title: Possible risk factors for increased suicide following bariatric surgery.
abstract: OBJECTIVE
  There is a growing research literature suggesting that there may be elevated risk of suicide following bariatric surgery. Most of the data reported thus far has been cross-sectional and observational, and very little is known about the possible specific causal variables involved.
  
  
  METHODS
  The purpose of this report is to review this literature and to review possible risk factors for increased suicidal risk following bariatric surgery, to delineate future research directions.
  
  
  RESULTS
  First a variety of medical, biological, and genetic factors, including the persistence or recurrence of medical comorbidities after bariatric surgery, the disinhibition and impulsivity secondary to changes in the absorption of alcohol, hypoglycemia, as well as pharmacokinetic changes that may affect the absorption of various medications including antidepressant medications are reviewed. Also reviewed are possible mediating factors involving changes in various peptidergic systems such as GLP-1 and Ghrelin. A number of psychosocial issues that might be involved are discussed, including lack of improvement in quality of life after surgery, continued or recurrent physical mobility restrictions, persistence or recurrence of sexual dysfunction and relationship problems, low self-esteem, and a history of child maltreatment. Inadequate weight loss or weight regain are also discussed.
  
  
  CONCLUSIONS
  A number of possible contributing factors have been identified. Possible theoretical models involved and directions for research are suggested.
authors: Neuropsychiatric Research Institute, Fargo, North Dakota, USA. Mitch@medicine.nodak.edu
authors: James E
authors: JE
authors: Mitchell
authors: Ross
authors: R
authors: Crosby
authors: Martina
authors: M
authors: de Zwaan
authors: Scott
authors: S
authors: Engel
authors: James
authors: J
authors: Roerig
authors: Kristine
authors: K
authors: Steffen
authors: Kathryn H
authors: KH
authors: Gordon
authors: Trisha
authors: T
authors: Karr
authors: Jason
authors: J
authors: Lavender
authors: Steve
authors: S
authors: Wonderlich
mesh_terms: D000928:Antidepressive Agents / Q000494:pharmacology; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000523:psychology*; D001835:Body Weight; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D054439:Ghrelin / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D009043:Motor Activity; D011788:Quality of Life; D012307:Risk Factors; D013405:Suicide / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents; D054439:Ghrelin; D052216:Glucagon-Like Peptide 1
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