Self-harm hospitalization following bariatric surgery in adolescents and young adults

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 41; no. 1; pp. 238 - 245
• Main Authors: Goueslard, K., Jollant, F., Petit, J.M., Quantin, C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2022; Elsevier / European Society for Clinical Nutrition and Metabolism
• Subjects: Adolescent; Adolescents; Adult; Bariatric surgery; Bariatric Surgery - adverse effects; Bariatric Surgery - psychology; Case-Control Studies; Child; Female; France - epidemiology; Health data; Hospitalization - statistics & numerical data; Human health and pathology; Humans; Hépatology and Gastroenterology; Life Sciences; Male; Mental Disorders - epidemiology; Mental Disorders - etiology; Obesity; Obesity - psychology; Postoperative Complications - epidemiology; Postoperative Complications - psychology; Postoperative Period; Risk Factors; Santé publique et épidémiologie; Self-harm; Self-Injurious Behavior - epidemiology; Self-Injurious Behavior - etiology; Surgery; Young Adult; Young adults; France; Obesity; Young adults; Health data; Adolescents; Self-harm; Bariatric surgery
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2021.11.034

While bariatric surgery has demonstrated physical and psychological benefits, a risk of suicide and non-fatal self-harm has also been shown. The aim of this study was to compared the rate of hospitalization for self-harm during a three-year observational follow-up period between adolescents/young adults who underwent bariatric surgery in France in 2013–2014 and two control groups.
All individuals aged 12–25 years old who underwent bariatric surgery in France between January 1st, 2013, and December 31st, 2014, were identified with a validated algorithm from the French national hospital database, and compared to a healthy sample of the general population matched for age and gender. Information relative to hospitalizations, including for self-harm (ICD-10 codes X60-84), were extracted i) between 2008 and the surgery, and ii) for a three-year follow-up period. A second unmatched control group with obesity but no bariatric surgery was also identified. Survival analyses with adjustments for confounding variables were used.
In 2013–2014, 1984 youths had bariatric surgery in France. During follow-up, 1.5% were hospitalized for self-harm vs. 0.3% for controls (p < 0.0001). After adjustment, subsequent hospitalization for self-harm was associated with bariatric surgery (HR 3.64, 95% CI 1.70–7.81), prior psychiatric disorders (HR 7.76, 95% CI 3.76–16.01), and prior self-harm (HR 4.43, 95% CI 1.75–11.24). When compared to non-operated youths with obesity, bariatric surgery was not associated with self-harm while prior mental disorders and self-harm were. Mortality reached 0.3% after surgery.
Bariatric surgery is associated with an increased risk of self-harm, mainly in relation to preexisting psychological conditions. Vigilance and appropriate care are thus warranted in vulnerable individuals.