Suicide, Self-harm, and Depression After Gastric Bypass Surgery A Nationwide Cohort Study
Suicide, Self-harm, and Depression After Gastric Bypass Surgery A Nationwide Cohort Study
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DOI：
10.1097/sla.0000000000001884
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发表时间：
2017-02-01
影响因子：
9
通讯作者：
Boden, Robert
中科院分区：
文献类型：
--
作者：
Lagerros, Ylva Trolle;Brandt, Lena;Boden, Robert
目的：本研究的目的是检查胃旁路手术（GBP）后自我伤害、抑郁症住院和自杀死亡的风险。背景资料概要：GBP后严重不良精神结局的担忧已经引起了人们的关注。方法：这项全国性的纵向自我匹配队列研究包括2008年至2012年期间接受GBP的22,539例患者。他们是通过瑞典国家病人登记册，处方药登记册和死亡原因登记册确定的。随访时间长达2年。主要结局指标是与没有这种暴露的患者相比，患有手术前自残和/或抑郁症的患者术后自残或因抑郁症住院的风险比（HR）;以及术后自杀的标准化死亡率（SMR）。结果：术前2年诊断为自残与HR为36.6相关（95%置信区间[CI] 25.5-52.4），与术前无自我伤害诊断的GBP患者相比。与既往无抑郁症诊断的GBP患者相比，GBP手术前诊断为抑郁症的患者因GBP后抑郁症住院的HR为52.3（95%CI 30.6-89.2）。女性GBP后自杀的SMR增加（n = 13），4.50（95% CI 2.50-7.50）。男性（n = 4）的SMR为1.71（95%CI 0.54-4.12）。结论：术后自伤和因抑郁住院的风险增加主要归因于术前诊断为自伤或抑郁的患者。需要提高认识，以识别有自残或抑郁史的脆弱患者，这些患者在GBP后可能需要精神支持。
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.