Background

Elevated suicidal risk for adult bariatric patients is concerning. Adolescence and young adulthood (AYA) are high risk periods for suicidal thoughts and behaviors (STBs). Understanding how STBs and associated risk factors unfold for adolescents following bariatric surgery is critical to inform care guidelines.

Methods

Utilizing a multi-site prospective observational controlled design, adolescents undergoing bariatric surgery (n=153; Mage=17;MBMI=52, 79% female; 65% White) and nonsurgical comparators (n=70; Mage=16; MBMI=47, 80% female; 54% White) completed standardized assessments with psychometrically sound measures and safety follow-up at presurgery/baseline, Year 2, and Year 4 postsurgery, with 117 surgical (MBMI=38) and 56 comparators (MBMI=48) at Year 4.

Results

Groups did not significantly differ on a composite of postsurgery STBs at Year 4 (PostSTBs:past year ideation/plan/attempt, past-month ideation, any attempt: n=18 surgical [16%], 10 [18%] nonsurgical; OR=0.95,p=0.90). Surgical group predictors/correlates of PostSTBs were consistent with broader suicide and AYA literatures (e.g., depressive symptoms, victimization, dysregulation, drug/alcohol use) as opposed to surgery-specific factors (e.g., % weight loss, weight satisfaction, procedure). Of those with an attempt history (lifetime), only a minority (4/13 surgical, 3/9 comparators) reported a first attempt during the four year study period (i.e. postsurgery). Of 3 decedents (2 surgical, 1 comparator), none were confirmed suicides.

Conclusions

Suicide risk reduction is a public health priority for AYAs. While bariatric surgery in adolescents does not appear to increase (or lessen) risk of engaging in postsurgery STBs to Year 4, suicide risks remain in a subgroup with poorer psychosocial health. Longer-term follow-up and controlled outcome studies are needed and ongoing.