Risk of suicide after metabolic bariatric surgery: a meta-analysis of matched cohort studies and population-based studies

Abstract

Background

Metabolic bariatric surgery (MBS) remains the optimal treatment for patients with severe obesity. However, concern is growing about the risk of suicide after MBS.

Objectives

To compare the risk of suicide in adult patients with obesity, treated with or without MBS.

Setting

University-affiliated hospital, China.

Methods

PubMed and Embase were searched through April 30, 2024. Eligible studies were matched cohort studies and population-based studies (PROSPERO ID: CRD42024561042). Effects were pooled using a random-effects model. Subgroup analysis was performed based on study type.

Results

A total of 3 matched cohort studies (4 matched cohorts) and 2 population-based studies, involving 114,615 adult patients with obesity treated with MBS (272 suicides) and 552,642 nonsurgery counterparts (622 suicides), met the selection criteria. Patients treated with MBS had a pooled hazard ratio (HR) of suicide of 2.12 (95% confidence interval [CI] 1.54−2.92, P < .01, I² = 24%) and a pooled risk ratio (RR) of suicide of 2.32 (95% CI 1.55−3.45, P < .01, I² = 58%) compared with those treated without MBS. In the subgroup analysis, relatively higher pooled HR (2.64 [1.84−3.77] versus 1.67 [1.32−2.12]) and RR (2.98 [2.02−4.41] versus 1.48 [.80−2.75]) were observed in the subgroup of matched cohort studies compared with the subgroup of population-based studies.

Conclusions

Adult patients treated with MBS are at more than double the risk of suicide than those treated without MBS in terms of both HR and RR. However, the absolute risk was low and did not warrant a general discouragement of MBS.