Suicide attempts after bariatric surgery: comparison to a nonsurgical cohort of individuals with severe obesity

Background: The rate of suicide is higher among individuals following bariatric surgery compared with the general population; however, it is not clear whether risk is associated with bariatric surgery beyond having severe obesity. Objective: To compare the risk of a suicide attempt among those who had bariatric surgery versus a nonsurgical cohort with severe obesity. Setting: Aggregate count data were collected from 5 healthcare systems. Methods: Individuals were identified in the surgical cohort if they underwent bariatric surgery between 2009 and 2017 (n 5 35,522) and then were compared with a cohort of individuals with severe obesity who never had bariatric surgery (n 5 691,752). Suicide attempts were identified after study enrollment date using International Classification of Diseases, Ninth and Tenth Editions (ICD-9 and ICD-10) diagnosis codes from 2009 to 2021. Results: The relative risk of a suicide attempt was 64% higher in the cohort with bariatric surgery than that of the nonsurgical cohort (2.2% versus 1.3%; relative risk 5 1.64; 95% CI, 1.53-1.76). Within the cohort with bariatric surgery, suicide attempts were more common among the 18- to 39-year age group (P,.001), women (P 5.002), Hawaiian-Pacific Islanders (P,.001), those with Medicaid insurance (P,.001), and those with a documented mental health condition at baseline (in the previous 2 years; P,.001). Conclusions: The relative risk of suicide attempts was higher among those who underwent bariatric surgery compared with a nonsurgical cohort, though absolute risk remained low. Providers should be aware of this increased risk. Screening for suicide risk after bariatric surgery may be useful to identify high-risk individuals. (Surg Obes Relat Dis 2023;19:1458-1466.) (c) 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.