1
|
Thomas TA, Tilk K, Klassen K, Pommnitz M, Wunder R, Mall JW, Köhler H, de Zwaan M, Meyer G, Hüttl TP, Müller A. Self-Harm Before and Six Months After Obesity Surgery. Obes Surg 2024; 34:3579-3591. [PMID: 39134834 DOI: 10.1007/s11695-024-07439-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE Previous research on obesity surgery (OS) showed that patients do not only experience weight loss but also improvements in certain mental health outcomes (e.g., depression) after OS. However, self-harm behaviors might increase after OS. Regarding self-harm, the literature is mostly limited to studies using data from hospital or emergency room charts. This longitudinal study examined self-reported self-harm behaviors and potential psychopathological correlates before and after OS. MATERIALS AND METHODS Pre-surgery patients (N = 220) filled out a set of questionnaires before and approximately six months after OS. Self-harm behaviors were captured with the Self-Harm Inventory. The assessments further included standardized instruments to measure symptoms of depression, anxiety, eating disorders, alcohol use, and suicidal ideations. RESULTS Any self-harm was reported by 24.6% before and by 25.0% after OS. No differences in the number of self-harm behaviors or prevalence of any self-harm before and after OS were found. Overall, 11.4% experienced self-harm behaviors at both times. A subset showed self-harm behaviors only before (13.2%) OS and another subset only after OS (13.6%). These two groups were about the same size. Self-harm behaviors showed strong associations with psychopathology after OS, especially with depression and suicidal ideation. CONCLUSION No increase in self-harm behaviors after OS emerged. Still, a subgroup showed self-harm behaviors after OS closely linked to further psychopathology. This mirrors the need to implement screening for self-harm before and after OS into OS care. Further studies with longer follow up periods are needed to extend these findings.
Collapse
Affiliation(s)
- Tobias A Thomas
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.
| | - Katja Tilk
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Katharina Klassen
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Melanie Pommnitz
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Ruth Wunder
- Department of General, Visceral, and Bariatric Surgery, DRK Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hanover, Germany
| | - Julian W Mall
- Department of General, Visceral, and Bariatric Surgery, KRH Nordstadt, Haltenhoffstr. 41, 30167, Hanover, Germany
| | - Hinrich Köhler
- Department of General, Visceral, and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Straße 24, 38124, Brunswick, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Günther Meyer
- Department of General, Visceral, and Bariatric Surgery, AMC-WolfartKlinik, Waldstraße 7, 82166, Gräfelfing, Germany
| | - Thomas P Hüttl
- Department of General, Visceral, and Bariatric Surgery, Dr. Lubos Kliniken Bogenhausen, Denninger Str. 44, 81679, Munich, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| |
Collapse
|
2
|
Mellin JE, Young CC, Rew L, Zuniga J, Monge MC. Sexual Activity as Self-Injury: A Scoping Review. JOURNAL OF SEX RESEARCH 2024:1-14. [PMID: 38416413 DOI: 10.1080/00224499.2024.2320828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Suicide and other self-injurious behaviors (SIB) are significant causes of morbidity and mortality as well as healthcare costs. Sexual risk behaviors are associated with many SIB, and sexual activities may act as SIB as well. In this scoping review, we consider ways in which sexual activity has been conceptualized as SIB - types of sexual activities as a form of self-injury - and cases in which sexual activities as SIB have been classified as direct or indirect self-injury. We include English-language publications that discuss any aspect of sexual activity as SIB. Database, citation list, and gray literature searches yielded 33 publications. Sexual activities as a form of self-injury included exposure to HIV/AIDS and other sexually transmitted infections, sadomasochistic behaviors undertaken for punishment rather than pleasure, selling sex, injury to the genitals, and sexual encounters with undesired partners or consisting of undesired acts. Twenty-three publications did not categorize sexual activities to self-injure as either direct or indirect self-injury, three publications categorized them as indirect self-injury, and seven publications as direct self-injury. Sexual activity is used to self-injure in a variety of ways and its conceptualization as indirect or direct self-injury remains unclear.
Collapse
Affiliation(s)
| | - Cara C Young
- School of Nursing, University of Texas at Austin
| | - Lynn Rew
- School of Nursing, University of Texas at Austin
| | - Julie Zuniga
- School of Nursing, University of Texas at Austin
| | | |
Collapse
|
3
|
Mohan S, Samaan JS, Premkumar A, Samakar K. History of abuse and bariatric surgery outcomes: a systematic review. Surg Endosc 2022; 36:4650-4673. [PMID: 35277764 DOI: 10.1007/s00464-022-09147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although there is evidence to support the relationship between abuse history and obesity, the association between abuse history and outcomes after bariatric surgery is not well-established. We aimed to summarize the current literature examining this relationship, as well as provide clinical recommendations to optimize postoperative outcomes. METHODS PubMed and SCOPUS databases were queried to identify relevant published studies. RESULTS Overall, 20 studies were included. Rates of the various types of abuse reported in the bariatric surgery population varied widely across studies, as did the methodology used to assess it. The majority of studies found no significant associations between abuse history and postoperative weight loss outcomes. The literature examining the relationship between abuse history and postoperative psychiatric outcomes was less conclusive. CONCLUSIONS Most current evidence demonstrates that abuse history is not associated with weight loss outcomes after bariatric surgery. Literature on postoperative psychiatric outcomes is mixed, and more robust studies are needed to further investigate the relationship between abuse history and postoperative psychiatric outcomes. Importantly, abuse history should not preclude patients from undergoing bariatric surgery. Of note, patients may benefit from careful monitoring for emotional distress and worsening of psychiatric comorbidities after surgery and psychiatric counseling and treatment when indicated.
