Patients more likely to seek psychiatric help after weight-loss surgery

By Linda Carroll

After weight-loss surgery, patients may be more likely to need mental health services, including psychiatric hospitalizations, a new study suggests.

Based on data for nearly 25,000 patients, bariatric surgery was linked to a greater than three-fold increased risk of admission to the emergency room and a three-fold increased risk of psychiatric hospitalization in the years following surgery, researchers report in JAMA Psychiatry.

"Our study is a caution to the bariatric community that greater consideration needs to be given to the selection, assessment and follow-up of bariatric patients with regard to their mental health," said David Morgan, an intensivist and emergency medicine specialist at St. John of God Subiaco Hospital in Subiaco, Australia.

"Patients with prior histories of major psychiatric illness, self-harm or eating disorders are probably at greatest risk and should have a period of mental health stability and professional psychiatric input before even being considered for bariatric surgery and then regularly followed up by their mental health teams post-operatively," he said.

It's known that obese people have higher rates of mental illness than the general population, Morgan told Reuters Health in an email. "Therefore, patients undergoing bariatric surgery are a vulnerable group of people undergoing an operation that they hope will give them both health and cosmetic benefits," Morgan added.

To take a closer look at how often patients seek help for mental health issues following bariatric surgery, Morgan and his colleagues analyzed the records of 24,766 patients who had weight-loss surgery in Western Australia between 2007 and 2016. The data included mental health-related healthcare use for an average of 10 years before the surgery and five years afterward.

The records came from the Western Australian Department of Health Data Linkage Branch, which keeps track of health data for the entire state of Western Australia. The patients' average age when they had surgery was 42.5 years, and 19,144, or 77.3%, were women.

The researchers found that 3,976 patients, or 16.1%, sought help from a mental health service at least one time, with 1,401 of them doing so only before the surgery, 1,025 both before and after surgery and 1,550 only after the surgery.

Comparing visits that occurred before and after surgery, the researchers found that patients were 2.3 times more likely to seek care at a clinic afterward, 3 times more likely to go to an ER and 3 times more likely to end up with a psychiatric hospitalization.

The researchers also found a five-fold increase in patients ending up in the ER for deliberate self-harm. Of 261 deaths in the period following surgery, 25, or 9.6%, were the result of suicide, they note in the report.

Several factors increased the likelihood of seeking psychiatric help, Morgan said. Among them: weight loss that was less than what had been expected and complications after the initial surgery that required further surgical intervention.

The new study "is essentially confirming the fact that bariatric surgery patients seek psychiatric services at high rates and that there is a need for providers to take that into consideration," said Dr. Wynne Lundblad, a clinical assistant professor of psychiatry at the University of Pittsburgh.

Moreover, Lundblad said, "healthcare providers should take into consideration when they see someone with a history of bariatric surgery that patient might be at higher risk for (mental health issues) down the line."

The new findings don't mean mental health issues should prevent a patient from getting bariatric surgery, Lundblad noted. But they do suggest that, "if somebody is suffering from significant untreated psychiatric illness, you want to get them treated before going forward with the surgery," Lundblad said. "This is a call to remember this is a vulnerable population and you should have a very low threshold for admitting them into treatment quickly."

SOURCE: JAMA Psychiatry, online September 25, 2019.