Meta-analysisindependent cross-checkabstract only checked★ key study I-BAR-06 in-depth review
Meta-analysis: self-harm after surgery
Risk of Suicide and Self-harm Is Increased After Bariatric Surgery-a Systematic Review and Meta-analysis.
Overview
Castaneda D et al.. Obes Surg 2019 · PMID 30343409 · DOI 10.1007/s11695-018-3493-4
Self-harm attempts were about twice as common after surgery as before; suicides occurred in about 2.7 per 1000 patients.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Self-harm
- How was the study done?
Meta-analysis
- How many people, animals or samples were studied?
148,643
- What was actually found?
Increased risk
- How large was the observed effect?
OR 1.9 / 3.8
- What do the results mean in everyday life?
Mental-health screening matters
- What are the study's limitations?
Observational
- What does it say about Elawady's specific claim?
Supports
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Causation
Scientific in-depth review
1. Full reference
- Authors
- Castaneda D et al.
- Journal
- Obes Surg
- Year
- 2019
- Identifier
- PMID 30343409 DOI 10.1007/s11695-018-3493-4
- Verification
- verified – PubMed efetch 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Suicide and self-harm after bariatric surgery
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis
- Population
Bariatric patients
- Period
To Jan 2018
- Sample size
32 studies, 148,643
4. Methods and endpoints
- Exposure / intervention
Bariatric surgery
- Comparator
Pre-surgery same population; matched controls
- Endpoints
Suicide; suicide/self-harm attempts
5. Actual results
- Results
Suicide event rate 2.7/1000 patients; attempt rate 17/1000. Self-harm/attempt OR 1.9 (1.23-2.95) vs same population pre-surgery and OR 3.8 (2.19-6.59) vs matched controls.
- Absolute risks
Suicide 2.7 per 1000 patients
- Authors' conclusion
Higher self-harm/suicide attempt risk vs matched controls.
6. Strengths
- Comprehensive
7. Weaknesses
- Observational studies
- Overlap with Bhatti/Neovius
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
9. Assessment of the statistical interpretation
10. Relevance to the specific claim
Supports C-BAR-07.
11. Independent contrary findings
12. Transferability to Germany and Europe
Applicable.
13. Overall methodological judgement
Confirms association; absolute risk low.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- Bariatric surgery is followed by documented rises in self-harm, suicide-related deaths and alcohol use disorder. – Studies supporting the claim