Collapse
Affiliation(s)
- Sukriti Mohan
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Jamil S Samaan
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Agnes Premkumar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA.
| |
Collapse
|
4
|
Yusufov M, Kopeski LM, Silverman AL, Björgvinsson T. Associations of Body Weight and Waist Circumference with Psychopathology, Substance Use, and Well-Being in an Adult Transdiagnostic Sample. J Affect Disord 2021; 281:279-288. [PMID: 33341010 DOI: 10.1016/j.jad.2020.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/10/2020] [Accepted: 12/05/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Prior studies have established inconsistent associations between body weight and mental health. However, most work has relied on body mass index (BMI) and examination of a single mental health variable. The present study examined associations of BMI and waist circumference with multiple mental health variables in a transdiagnostic psychiatric sample. METHODS Nursing staff measured waist circumference and calculated the BMI of 742 adults (54.6% female, 45.4% male) presenting for psychiatric treatment. Participants completed the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Behavior and Symptom Identification Scale (BASIS-24), and Mental Health Continuum-Short Form (MHC-SF) as part of standard clinical monitoring. Suicide risk was assessed using the clinician-administered Mini International Neuropsychiatric Interview (M.I.N.I.). For curve fit estimation regression models, we entered BMI and waist circumference as independent variables separately; we entered seven dependent variables separately: 1) depression, 2) anxiety, 3) substance use, 4) self-harm, 5) interpersonal functioning, 6) well-being, and 7) suicide risk. RESULTS Increased BMI was associated with decreased well-being and increased depression. Increased waist circumference was associated with worse interpersonal functioning. Non-linear (quadratic) associations were observed between weight and depression, substance use, self-harm, and suicide. LIMITATIONS Most of the sample was White and only 2.6% was in the underweight category, limiting broad applicability of findings. Cross-sectional design precludes causal attributions. CONCLUSIONS Given associations between well-being, depression, interpersonal functioning, substance use, self-harm, and suicide with weight, findings may be used to inform mental health treatment, particularly by tailoring interventions to high-risk weight categories (underweight, obese) in psychiatric populations.
Collapse
Affiliation(s)
- Miryam Yusufov
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology & Palliative Care, 450 Brookline Avenue, Boston, MA 02215; McLean Hospital, Behavioral Health Partial Program, 115 Mill Street, Belmont, MA 02478; Harvard Medical School, Department of Psychiatry, Boston, MA 02115.
| | - Lynne M Kopeski
- McLean Hospital, Behavioral Health Partial Program, 115 Mill Street, Belmont, MA 02478
| | | | - Thröstur Björgvinsson
- McLean Hospital, Behavioral Health Partial Program, 115 Mill Street, Belmont, MA 02478; Harvard Medical School, Department of Psychiatry, Boston, MA 02115
| |
Collapse
|
5
|
Wnuk S, Parvez N, Hawa R, Sockalingam S. Predictors of suicidal ideation one-year post-bariatric surgery: Results from the Toronto Bari-Psych Cohort Study. Gen Hosp Psychiatry 2020; 63:39-45. [PMID: 30503220 DOI: 10.1016/j.genhosppsych.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 11/16/2018] [Accepted: 11/25/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous studies have shown higher rates of death by suicide, suicide attempts, suicidal ideation and non-suicidal self-directed violence (NS-SDV) in bariatric surgery patients. METHODS Data came from the Toronto Bari-Psych Cohort study of adult patients who underwent bariatric surgery between 2010 and 2016. The MINI International Neuropsychiatric Interview was used to obtain lifetime psychodiagnostic data. Information about lifetime suicidal ideation, suicide attempts, NS-SDV and hospitalizations related to any of these phenomena was collected during clinical interview. Pre-surgery sociodemographic data, lifetime psychiatric disorders, mental health symptoms, mental health treatment, suicidal ideation and surgical complications were covariates. Logistic regression analyses were used to examine the relationship between these variables and suicidal ideation one-year post-surgery. RESULTS Among a total of 284 participants, 4.2% reported a past suicide attempt and 15.1% reported past suicidal ideation. One-year post-surgery, no suicide attempts were reported. In the multivariate regression model, a history of suicidal ideation was the strongest predictor of suicidal ideation one-year post-surgery (p < 0.01), followed by younger age (p = 0.05). Mental health symptoms decreased from pre to post-surgery. CONCLUSION One-year post-surgery, a history of suicidal ideation was the strongest predictor of post-surgery suicidal ideation. Results should be interpreted with caution given the short duration of follow-up.
Collapse
Affiliation(s)
- Susan Wnuk
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada.
| | - Neha Parvez
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Raed Hawa
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada
| | - Sanjeev Sockalingam
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada
| |
Collapse
|
6
|
Lent MR, Avakoff E, Hope N, Festinger DS, Still CD, Cook AM, Petrick AT, Benotti PN, Craig Wood G. Clinical Characteristics of Roux-en-Y Gastric Bypass Patients with Death from Accidental Overdose or Intentional Self-Harm: a Descriptive Study. Obes Surg 2019; 28:3531-3537. [PMID: 29982972 DOI: 10.1007/s11695-018-3379-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The objective of this descriptive study was to identify clinical characteristics of Roux-en-Y gastric bypass (RYGB) patients who died from intentional self-harm or accidental overdose postoperatively. MATERIALS AND METHODS This retrospective, descriptive study included RYGB patients from a large rural medical center that completed surgery between January 2004 and December 2014 and died from intentional self-harm or accidental overdose through December 2015. Specific causes of death were obtained from the National Death Index and clinical data from electronic health records. Clinical characteristics explored were age, sex, time to surgery, weight loss expectations, postoperative weight loss, medication, diagnoses, psychiatric histories (diagnoses, self-harm, suicidal ideation and behaviors, medications, substance use, preoperative Beck Depression Inventory-II scores), pain, social support, and reported life stressors. RESULTS Overall, 22 patients of 146 total deceased patients died from intention self-harm (n = 6) or accidental overdose (n = 16) over the study period (77.3% female, mean age at time of surgery = 38.4 ± 9.1 years). Younger age (< 40 years), history of self-harm or depression, preoperative pain, and use of opioids at the time of surgery emerged as common characteristics in weight loss surgery patients who died from intentional self-harm or accidental overdose. No trends regarding social support, life stressors, or actual or expected weight loss were identified. CONCLUSION Certain weight loss surgery patients may be at risk for death from self-harm or overdose and may benefit from greater surveillance postoperatively.
