A longitudinal examination of suicide-related thoughts and behaviors among bariatric surgery patients

Kathryn H. Gordon, Wendy C. King, Gretchen E. White, Steven H. Belle, Anita P. Courcoulas, Faith E. Ebel, Scott G. Engel, Dave R. Flum, Marcelo W. Hinojosa, Alfons Pomp, Walter J. Pories, Dino Spaniolas, Bruce M. Wolfe, Susan Z. Yanovski, James E. Mitchell

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


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/m 2 . 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.

Original languageEnglish (US)
Pages (from-to)265-274
Number of pages10
JournalSurgery for Obesity and Related Diseases
Issue number2
StatePublished - Feb 2019


  • Bariatric surgery
  • Obesity
  • Suicidal ideation
  • Suicide

ASJC Scopus subject areas

  • Surgery


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