Improving suicide risk identification after bariatric surgery: A mixed methods approach

About This Grant

Though bariatric surgery is the most effective and durable treatment for severe obesity, patients have a 4-fold increased risk for suicide compared to the general population. This is one of the highest adverse event rates reported following bariatric surgery, yet there has been little research to understand the etiology. The number of those undergoing bariatric surgery is rising and so we need to understand the unique reasons for increased suicide risk among this growing, at-risk population; otherwise, patients who undergo bariatric surgery remain at risk for suicide attempts and death. The purpose of the proposed study is to determine whether the bariatric surgery operation confers the increased suicide risk, investigate the times at which post-surgical risk is highest, identify factors associated with increased suicide risk, and understand perceptions regarding methods for suicide risk identification within health care systems. Our team of researchers are embedded in six health systems across the United States and are members of the Mental Health Research Network where data will be collected using a convergent mixed methods design. Quantitative data will be extracted from participating sites’ Virtual Data Warehouses, which store data from patients’ electronic health records, insurance claims, and government-reported official death records beginning in 2009. We will have more than 70,000 patients that have undergone bariatric surgery and these patients will be compared with a rigorously matched non-surgical cohort with severe obesity. Using the social-ecological suicide prevention model, we will examine unique factors after bariatric surgery that could explain increased risk including individual biological factors, individual psychiatric factors, societal factors, community factors, and interpersonal factors. Given that there are pharmacokinetic alterations of psychiatric medications after bariatric surgery, we will also explore the role of antidepressants. Patient interviews will be conducted to gain a deeper understanding of factors associated with suicide attempts after bariatric surgery beyond the available structured quantitative data. Patient and provider interviews will be utilized to understand optimal ways to identify and engage high-risk patients within health care systems. Our long-term goal is to prevent suicide attempts and death within health care systems. This project contains multiple innovative components that advances prior work on suicide after bariatric surgery including: access to a large, diverse and representative patient population; inclusion of a rigorously matched cohort; utilization of a mixed methods approach; longitudinal design; and use of machine learning to analyze these complex data. The proposed line of research is relevant to NIH’s mission because we will improve suicide risk identification following bariatric surgery. Results from this study would be significant and inform pre- and post-surgical monitoring of patients pursuing bariatric surgery. Findings will also lead to optimal methods of identifying and engaging at-risk patients in suicide prevention strategies within health care systems, which may also translate to other health care settings outside of bariatric surgery.