Collapse
Affiliation(s)
- Michelle R Lent
- Department of Psychology, Philadelphia College of Osteopathic Medicine (PCOM), 4190 City Avenue, Philadelphia, PA, 19131, USA. .,Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA.
| | - Elizabeth Avakoff
- Department of Psychology, Philadelphia College of Osteopathic Medicine (PCOM), 4190 City Avenue, Philadelphia, PA, 19131, USA
| | - Nicholas Hope
- Department of Psychology, Philadelphia College of Osteopathic Medicine (PCOM), 4190 City Avenue, Philadelphia, PA, 19131, USA
| | - David S Festinger
- Department of Psychology, Philadelphia College of Osteopathic Medicine (PCOM), 4190 City Avenue, Philadelphia, PA, 19131, USA
| | - Christopher D Still
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Adam M Cook
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Anthony T Petrick
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Peter N Benotti
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - G Craig Wood
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
| |
Collapse
|
7
|
Gallinat C, Moessner M, Claes L, Müller A. Skin picking in patients with obesity: Associations with impulsiveness and self-harm. Scand J Psychol 2019; 60:361-368. [PMID: 31006888 DOI: 10.1111/sjop.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/04/2019] [Indexed: 11/29/2022]
Abstract
Previous studies suggest elevated prevalence rates of skin picking and self-harm in patients with obesity compared to individuals in the general population. Hence, further studies should investigate prevalence rates and correlates of skin picking in this population - especially its differentiation to self-harm. Skin picking and obesity are both associated with specific facets of impulsiveness. This relation should be explored to shed light on potentially shared mechanisms in etiology. Therefore, the present study examined the occurrence of skin picking and its associations with impulsiveness and self-harm in a sample of pre-bariatric surgery patients with obesity class II/III. Within the routine preoperative psychiatric evaluation, a total of 139 bariatric surgery candidates (78% female, BMI range 35-69) completed a self-report questionnaire assessing sociodemographic variables, anxiety, depression, self-harm, impulsiveness, and skin picking severity (urges: frequency, intensity, controllability; behavior: frequency, intensity, controllability; resistance, emotional distress, impairment, and avoidance). Ten participants (7.2% of the sample) reported recurrent skin picking leading to skin damage, repeated attempts to decrease skin picking, and psychosocial impairment (emotional distress, impairment in functional areas, avoidance) due to skin picking. In line with previous findings, skin picking severity shows a medium correlation with attentional impulsiveness. The majority of self-harm types were not associated with skin picking severity. The current study reveals a high occurrence of skin picking compared to the general population. The results indicate an association between skin picking severity and attentional impulsiveness. Further research is needed to investigate the differentiation of skin picking and self-harm in more detail.
Collapse
Affiliation(s)
- Christina Gallinat
- University Hospital Heidelberg, Center for Psychotherapy Research, Heidelberg, Germany
| | - Markus Moessner
- University Hospital Heidelberg, Center for Psychotherapy Research, Heidelberg, Germany
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| |
Collapse
|
8
|
Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know? ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 63:344-369. [PMID: 29214946 DOI: 10.13109/zptm.2017.63.4.344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUBJECT In view of the epidemic increase in severe obesity and the ineffectiveness of conservative weight-loss interventions, bariatric surgery delivers compelling results for patients with class II (BMI ≥ 35 kg/m²) and class III obesity (BMI ≥ 40 kg/m²), not only in reducing weight over the long term, but also in reducing obesity-related somatic comorbidity and improving psychosocial functioning and quality of life. Investigations into the psychosocial aspects of obesity surgery have proliferated over the last 15 years, providing a huge amount of essential research data. Yet the results are partly contradictory and highly dependent on the duration of follow-up. METHODS Based of a narrative review, this article provides an overview of the current status and recent developments of the reciprocal effects between bariatric surgery and psychosocial functioning. The review focused on eight domains representing important psychosomatic and psychosocial aspects of bariatric surgery. RESULTS Especially in cases of class II and III obesity, bariatric surgery is the only means to reduce bodyweight significantly and permanently, though they carry with them the associated risk factors of metabolic, cardiovascular, and oncological diseases.With regard to psychosocial and psychosomatic aspects, studies with a short-term catamnesis (approx. 3 years) speak in favor of an improvement in the quality of life including mental disorders. If we consider studies with longer follow-ups, however, the results are not as uniform. In particular, we observe an increase in harmful alcohol consumption, self-harm behavior, and suicide risk. CONCLUSIONS In light of mental well-being and thus also quality of life, bariatric surgery would appear to convey an elevated risk for a minority of patients.Yet identifying these patients before surgery has so far been insufficient.
