title: Self-harm Emergencies After Bariatric Surgery: A Population-Based Cohort Study.
abstract: OBJECTIVE
  Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery.
  
  
  OBJECTIVE
  To compare the risk of self-harm behaviors before and after bariatric surgery.
  
  
  METHODS
  In this population-based, self-matched, longitudinal cohort analysis, we studied 8815 adults from Ontario, Canada, who underwent bariatric surgery between April 1, 2006, and March 31, 2011. Follow-up for each patient was 3 years prior to surgery and 3 years after surgery.
  
  
  METHODS
  Self-harm emergencies 3 years before and after surgery.
  
  
  RESULTS
  The cohort included 8815 patients of whom 7176 (81.4%) were women, 7063 (80.1%) were 35 years or older, and 8681 (98.5%) were treated with gastric bypass. A total of 111 patients had 158 self-harm emergencies during follow-up. Overall, self-harm emergencies significantly increased after surgery (3.63 per 1000 patient-years) compared with before surgery (2.33 per 1000 patient-years), equaling a rate ratio (RR) of 1.54 (95% CI, 1.03-2.30; P = .007). Self-harm emergencies after surgery were higher than before surgery among patients older than 35 years (RR, 1.76; 95% CI, 1.05-2.94; P = .03), those with a low-income status (RR, 2.09; 95% CI, 1.20-3.65; P = .01), and those living in rural areas (RR, 6.49; 95% CI, 1.42-29.63; P = .02). The most common self-harm mechanism was an intentional overdose (115 [72.8%]). A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the 5 years before the surgery.
  
  
  CONCLUSIONS
  In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.
authors.affiliation: Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada2Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Junaid A
authors.initials: JA
authors.lastname: Bhatti
authors.affiliation: Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada2Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada4Department of Surgery, Sunnyb.
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Deva
authors.initials: D
authors.lastname: Thiruchelvam
authors.affiliation: Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada6Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.
authors.forename: Teodor
authors.initials: T
authors.lastname: Grantcharov
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
authors.affiliation: Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada2Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000523:psychology*; D018592:Cross-Over Studies; D004630:Emergencies / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000523:psychology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D055815:Young Adult