​Bariatric weight-loss surgery is associated with reduced incidence of depression and reduced severity of depression symptoms, according to a review of more than 60 studies in the January 12, 2016, Journal of the American Medical Association. The review found that certain mental health conditions were common among patients seeking bariatric surgery, occurring in 23% of such patients; the most frequent diagnoses were depression (19%), binge eating disorder (17%), and anxiety (12%). There was no consistent evidence regarding an association between preoperative mental health status and postoperative weight loss, and neither of the two most common conditions, when present preoperatively, was linked to changes in weight-loss outcome. However, the corollary was true, in that postoperative weight loss was associated with consistent decreases in incidence of depression (8% to 74% decrease) and in depression symptom severity (40% to 70% decrease). Similarly, binge eating disorder was found to be less frequent two years after surgery, although rates tended to increase at later time intervals and returned to baseline in one study. The authors note that other mental health indicators, notably alcohol abuse, self-harm, and suicide, increased after surgery in some studies—cause for concern even in the absence of consistent patterns of evidence. Given the inconsistent results for many outcomes, the authors emphasize the need for providers to carefully evaluate all patients seeking bariatric surgery and ensure that postoperative support systems are attentive to changes in mental health.

HRC Recommends: Post-surgical increase in alcohol abuse, self-harm, and suicide—even if inconsistent—is a significant concern for facilities providing bariatric weight-loss surgery. Risk managers may wish to share study findings with appropriate clinical staff to ensure that appropriate screening and follow-up procedures are in place for patients seeking bariatric surgery. More broadly, healthcare facilities with bariatric surgery programs should assemble a competent, knowledgeable, multispecialty team of healthcare providers experienced in bariatric medicine and the care of overweight and morbidly obese patients. This includes appropriate personnel to evaluate and address mental health issues before and after surgery. Ongoing monitoring of patient outcomes should be in place to identify and correct any deficiencies in the bariatric surgery program.