Collapse
|
9
|
Gordon KH, King WC, White GE, Belle SH, Courcoulas AP, Ebel FE, Engel SG, Flum DR, Hinojosa MW, Pomp A, Pories WJ, Spaniolas D, Wolfe BM, Yanovski SZ, Mitchell JE. A longitudinal examination of suicide-related thoughts and behaviors among bariatric surgery patients. Surg Obes Relat Dis 2018; 15:269-278. [PMID: 31010651 DOI: 10.1016/j.soard.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Past research suggests self-harm/suicidality are more common among adults who have undergone bariatric surgery than the general population. OBJECTIVES To compare prevalence of self-harm/suicidal ideation over time and identify presurgery risk factors for postsurgery self-harm/suicidal ideation. SETTING The Longitudinal Assessment of Bariatric Surgery-2 is a cohort study with presurgery and annual postsurgery assessments conducted at 10 U.S. hospitals. METHODS Adults with severe obesity undergoing bariatric surgery between March 2006 and April 2009 (n = 2458). Five-year follow-up is reported. Self-reported history of suicidality assessed retrospectively via the Suicide Behavior Questionnaire-Revised (SBQ-R) and self-reported self-harm/suicidal ideation assessed prospectively via the Beck Depression Inventory-Version 1 (BDI-1). RESULTS The SBQ-R was completed by 1540 participants; 2217 completed the BDI-1 pre- and postsurgery. Over 75% of participants were female, with a median age of 46 years and body mass index of 45.9 kg/m2. Approximately one fourth of participants (395/1534) reported a presurgery history of suicidal thoughts or behavior (SBQ-R). The prevalence of self-harm/suicidal ideation (BDI-1) was 5.3% (95% confidence interval [CI], 3.7-6.8) presurgery and 3.8% (95% CI, 2.5-5.1) at year 1 postsurgery (P = .06). Prevalence increased over time postsurgery to 6.6% (95% CI, 4.6-8.6) at year 5 (P = .001) but was not significantly different than presurgery (P = .12). CONCLUSIONS A large cohort of adults with severe obesity who underwent bariatric surgery had a prevalence of self-harm/suicidal ideation that may have decreased in the first postoperative year but increased over time to presurgery levels, suggesting screening for self-harm/suicidality is warranted throughout long-term postoperative care. Several risk factors were identified that may help with enhanced monitoring.
Collapse
Affiliation(s)
- Kathryn H Gordon
- Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Psychology, North Dakota State University, Fargo, North Dakota.
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Gretchen E White
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Dave R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | | | | | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Dino Spaniolas
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon
| | - Susan Z Yanovski
- Office of Obesity Research, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | |
Collapse
|
10
|
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; 11:109-115. [PMID: 29631270 PMCID: PMC5981630 DOI: 10.1159/000486484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE The study aimed at investigating the lifetime prevalence of 22 self-harm behaviors in bariatric surgery candidates (pre-bariatric surgery group; PSG) compared to community controls with obesity (obese community group; OCG). METHODS The Self-Harm Inventory (SHI) was administered to the PSG (n = 139, BMI ≥ 35 kg/m2) and to the OCG (n = 122, BMI ≥ 35 kg/m2). RESULTS Group comparison of cumulative SHI scores indicated a trend towards less endorsed SHI items in the PSG compared to the OCG (medianPSG = 1.00, IQRPSG = 2.00, medianOCG = 1.00, IQROCG = 2.25, U = 7.241, p = 0.033, η2 = 0.02). No significant group differences were found with regard to the rate of suicide attempts (12.4% vs. 9.4% for OCG vs. PSG). At least one type of lifetime self-harm behavior was admitted by 51.8% of the PSG and 63.9% of the OCG (χ2(1) = 3.91, p = 0.048). The results of logistic regressions using Firth's bias reduction method with at least one SHI item endorsed as dependent variable, group as categorical predictor (PSG as baseline), and age or BMI or PHQ-4 as continuous control variable indicated that only PHQ-4 had a positive effect on the odds ratio. CONCLUSION The results suggest that self-harm (including suicidal attempts) is not more prevalent in bariatric surgery candidates than in community control participants with obesity. Further studies are needed to investigate self-harm in bariatric surgery patients, prior and following surgery, compared to non-operated patients with obesity.
Collapse
Affiliation(s)
- Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
- *Astrid Müller, Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30265 Hanover, Germany,
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Dirk Smits
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Odisee University College, Brussels, Belgium
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| |
Collapse
|
11
|
Abstract
OBJECTIVE The aim of this study was to examine risk of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery (GBP). SUMMARY OF BACKGROUND DATA Concerns regarding severe adverse psychiatric outcomes after GBP have been raised. METHODS This nationwide, longitudinal, self-matched cohort encompassed 22,539 patients who underwent GBP during 2008 to 2012. They were identified through the Swedish National Patient Register, the Prescribed Drug Register, and the Causes of Death Register. Follow-up time was up to 2 years. Main outcome measures were hazard ratios (HRs) for post-surgery self-harm or hospitalization for depression in patients with presurgery self-harm and/or depression compared to patients without this exposure; and standardized mortality ratio (SMR) for suicide post-surgery. RESULTS A diagnosis of self-harm in the 2 years preceding surgery was associated with an HR of 36.6 (95% confidence interval [CI] 25.5-52.4) for self-harm during the 2 years of follow up, compared to GBP patients who had no self-harm diagnosis before surgery. Patients with a diagnosis of depression preceding GBP surgery had an HR of 52.3 (95% CI 30.6-89.2) for hospitalization owing to depression after GBP, compared to GBP patients without a previous diagnosis of depression. The SMR for suicide after GBP was increased among females (n = 13), 4.50 (95% CI 2.50-7.50). The SMR among males (n = 4), was 1.71 (95% CI 0.54-4.12). CONCLUSIONS The increased risk of post-surgery self-harm and hospitalization for depression is mainly attributable to patients who have a diagnosis of self-harm or depression before surgery. Raised awareness is needed to identify vulnerable patients with history of self-harm or depression, which may be in need of psychiatric support after GBP.
