Spunkycat

Sunnybrook Research Institute study findings

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just heard a brief 30 second news report recently released by the above institute. What I heard was that at 2 years after WLS, patients have a 50% increased risk of suicide.

Found  the Sunnybrook web site but could not find the study itself.

This research institute is prestigious and one of Canada's largest research centers. I am aware of this facility because of their breakthrough work into anti cancer vaccines.

If someone can find the actual research article, please share.

Thanks

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Here's the link. The article was in the Wall Street Journal, of all places!

http://www.wsj.com/articles/attempted-suicide-rises-after-weight-loss-surgery-study-finds-1444230034

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The article makes sense, but as I was reading I jumped straight to the thought the first commenter suggested, which was that the findings weren't surprising given the reluctance of some surgeons to perform WLS on patients with prior suicide attempts. With a certain portion of people known to be prone to suicide attempts being excluded from the study, it follows that the rate of suicide attempts would be higher post-op.

The interesting finding was the time frame. That the increase was seen 2-3 years post-op would support their recommendation that follow-up services extend out further, past the honeymoon and into the period where the novelty has worn off and the real work begins.

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If found it on CNN.com.  For me I don't get it, yes I have struggled with depression since I was a teen, but I am happier now than before.  I wonder if the suicide rate/attempt rate is effected by success of the surgery.  I can understand if someone had WLS and didn't lose what they wanted or did reach the goal they had set they could be more depressed and feel hopeless, but if you are successful I would think people would be happier.

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haven't read the article yet but for what it's worth, I have always found success to be problematic.  success sets up a whole nother level of expectations that may be difficult for a person with depression and/or other mental "problems". 

depression hasn't been a problem since surgery, although I am ever vigilant, but I do struggle with what success means to me and the concept of being "out there" in the world.  I spent most of my life striving to be invisible.  not such an easy task when you are big, but it is amazing how much people don't notice you when you are fat.  now suddenly I am noticible.  people who have never talked to me will now talk to me.  people who know me now make comments on my appearance (all positive), which indicates to me - - - OMG! they can see me. 

losing weight may fix a lot of things about your health but it doesn't fix your life. 

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Still needed to finish the article but I can see how this could be possible, but of course one study doesn't prove anything definitively.

For many, eating is a coping mechanism for many feelings ranging from depression to things even worse.  Take that coping mechanism away, then let the ease of the honeymoon period end along with the reality that weight maintenance is hard work and other problems that lead to overeating are still there and I can see how the situation would be seen by some as hopeless.  This is an example why support is so important, this sort of journey is not something to do alone.

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Just to put this in perspective:  https://www.nlm.nih.gov/medlineplus/news/fullstory_155028.html

" .......111 patients had 158 self-harm emergencies during the follow-up period, the study found. Most of the suicide attempts occurred in the second and third year after the surgery, the findings showed.

And about 93 percent of those suicide attempts occurred in patients diagnosed with a mental health disorder prior to surgery, the researchers reported. The most common type of suicide attempt was an intentional overdose, which occurred in 73 percent of cases.".

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I would also be curious as to how many folks were in a "fast track" program. We know there are some out there. My program was in depth and really brought forward many questions that I had not even thought of. I was disappointed at the pace to receive my surgery date and now realize that the program is set up to weed out the candidates that are not ready or able to handle such a change. This surgery is not like fixing a knee.

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Duff

i agree with you. I know there are people who go to Mexico to self pay. I understand why some people have to get that route but they lack both the preparation time and the in person follow up. Not criticizing , just saying how important formal support and  follow up should be available to post-op patients for a longer period of time. I am fortunate that my bariatric program offers forever support in terms of groups and NUT visits.

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I would also be curious as to how many folks were in a "fast track" program. We know there are some out there. My program was in depth and really brought forward many questions that I had not even thought of. I was disappointed at the pace to receive my surgery date and now realize that the program is set up to weed out the candidates that are not ready or able to handle such a change. This surgery is not like fixing a knee.

Hmmm, I had both WLS and knee surgery exactly two years apart. My WLS was fast track over a two month time period, but very intense with many many meetings with PCP, surgeon, dietitians, psychologists, cardiologists, and a chemical stress test and CT scan.

The knee surgery recovery was also intense, with in home follow up, and four months of physical therapy. I have no more knee pain, just aches when the weather is lousy, and there will continue to be stretching exercises, probably indefinitely.

