Meg H Zeller1, Jennifer Reiter-Purtill2, Todd M Jenkins3, Katherine M Kidwell2, Heather E Bensman2, James E Mitchell4, Anita P Courcoulas5, Thomas H Inge6, Sanita L Ley7, Kathryn H Gordon4, Eileen A Chaves8, Gia A Washington9, Heather M Austin10, Dana L Rofey11. 1. Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: Meg.Zeller@cchmc.org. 2. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 3. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 4. Sanford Health, Fargo, North Dakota. 5. Division of Minimally Invasive Bariatric Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 6. Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado. 7. Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 8. Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital Medical Center, Columbus, Ohio. 9. Department of Psychology, Texas Children's Hospital, Houston, Texas. 10. Department of Pediatrics, Children's of Alabama, Birmingham, Alabama. 11. Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Extant literature warns of elevated suicide risks in adults postbariatric surgery, making understanding risks for adolescent patients imperative. OBJECTIVES: To examine prevalence and predictors/correlates of suicidal thoughts and behaviors (STBs) in adolescents with severe obesity who did/did not undergo bariatric surgery from presurgery/baseline to 4 years postsurgery. SETTING: Five academic medical centers. METHODS: Using a prospective observational design, surgical adolescents (n = 153; 79% female, 65% white, mean [M]age = 17 yr, Mbody mass index[BMI] = 52 kg/m2) and nonsurgical comparators (n = 70; 80% female, 54% white, Mage = 16 yr, MBMI = 47 kg/m2) completed psychometrically sound assessments at presurgery/baseline and postsurgery years 2 and 4 (year 4: n = 117 surgical [MBMI = 38 kg/m2], n = 56 nonsurgical [MBMI = 48 kg/m2]). RESULTS: For the surgical group, rates of STBs were low (year 2 [1.3%-4.6%]; year 4 [2.6%-7.9%], similar to national base rates. Groups did not differ on a year 4 postsurgical STBs (post-STBs) composite (post-STBs: ideation/plan/attempt; n = 18 surgical [16%], n = 10 nonsurgical [18%]; odds ratio = .95, P = .90). For the surgical group, predictors/correlates identified within the broader suicide literature (e.g., psychopathology [P < .01], victimization [P < .05], dysregulation [P < .001], drug use [P < .05], and knowing an attemptor/completer [P < .001]) were significantly associated with post-STBs. Surgery-specific factors (e.g., percent weight loss, weight satisfaction) were nonsignificant. Of those reporting a lifetime attempt history at year 4, only a minority (4/13 surgical, 3/9 nonsurgical) reported a first attempt during the study period. Of 3 decedents (2 surgical, 1 nonsurgical), none were confirmed suicides. CONCLUSIONS: The present study indicates that undergoing bariatric surgery in adolescence does not heighten (or lower) risk of STB engagement across the initial 4 years after surgery. Suicide risks present before surgery persisted, and also newly emerged in a subgroup with poorer psychosocial health.
BACKGROUND: Extant literature warns of elevated suicide risks in adults postbariatric surgery, making understanding risks for adolescent patients imperative. OBJECTIVES: To examine prevalence and predictors/correlates of suicidal thoughts and behaviors (STBs) in adolescents with severe obesity who did/did not undergo bariatric surgery from presurgery/baseline to 4 years postsurgery. SETTING: Five academic medical centers. METHODS: Using a prospective observational design, surgical adolescents (n = 153; 79% female, 65% white, mean [M]age = 17 yr, Mbody mass index[BMI] = 52 kg/m2) and nonsurgical comparators (n = 70; 80% female, 54% white, Mage = 16 yr, MBMI = 47 kg/m2) completed psychometrically sound assessments at presurgery/baseline and postsurgery years 2 and 4 (year 4: n = 117 surgical [MBMI = 38 kg/m2], n = 56 nonsurgical [MBMI = 48 kg/m2]). RESULTS: For the surgical group, rates of STBs were low (year 2 [1.3%-4.6%]; year 4 [2.6%-7.9%], similar to national base rates. Groups did not differ on a year 4 postsurgical STBs (post-STBs) composite (post-STBs: ideation/plan/attempt; n = 18 surgical [16%], n = 10 nonsurgical [18%]; odds ratio = .95, P = .90). For the surgical group, predictors/correlates identified within the broader suicide literature (e.g., psychopathology [P < .01], victimization [P < .05], dysregulation [P < .001], drug use [P < .05], and knowing an attemptor/completer [P < .001]) were significantly associated with post-STBs. Surgery-specific factors (e.g., percent weight loss, weight satisfaction) were nonsignificant. Of those reporting a lifetime attempt history at year 4, only a minority (4/13 surgical, 3/9 nonsurgical) reported a first attempt during the study period. Of 3 decedents (2 surgical, 1 nonsurgical), none were confirmed suicides. CONCLUSIONS: The present study indicates that undergoing bariatric surgery in adolescence does not heighten (or lower) risk of STB engagement across the initial 4 years after surgery. Suicide risks present before surgery persisted, and also newly emerged in a subgroup with poorer psychosocial health.
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Authors: Thomas H Inge; Anita P Courcoulas; Todd M Jenkins; Marc P Michalsky; Michael A Helmrath; Mary L Brandt; Carroll M Harmon; Meg H Zeller; Mike K Chen; Stavra A Xanthakos; Mary Horlick; C Ralph Buncher Journal: N Engl J Med Date: 2015-11-06 Impact factor: 91.245
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