Collapse
|
12
|
Kovacs Z, Valentin JB, Nielsen RE. Risk of psychiatric disorders, self-harm behaviour and service use associated with bariatric surgery. Acta Psychiatr Scand 2017; 135:149-158. [PMID: 27864830 DOI: 10.1111/acps.12669] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate psychiatric outcomes after bariatric surgery, including suicide, self-harm, psychiatric service use and substance misuse. METHOD Retrospective study on a Danish nationwide register-based cohort of 22 451 patients followed for 1 029 736 person-years. Data were analysed utilizing single- and multi-event Cox regression with non-operated controls with obesity and mirror-image analyses with the operated patient serving as their own controls. RESULTS We showed an increased ratio of self-harm (hazard ratio [HR] 3.23, P < 0.001; incidence rate ratio [IRR] 1.71, P < 0.001), psychiatric service use (admissions IRR 1.52, P < 0.001; emergency room visits IRR 1.70, P < 0.001), psychiatric diagnosis (organic psychiatric disorders HR 1.78, P < 0.001; substance use HR 2.06, P < 0.001; mood disorders HR 2.66, P < 0.001; neurotic, stress-related and somatoform disorders HR 2.48, P < 0.001; behavioural syndromes HR 3.15, P < 0.001; disorders of personality HR 2.68, P < 0.001; behavioural and emotional disorders HR 6.43, P < 0.001), as well as substance misuse utilizing Cox regression as well as mirror-image analyses, as compared to non-operated. We did not find an increased suicide rate (HR 1.35, P = 0.658) among operated as compared to non-operated. CONCLUSION Our study shows that undergoing bariatric surgery is associated with increases in self-harm, psychiatric service use and occurrence of mental disorders.
Collapse
Affiliation(s)
- Z Kovacs
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - J B Valentin
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - R E Nielsen
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
13
|
Tarrant M, Khan SS, Farrow CV, Shah P, Daly M, Kos K. Patient experiences of a bariatric group programme for managing obesity: A qualitative interview study. Br J Health Psychol 2016; 22:77-93. [DOI: 10.1111/bjhp.12218] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mark Tarrant
- University of Exeter Medical School; University of Exeter; UK
| | - Sammyh S. Khan
- University of Exeter Medical School; University of Exeter; UK
- School of Psychology; Keele University; UK
| | | | - Pooja Shah
- University of Exeter Medical School; University of Exeter; UK
| | - Mark Daly
- University of Exeter Medical School; University of Exeter; UK
- Royal Devon and Exeter NHS Foundation Trust; Exeter UK
| | - Katarina Kos
- University of Exeter Medical School; University of Exeter; UK
| |
Collapse
|
14
|
Donnadieu-Rigole H, Olive L, Nalpas B, Duny Y, Nocca D, Perney P. Prevalence of Psychoactive Substance Consumption in People With Obesity. Subst Use Misuse 2016; 51:1649-1654. [PMID: 27486825 DOI: 10.1080/10826084.2016.1191514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence and the kind of psychoactive substances consumed by people with obesity. METHODS Patients were included at their first visit for bariatric surgery. Socio-demographic characteristics, anxiety, depressive disorders and psychoactive substance consumption were assessed. The prevalence of psychoactive substance consumption was compared to that of the general population reported by the French National Institute of Prevention and Health Education. RESULTS One hundred (100) patients were consecutively recruited: 60 women (mean age 41 ± 14 years) and 40 men (mean age 46 ± 13 years). Sixty-seven percent of subjects consumed alcohol. Consumption rates of cannabis (21% vs. 10%), cocaine (7.0% vs. 0.8%) and amphetamine (6.0% vs. 0.3%) were significantly (p < .0001) higher in people with obesity than in the general population. CONCLUSIONS People with obesity have an excess risk of amphetamine, cocaine and cannabis consumption. This consumption may increase the risk of cardiovascular and psychiatric morbidity and should therefore be detected before surgery.
Collapse
Affiliation(s)
- Hélène Donnadieu-Rigole
- a Department of Internal Medicine and Addiction Treatment , Hôpital Saint Eloi , University Hospital of Montpellier , Montpellier , France.,b University of Medicine of Montpellier (UM1) , Montpellier , France.,c INSERM U844 , Hôpital Saint Eloi , Montpellier , France
| | - Laetitia Olive
- a Department of Internal Medicine and Addiction Treatment , Hôpital Saint Eloi , University Hospital of Montpellier , Montpellier , France
| | - Bertrand Nalpas
- d INSERM Department of Information and Scientific Communication , Paris , France.,e Department of Addiction Treatment , Hôpital Caremeau , Nîmes , France
| | - Yohan Duny
- f Department of Information , University Hospital of Montpellier , Montpellier , France
| | - David Nocca
- b University of Medicine of Montpellier (UM1) , Montpellier , France.,g Department of Visceral Surgery , Hôpital Saint Eloi , University Hospital of Montpellier , Montpellier , France
| | - Pascal Perney
- b University of Medicine of Montpellier (UM1) , Montpellier , France.,e Department of Addiction Treatment , Hôpital Caremeau , Nîmes , France
| |
Collapse
|
15
|
Adamowicz JL, Salwen JK, Hymowitz GF, Vivian D. Predictors of suicidality in bariatric surgery candidates. J Health Psychol 2016; 21:1992-8. [DOI: 10.1177/1359105315569618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Risk for suicidality (current or past suicidal ideation or attempt) increases after bariatric surgery; however, there is a paucity of research investigating suicidality predictors in this population. This study involved a retrospective chart review of individuals seeking psychological clearance for bariatric surgery. In total, 32 participants (15.8%) were classified as reporting suicidality. These participants endorsed greater depressive symptomatology and hopelessness, and hopelessness and mood disorder diagnosis each uniquely predicted whether or not a patient was classified as reporting suicidality. The findings within suggest that increased attention to the relationship among these variables may improve methods for identification of high-risk patients. Implications for clinical practiced are discussed.