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Walk

you are so right. The surgery is on our stomach and intestines not our heads.

life is different after weight loss.

i am fortunate that I do not have a 66 year history of obesity. I have the yo yo dieting history. So having enough periods of thinness, I am pretty comfortable with being thin( actually I am at a healthy weight-not underweight).

i agree that it is a huge change for people who have been obese most of their lives. I think that appropriate counseling with a licensed therapist is a wise investment of both time and money to help someone going thru the huge changes associated with a  large weight loss.

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Just to put this in perspective:  https://www.nlm.nih.gov/medlineplus/news/fullstory_155028.html

" .......111 patients had 158 self-harm emergencies during the follow-up period, the study found. Most of the suicide attempts occurred in the second and third year after the surgery, the findings showed.

And about 93 percent of those suicide attempts occurred in patients diagnosed with a mental health disorder prior to surgery, the researchers reported. The most common type of suicide attempt was an intentional overdose, which occurred in 73 percent of cases.".

I wonder what percentage of WLS patients have a mental health disorder (w/o suicide attempt) prior to surgery? My guess is it would be pretty high.

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I wonder what percentage of WLS patients have a mental health disorder (w/o suicide attempt) prior to surgery? My guess is it would be pretty high.

That's a good question!

This is an interesting read from the Centers for Disease Control and Prevention  The whole article is a good read:

Data from the National Health and Nutrition Examination Surveys, 2005–2010

Data from the National Health and Nutrition Examination Surveys, 2005–2010

  • Forty-three percent of adults with depression were obese, and adults with depression were more likely to be obese than adults without depression.
  • In every age group, women with depression were more likely to be obese than women without depression.
  • The prevalence of obesity was higher for non-Hispanic white women with depression compared with non-Hispanic white women without depression, a relationship that was not present in non-Hispanic black and Mexican-American women.
  • The proportion of adults with obesity rose as the severity of depressive symptoms increased.
  • Fifty-five percent of adults who were taking antidepressant medication, but still reported moderate to severe depressive symptoms, were obese.

In 2005–2010, 34.6% of U.S. adults aged 20 and over were obese and 7.2% had depression, based on depressive symptoms experienced in the past 2 weeks (1). Both obesity and depression are associated with many health risks, including cardiovascular disease, diabetes, and functional limitations (24). Studies have shown higher rates of obesity in persons with depression (5,6). This relationship may vary by sex (7). Almost 11% of adults take antidepressant medication (8) including persons who are responding well and persons who still have moderate to severe symptoms of depression. Use of some antidepressants is positively related to obesity (9). Understanding the relationship between depression (defined by moderate to severe symptoms) and antidepressant usage and obesity may inform treatment and prevention strategies for both conditions.

 

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Just to put this in perspective:  https://www.nlm.nih.gov/medlineplus/news/fullstory_155028.html

" .......111 patients had 158 self-harm emergencies during the follow-up period, the study found. Most of the suicide attempts occurred in the second and third year after the surgery, the findings showed.

And about 93 percent of those suicide attempts occurred in patients diagnosed with a mental health disorder prior to surgery, the researchers reported. The most common type of suicide attempt was an intentional overdose, which occurred in 73 percent of cases.".

Seems to me that if 93% of these attempted suicides were already diagnosed with a mental disorder prior to surgery how many of them would have attempted suicide anyways.  (And maybe even sooner)  Having had surgery may be incidental, not a cause and effect.  One study does not make something true, especially when it's as complicated as depression, mental health and obesity.

personally, my suicidal thoughts never did and still don't have anything to do with my weight.  Studies like these always give me the impression the researchers are just looking for an excuse and any easy fix.  Sometimes there just are no answers to the questions.

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This is EXACTLY why i have ticked off a few family members by saying that I think there should be more strict psychological prep BEFORE and required therapy for a time after WLS.  I am not trying to offend anyone that was fast tracked, I am VERY happy for all of you and your weight loss. However, it took me a year to be approved for the surgery and my insurance required me to see a therapist and go to group counseling before surgery. There was no requirement for after the surgery and there have been times when I have really struggled emotionally. Food was a coping mechanism for me and I had to learn how to deal with my emotional pain another way.

