Department of Intensive Care Medicine, St John of God Subiaco Hospital, Perth, Western Australia.
University of Western Australia, Perth, Western Australia.
JAMA Psychiatry. 2020 Jan 1;77(1):60-67. doi: 10.1001/jamapsychiatry.2019.2741.
Obesity is associated with an increased prevalence of psychiatric disorders. The association of bariatric surgery with mental health outcomes is poorly understood.
To investigate the association of bariatric surgery with the incidence of outpatient, emergency department (ED), and inpatient mental health service use.
DESIGN, SETTING, AND PARTICIPANTS: This statewide, mirror-image, longitudinal cohort study used data from Western Australian Department of Health Data Linkage Branch records from all patients undergoing index (ie, first) bariatric surgery in Western Australia over a 10-year period (January 2007-December 2016), with mean (SD) follow-up periods of 10.2 (2.9) years before and 5.2 (2.9) years after index bariatric surgery. The data analysis was performed between November 2018 and March 2019.
Index bariatric surgery.
The incidence and predictors for mental health presentations, deliberate self-harm, and suicide in association with the timing of bariatric surgery.
A total of 24 766 patients underwent index bariatric surgery; of these, the mean (SD) age was 42.5 (11.7) years and 19 144 (77.3%) were women. Use of at least 1 mental health service occurred in 3976 patients (16.1%), with 1401 patients (35.2%) presenting only before surgery, 1025 (25.8%) presenting before and after surgery, and 1550 patients (39.0%) presenting only after surgery. There was an increase in psychiatric illness presentations after bariatric surgery (outpatient clinic attendance: incidence rate ratio [IRR], 2.3; 95% CI, 2.3-2.4; ED attendance: IRR, 3.0; 95% CI, 2.8-3.2; psychiatric hospitalization: IRR, 3.0; 95% CI, 2.8-3.1). There was also a 5-fold increase in deliberate self-harm presentations to an ED after surgery (IRR, 4.7; 95% CI, 3.8-5.7), with 25 of 261 postoperatives deaths (9.6%) due to suicide. Complications after bariatric surgery requiring further surgical intervention and a history of mental health service provision before surgery were the most important associations with subsequent mental health presentations after surgery. Deliberate self-harm and mental and behavioral disorders due to psychoactive substance use before bariatric surgery were the main associations with subsequent deliberate self-harm or suicide after surgery.
We observed an increase in mental health service presentations after bariatric surgery, particularly among those who had prior psychiatric illnesses or developed surgical complications requiring further surgery. These findings caution the hypothesis that weight reduction by bariatric surgery will improve mental health in patients with obesity.
肥胖与精神疾病发病率的增加有关。减重手术与心理健康结果的关联尚不清楚。
研究减重手术与门诊、急诊（ED）和住院精神卫生服务使用的发生率之间的关联。
设计、地点和参与者：这是一项全州范围内的镜像纵向队列研究，使用了西澳大利亚州卫生部数据链接分支机构记录中所有在西澳大利亚州接受首次（即首次）减重手术的患者的数据，研究时间为 10 年（2007 年 1 月至 2016 年 12 月），平均（SD）随访期为术前 10.2（2.9）年，术后 5.2（2.9）年。数据分析于 2018 年 11 月至 2019 年 3 月进行。
指数减重手术。
与减重手术时机相关的心理健康表现、蓄意自我伤害和自杀的发生率和预测因素。
共有 24766 例患者接受了指数减重手术；其中，平均（SD）年龄为 42.5（11.7）岁，19144 例（77.3%）为女性。至少使用 1 项精神卫生服务的患者有 3976 例（16.1%），其中 1401 例（35.2%）仅在手术前就诊，1025 例（25.8%）在手术前和手术后就诊，1550 例（39.0%）仅在手术后就诊。减重手术后精神疾病的发病率增加（门诊就诊：发病率比[IRR]，2.3；95%CI，2.3-2.4；ED 就诊：IRR，3.0；95%CI，2.8-3.2；精神科住院：IRR，3.0；95%CI，2.8-3.1）。手术后，因故意自我伤害到 ED 的就诊率也增加了 5 倍（IRR，4.7；95%CI，3.8-5.7），261 例术后死亡中有 25 例（9.6%）是自杀。减重手术后需要进一步手术干预的并发症和手术前有精神卫生服务提供史是与手术后精神卫生表现最相关的因素。减重手术前因精神活性物质使用导致的蓄意自我伤害和精神及行为障碍是与手术后蓄意自我伤害或自杀相关的主要因素。
我们观察到减重手术后精神卫生服务就诊率增加，特别是在那些有既往精神疾病或出现需要进一步手术的手术并发症的患者中。这些发现告诫我们，减重手术减轻体重会改善肥胖患者的心理健康的假说。