Collapse
|
16
|
Prevalence and Correlates of Self-Harm in the German General Population. PLoS One 2016; 11:e0157928. [PMID: 27362348 PMCID: PMC4928828 DOI: 10.1371/journal.pone.0157928] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/07/2016] [Indexed: 11/23/2022] Open
Abstract
The study aimed at evaluating the psychometric properties of the German version of the Self- Harm Inventory (SHI) and examining the lifetime prevalence and correlates of self-harm in a representative German population sample (N = 2,507; age mean = 48.79, SD = 18.11; range 14 to 94 years; 55.5% women) using the SHI. All participants answered the German SHI, the short form of the Barratt Impulsiveness Scale (BIS-15), the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and provided sociodemographic information. The one-factorial structure of the SHI was replicated using a confirmatory factor analysis. Internal consistency coefficients were sufficient and in line with previous studies. Almost half of the sample (49%) acknowledged at least one self-harming behavior over the life-span, most frequently indirect forms of self-harm. The rate of participants who engaged in at least one SHI behavior was higher among men than women (51.6% vs. 46.9%, respectively, χ2= 5.38, p = 0.020). Higher SHI scores were related to younger age, male gender, living alone, more symptoms of anxiety and depression (PHQ-4), higher impulsivity scores (BIS-15), and suffering from obesity grade 2. Women engaged more often in discreet forms of self-harm than men, e.g., preventing wounds from healing, exercising an injury, starving, and abusing laxatives. In terms of other indirect self-harming behaviors, men admitted more often driving recklessly, being promiscuous and losing a job on purpose, while women reported more frequently engaging in emotionally abusive relationships. With respect to direct self-harm, women were more likely to endorse suicide attempts and cutting, while men admitted more often head-banging. The findings suggest that self-harm constitutes a common problem. Future longitudinal studies are required to examine the natural course, sociodemographic and psychopathological risk factors, as well as possible time-trends of self-harming behaviors in more depth.
Collapse
|
17
|
Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis 2016; 12:731-749. [DOI: 10.1016/j.soard.2016.02.008] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 12/20/2022]
|
18
|
McPhee J, Khlyavich Freidl E, Eicher J, Zitsman JL, Devlin MJ, Hildebrandt T, Sysko R. Suicidal Ideation and Behaviours Among Adolescents Receiving Bariatric Surgery: A Case-Control Study. EUROPEAN EATING DISORDERS REVIEW 2015; 23:517-23. [PMID: 26377705 DOI: 10.1002/erv.2406] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/21/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study examined the prevalence and correlates of suicidal ideation and behaviour (SI/B) among adolescents receiving bariatric surgery. METHOD Charts of 206 adolescents receiving bariatric surgery were reviewed. Cases with SI/B (current/lifetime reported at baseline or event occurring in the programme n = 31, 15%) were case matched on gender, age and surgery type to 31 adolescents reporting current or past psychiatric treatment and 31 adolescents denying lifetime SI/B or psychiatric treatment. RESULTS Before surgery, adolescents with SI/B reported significantly lower total levels of health-related quality of life (p = 0.01) and greater depressive symptoms (p = 0.004) in comparison with candidates who never received psychiatric treatment. No significant differences were found between groups for the change in depressive symptoms or body mass index following surgery. CONCLUSIONS As in studies of adults, a notable subset of adolescents receiving bariatric surgery indicated pre-operative or post-operative SI/B. It is critical that clinicians evaluate and monitor adolescent patients undergoing bariatric surgery for risk of SI/B.
Collapse
Affiliation(s)
- Jeanne McPhee
- Columbia Centre for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, NY, USA
| | - Eve Khlyavich Freidl
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, NY, USA.,Columbia University Clinic for Anxiety and Related Disorders, Division of Child Psychiatry, College of Physicians and Surgeons of Columbia University, NY, USA
| | - Julia Eicher
- Centre for Adolescent Bariatric Surgery, Department of Surgery, Columbia University Medical Centre, NY, USA
| | - Jeffrey L Zitsman
- Centre for Adolescent Bariatric Surgery, Department of Surgery, Columbia University Medical Centre, NY, USA
| | - Michael J Devlin
- Columbia Centre for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, NY, USA
| | - Tom Hildebrandt
- Eating and Weight Disorders Programme, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Robyn Sysko
- Eating and Weight Disorders Programme, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| |
Collapse
|
19
|
Winsby AB, Thomlinson RP. Behavioral Health Problems among Postsurgical Bariatric Patients: The Need for Continuing Behavioral Health Interventions. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amelia B. Winsby
- The School of Professional Psychology at Forest Institute, Springfield, Missouri
| | - R. Paul Thomlinson
- The School of Professional Psychology at Forest Institute, Springfield, Missouri
| |
Collapse
|
20
|
Ratcliffe D, Ali R, Ellison N, Khatun M, Poole J, Coffey C. Bariatric psychology in the UK National Health Service: input across the patient pathway. BMC OBESITY 2014; 1:20. [PMID: 26217507 PMCID: PMC4510897 DOI: 10.1186/s40608-014-0020-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 08/21/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Providers of bariatric surgery within the National Health Service (NHS) are required to provide psychological assessment and intervention, yet operational definitions regarding the purpose and scope of this input are lacking. This has led to significant variation in the provision of psychology, with some providing an assessment-only service and others providing a more comprehensive package of intervention throughout the patient pathway. The aims of this paper are to document the current psychology provision and service models of National Health Service (NHS) bariatric surgery services in the UK. Psychologists belonging to a bariatric psychology forum completed a survey. This focused on provision of psychological assessment and intervention throughout the bariatric pathway as well as the ratio between psychology resources and number of bariatric procedures per year. We obtained information from 22 NHS services which provide 3691 procedures per year. RESULTS There is significant variation in the ratio between psychology resources and number of bariatric procedures undertaken per service. Whilst all services offer pre-surgery psychology assessments, less than one-third routinely assess all potential bariatric surgery candidates. Over 90% of services offer pre-surgery individual interventions and 41% offer pre-surgery groups. None of the services routinely offer post-surgery assessments but 68% offer post-surgery assessment and intervention following referral. None offered post-operative structured psychological group interventions. CONCLUSION There are significant disparities and inconsistencies in the provision of psychology resources in relation to surgery volume in the NHS. Most of these resources are directed at pre-surgery assessment and this raises issues regarding the function of these assessments. Rather than focusing on assessing psychological (un)suitability for surgery, an evidence-based approach involves psychologists offering pre-operative interventions to improve readiness for surgery and post-operative interventions to address recurring or emerging difficulties which impact on outcomes.