My own cousin committed suicide 3 years after her WLS. I miss her everyday and I don't believe that she killed herself because she had WLS, but i DO believe that the loss of her "go to" comfort had a bit of an influence on how low she actually got. 

 

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I am friends with the RN who is the coordinator of the bariatric center of excellence where I had my surgery. I called her and told her about the study findings. She said she was going to present the findings at the Team's weekly Journal Club meeting. I think everyone here that has questions about the study is spot on. Research studies do not necessarily cover every variable. One of the most important things a research study like this can do is to heighten our awareness about potential issues that we might face in the 2nd and 3rd years after surgery. I can see that this study might be on to something. Some people lose the weight and I think expect their life to be totally wonderful because they are thin. So their expectations don't match the reality of their life. I can see someone facing the reality of not having their expectations met, becoming depressed and committing suicide. I think there are people who have surgery , lose weight, and expect their life to change to a life of nothing but happiness and having everything they ever wanted. Reality can be harsh and cold when people find out that weight loss does not solve all their problems. We already know about the reality of addiction transfer so I think we need to be aware of the possibility of increased suicide risks.

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It's such a sad thing to know that someone feels so hopeless that they think the only solution is suicide.  Depression is a very real thing and unfortunately our society still dismisses mental illness and often it's perceived as a personal weakness. No one expects you to just get over high blood pressure or thyroid disease but if depressed people are often told by loved ones to just stop thinking that way and get over it.  It's a real shame because the truth is that's simply not possible for truly suffering from depression. Many people suffer in silence for fear of judgement or ridicule.  

I'm of a mind that knowledge is a powerful thing and the more information you have the better prepared you can be for things that come up along the way.  Just like knowing that tastes can change or addiction transfer can be a problem awareness that depression can become severe is important.  If you know that depression with suicidal ideation or action is possibly a complication a few years following WLS, then you can be armed and hopefully ready to get help as soon as you start feeling low.  It may or may not be a chicken and egg situation. It may be that people have been suffering more than anyone realized. It may be the study is flawed.  It may be sit on. Or just like  people who have never had problems with drinking  but turn to alcohol after WLS, depression may rear it's head unexpectedly. Who knows. But awareness is really important. Great information!!

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Raeme

Your words are very powerful.

i have posted several times about how knowledge brings power. Power gives us a better chance to advocate for ourselves. Self advocacy is something that women sometimes have more trouble doing than men do. Girls are not always raised to speak out for themselves. They are sometimes raised to just accept whatever is given to them. In my perfect world, women would be paid the same salary as men for the same job. Women would be praised for assertiveness and encouraged to pursue their dreams no matter how impossible the dream seems to be. Off my soapbox. I believe there are people who are depressed and never have an official diagnosis. They go through a screening and never are identified as being depressed and fly under the radar. They have surgery and then the weight loss does not  fix their life as they hoped. Some may go onto addiction transfer, some may commit suicide. Alcohol and recreational drug use for some people is self medication. Anything to take away the pain they are feeling. There is also ample evidence that depression and suicide has a genetic basis. Depression/ suicide is present in some family lineages. Families who carry that genetic predisposition should be aware that they are at increased risk for depression and suicide. It is the same concept as diabetes and high cholesterol being present in multiple generations of a family. 

One of the reasons I shared this with the bariatric coordinator was to give her info that she could share. Maybe bariatric programs need to tighten their psychological screenings.? Maybe the waiting period for surgery should be longer?

I don't have an answer but my awareness is certainly heightened.

 

 

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I have struggled with clinical depression pretty much my whole life.  I wasn't diagnosed until my late 30s.  I have only a few vague memories about my childhood but talking to my older brother he told me that what he remembers about my mom is her lying in bed all day eating chocolates.  sounds like depression to me.  my mother was also an alcoholic.  so I don't drink and I pay attention if I start to have too many down days in a row for no good reason.  sometimes down days are a perfectly reasonable response to what is going on in your life. 

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I don't accept doctors,  and all other stakeholders are not aware of cross addiction potenttialities.  Any layman with am Internet connection can figure it out.  Comprehensive psychotherapy however could hinder the surgical process ultimately impacting the bottom line. Not a "big revelation"  to medically trained and I'd even go so far to say it a no brainer.  

Doctors and stakeholders need to not ignore this real side effect post surgery potential and ensure their patients have the needed resources to address the matter should it present itself.   

 

Edited by Wusang
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