Overview Risk of Suicide after Bariatric Surgery Obesity and Depression Suicidality and Obesity German Obesity-Suicidality Study Birgit Wagner, PhD Department of Psychosomatic Medicine and Psychotherapy Bariatric Surgery and Suicide Rates Discussion Depression and Obesity Suggestive evidence that major depression has risen markedly in the US with the rise of obesity A number of cross-sectional studies found no or a negative association between obesity and depression ( the jolly fat ) Past and lifetime depression raises probability of being overweight or obese among females only (Dave et al., 2011) 17 community-based studies (N=204 507) Significant association between depression and obesity (OR = 1.26; 95% CI; 1.17-1.36, P 0.001 Moderators (age, continent of residence, different assessment methods) did not influence the association Female participants showed a stronger association
Depression and Obesity Why do we need to care about depression? De Wit et al. Psych Res (2010) Pathway for completed suicide Depression is associated with mortality About 15% of patients with severe major depression die of suicide (Paykel et al. (2005) Suicide risk in females was estimated as low as 1% against 7% for males (Bradvik et al., 2008) Mukamal K J, Miller M Am. J. Epidemiol. (2010) American Journal of Epidemiology The Author 2010. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.
Suicidality and Obesity (review, k = 15) The German Obesity-Suicidality Study K Results Completed suicide 8 Obese people are less likely to commit suicide than people of normal weight 1 No association found Suicide attempts 3 Increased risk of suicide attempt in obese people 1 Decrease of attempted suicide with increased BMI Suicide ideation 1 Obesity is related to increased suicide ideation Population-based representative survey 258 sample points N = 4386 invited Face-to-face interviews N = 2555 (59%) Participants completed BMI N = 2510 Inclusion criteria: Age 14 Jahre Knowledge of German Klinitzke et al. (submitted) Prevalence of Major Depression (N = 2501) Prevalence Suicidal Risk (N = 2501)
Mean of Suicidal Attempts and Obesity Mean of Suicidal Attempts by Gender Positive association between depression and BMI Paradoxical relationship between BMI and suicide Highest risk shown by women in obese class III: 66% suffer of major depression 62% are suicidal Average 1.1 attempted suicides Suicidality and Bariatric Surgery
Suicidality and Bariatric Surgery 46% of bariatric patients meet the diagnostic criteria for a mood disorder (Kalarchiam et al., 2007). Several studies have reported an increased number of suicides after bariatric surgery 30% of suicides occurred within the first two years, 70% within 3 years (Tindle et al., 2010) Study Limitations Suicide as cause of death is in most studies only mentioned, but not analyzed Gender aspects are not considered No person/year suicide rates Rarely are control groups used No longitudinal studies with focus on suicide ideation, depression and suicide
Mortality and Bariatric Surgery Coronary artery disease 56% Diabetes 92% Cancer 60% Suicides/Accidents 58% Adams et al., 2007 Suicide Rates by Gender (Tindle et al., 2010) Comparison of Bariatric Patients and Control Groups: State Control group Suicide rate/ 10 000 year Suicide rate/ 10 000 year Adams et al. (2007) Tindle et al. (2010) USA, Utah Applicants for driver licence in Utah USA, Pennsylvania US suicide rates 5.2 (female) 13.7 (male) Bariatric Control group surgery 2.6 0.9 0.7 (female) 2.4 (male)
Reasons for Increased Suicide Rates Preoperative psychopathology, e.g. affective disorders Dissatisfaction with body image after dramatic weight loss (similar findings in patients after breast surgery, 2-3x higher suicide rates) Regain of weight cause for depression Quality of life has not changed as expected Lack of postoperative psychotherapeutic support concentration on weight loss Conclusion: Postbariatric surgery patients show a higher level of suicide rates than control groups Need for identifying risk patients Postoperative psychological monitoring is recommended Thank you for your attention! Contact: birgit.wagner@medizin.uni-leipzig.de