Collapse
Affiliation(s)
- Denise Ratcliffe
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
- />Department of Clinical, Educational & Health Psychology, University College London, London, UK
- />Phoenix Health, Chester, UK
| | - Rukshana Ali
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Nell Ellison
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
- />Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Mahbuba Khatun
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Jolyon Poole
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Caroline Coffey
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
| |
Collapse
|
21
|
Steinig J, Wagner B, Shang E, Dölemeyer R, Kersting A. Sexual abuse in bariatric surgery candidates: impact on weight loss after surgery: a systematic review. Obes Rev 2012; 13:892-901. [PMID: 22564306 DOI: 10.1111/j.1467-789x.2012.01003.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Bariatric surgery is becoming more and more influential as efficient weight loss therapy for the morbidly obese. As many studies propose a relationship between sexual abuse and obesity in general, but especially with regard to weight regain after successful weight loss, sexual abuse might also have a crucial impact on the outcome of the surgical procedures. This review examines the literature comparing weight loss after bariatric surgery in sexually abused and non-abused individuals. We conducted a systematic electronic literature search covering PubMed/Medline, ScienceDirect, PsychInfo and Web of Science. While 13 studies examined prevalence rates of sexual abuse among bariatric patients, eight studies explicitly investigated the effect of sexual abuse on surgery outcome. We hypothesized that individuals with a history of sexual abuse lose less weight compared to individuals with no such abuse history. At first glance, only three out of eight studies demonstrated significantly reduced weight loss in the sexually abused patients. However, a closer investigation of all studies revealed that patients with abuse experiences may indeed tend to lose less weight initially. Still, this sub-population apparently benefits from the surgical procedure, as revealed by increased weight loss over time. Reasons for these mixed results are discussed, as well as the clinical implications that can be drawn from these studies.
Collapse
Affiliation(s)
- J Steinig
- IFB AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.
| | | | | | | | | |
Collapse
|
22
|
Chen EY, Fettich KC, Tierney M, Cummings H, Berona J, Weissman J, Ward A, Christensen K, Southward M, Gordon KH, Mitchell J, Coccaro E. Factors associated with suicide ideation in severely obese bariatric surgery-seeking individuals. Suicide Life Threat Behav 2012; 42:541-9. [PMID: 22957662 PMCID: PMC5670739 DOI: 10.1111/j.1943-278x.2012.00110.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There are high rates of suicide ideation and/or behavior in severely obese individuals. The potential contributors to suicide ideation in a sample of 334 severely obese bariatric surgery candidates was explored. Lack of college education, a history of suicide ideation and/or behavior, psychological distress, hopelessness, loneliness, history of physical and/or sexual abuse, and lifetime major depression were associated with current suicide ideation. Some of the correlates of suicide ideation in severely obese bariatric surgery-seeking samples are similar to those found in the general community and this knowledge may serve to improve the psychological assessment and care for this group.
Collapse
Affiliation(s)
- Eunice Y. Chen
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, and Department of Psychology, Temple University, Philadelphia PA, USA
| | - Karla C. Fettich
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, and Department of Psychology, Temple University, Philadelphia PA, USA
| | - Megan Tierney
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, and Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Hakeemah Cummings
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL
| | - Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, and Psychology Department, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Weissman
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, and Department of Clinical Psychology, Columbia University Teachers College, NY, USA
| | - Amanda Ward
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, and Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Kara Christensen
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, and Brigham and Division of Women’s Health, Women’s Hospital, Boston, MA, USA
| | - Matthew Southward
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, and Department of Psychology, Ohio State University, Columbus, OH, USA
| | | | - James Mitchell
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Emil Coccaro
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL
| |
Collapse
|
23
|
Sansone RA, Chang J, Jewell B. The prevalence of 22 self-harm behaviors in a consecutive sample of obstetrics/gynecology outpatients. Int J Psychiatry Med 2012; 43:179-87. [PMID: 22849039 DOI: 10.2190/pm.43.2.f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND While a number of previous studies have examined limited forms of self-harm behavior, such as suicidal ideation/attempts/completions, or one specific behavior such as cutting or burning oneself(most frequently in psychiatric populations), few studies have examined the lifetime prevalence of multiple self-harm behaviors in a single non-psychiatric population and no study has done so among obstetrics/gynecology outpatients. METHOD Using a cross-sectional consecutive sample of 370 women presenting to an obstetrics/gynecology outpatient clinic and a self-report survey methodology, we examined the lifetime prevalence of 22 self-harm behaviors. RESULTS In this sample, the most frequently self-reported self-harm behaviors were: engaged in emotionally abusive relationships (24.7%), abused alcohol (22.0%), been promiscuous (21.0%), attempted suicide (18.3%), and tortured self with self-defeating thoughts (16.7%). Four of these preceding behaviors were also the most commonly reported 5 of 22 behaviors in 3 previous studies of self-harm behavior in different clinical populations. CONCLUSIONS It appears that the most frequently reported lifetime self-harm behaviors are relatively common across various non-psychiatric clinical populations of adults, albeit in different proportions, with some exceptions (i.e., suicide attempts in the present sample).
