bariatric surgery.

    Main Outcomes and Measures  The incidence and predictors for mental health presentations, deliberate self-harm, and suicide in association with the timing of bariatric surgery.

    Results  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. Use of at least 1 mental health service occurred in 3976 patients (16.1%), with 1401 patients (35.2%) presenting only before surgery, 1025 (25.8%) presenting before and after surgery, and 1550 patients (39.0%) presenting only after surgery. There was an increase in psychiatric illness presentations after bariatric surgery (outpatient clinic attendance: incidence rate ratio [IRR], 2.3; 95% CI, 2.3-2.4; ED attendance: IRR, 3.0; 95% CI, 2.8-3.2; psychiatric hospitalization: IRR, 3.0; 95% CI, 2.8-3.1). There was also a 5-fold increase in deliberate self-harm presentations to an ED after surgery (IRR, 4.7; 95% CI, 3.8-5.7), with 25 of 261 postoperatives deaths (9.6%) due to suicide. Complications after bariatric surgery requiring further surgical intervention and a history of mental health service provision before surgery were the most important associations with subsequent mental health presentations after surgery. Deliberate self-harm and mental and behavioral disorders due to psychoactive substance use before bariatric surgery were the main associations with subsequent deliberate self-harm or suicide after surgery.

    Conclusions and Relevance  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. These findings caution the hypothesis that weight reduction by bariatric surgery will improve mental health in patients with obesity.

    ×