Collapse
Affiliation(s)
- Randy A Sansone
- Wright State University School of Medicine, Ohio and Kettering Medical Center, Ohio, USA.
| | | | | |
Collapse
|
24
|
Chen EY, Fettich KC, McCloskey MS. Correlates of Suicidal Ideation and/or Behavior in Bariatric-Surgery-Seeking Individuals With Severe Obesity. CRISIS 2012; 33:137-43. [DOI: 10.1027/0227-5910/a000115] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Approximately 10% of severely obese bariatric-surgery-seeking individuals report a lifetime history of suicide attempts, a higher rate than in the general community. Being overweight is associated with weight-related stigma, making an individual more vulnerable to social isolation, a potential risk factor for suicidal ideation and/or behavior. Aims: In this cross-sectional study of surgery-seeking adults with severe obesity, we examined whether weight-related stigma increases (1) the likelihood of suicidal ideation and/or behavior or (2) the degree of loneliness; and whether hypotheses (1) and (2) are supported (3) if loneliness mediates the effect of weight-related stigma on suicidal ideation and/or behavior. Methods: Online questionnaires were administered to 301 women and 95 men seeking bariatric surgery. Results: Approximately 30.3% reported having at least a passing thought of suicide, and 5.55% a suicide attempt during their lifetime. The suicide attempt rate appears lower than other bariatric surgery samples, but possibly higher than community and other surgery sample rates. For severely obese surgery-seeking women, weight-related stigma was associated with suicidal ideation and/or behavior, though this was not mediated by loneliness. Conclusions: Future studies are needed to model and compare suicidal ideation and/or behavior in bariatric-surgery-seeking individuals and control groups.
Collapse
Affiliation(s)
- E. Y. Chen
- Adult Eating and Weight Disorders Program, Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - K. C. Fettich
- Adult Eating and Weight Disorders Program, Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - M. S. McCloskey
- Department of Psychology, Temple University, Philadelphia, PA, USA
| |
Collapse
|
25
|
Fogger SA, McGuinness TM. The relationship between addictions and bariatric surgery for nurses in recovery. Perspect Psychiatr Care 2012; 48:10-5. [PMID: 22188042 DOI: 10.1111/j.1744-6163.2010.00298.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Determinants of morbid obesity are complex and numerous, yet understanding the neurobiological underpinnings improves our knowledge of this serious issue. Emerging science supports a comparison of disordered eating with other addictive substances. DESIGN AND METHODS The study used a sub-analysis of a cross-sectional study of nurses in a state-monitoring program. FINDINGS A study of 173 participants in a state-monitoring program for impaired nurses revealed that 14% (n= 25) had undergone bariatric surgery. Of these, 17 developed an addiction after surgery. PRACTICE IMPLICATIONS Evidence suggests that some individuals may require additional treatment, similar to those with pharmacological addictions.
Collapse
Affiliation(s)
- Susanne A Fogger
- School of Nursing, University of Alabama, Birmingham, Alabama, USA.
| | | |
Collapse
|
26
|
Sansone RA, Wiederman MW, Schumacher D, Routsong-Weichers L. The relationship between suicide attempts and borderline personality in gastric surgery candidates. Prim Care Companion CNS Disord 2011; 13:10l01012blu. [PMID: 21731841 DOI: 10.4088/pcc.10l01012blu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Randy A Sansone
- Departments of Psychiatry and Internal Medicine, Wright State University School of Medicine, Dayton, Ohio, USA
| | | | | | | |
Collapse
|
27
|
Windover AK, Merrell J, Ashton K, Heinberg LJ. Prevalence and psychosocial correlates of self-reported past suicide attempts among bariatric surgery candidates. Surg Obes Relat Dis 2010; 6:702-6. [DOI: 10.1016/j.soard.2010.08.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 08/26/2010] [Accepted: 08/30/2010] [Indexed: 02/01/2023]
|
28
|
Tindle HA, Omalu B, Courcoulas A, Marcus M, Hammers J, Kuller LH. Risk of suicide after long-term follow-up from bariatric surgery. Am J Med 2010; 123:1036-42. [PMID: 20843498 PMCID: PMC4296730 DOI: 10.1016/j.amjmed.2010.06.016] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/24/2010] [Accepted: 06/08/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE Bariatric surgery is recognized as the treatment of choice for class III obesity (body mass index ≥40) and has been increasingly recommended for obese patients. Prior research has suggested an excess of deaths due to suicide following bariatric surgery, but few large long-term follow-up studies exist. We examined postbariatric surgery suicides by time since operation, sex, age, and suicide death rates as compared with US suicide rates. METHODS Medical data following bariatric operations performed on Pennsylvania residents between January 1, 1995 and December 31, 2004 were obtained from the Pennsylvania Health Care Cost and Containment Council. Matching mortality data from suicides between September 1, 1996 and December 28, 2006 were obtained from the Division of Vital Records, Pennsylvania State Department of Health. RESULTS There were 31 suicides (16,683 operations), for an overall rate of 6.6/10,000; 13.7 per 10,000 among men and 5.2 per 10,000 among women. About 30% of suicides occurred within the first 2 years following surgery, with almost 70% occurring within 3 years. For every age category except the youngest, suicide rates were higher among men than women. Age- and sex-matched suicide rates in the US population (ages 35-64 years) were 2.4/10,000 (men) and 0.7/10,000 (women). CONCLUSIONS Compared with age and sex-matched suicide rates in the US, there was a substantial excess of suicides among all patients who had bariatric surgery in Pennsylvania during a 10-year period. These data document a need to develop more comprehensive longer-term surveillance and follow-up methods in order to evaluate factors associated with postbariatric surgery suicide.
Collapse
|
29
|
Sansone RA, Whitecar P, Wiederman MW. Self-harm behaviors among buprenorphine-treated patients. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 20694125 DOI: 10.4088/pcc.09l00813ecr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|