Meta-analysisindependent cross-checkabstract checked★ key study I-BAR-128 in-depth review

Meta-analysis: suicide after weight-loss surgery

Risk of suicide after metabolic bariatric surgery: a meta-analysis of matched cohort studies and population-based studies.

Overview

Cui et al.. Surg Obes Relat Dis 2025 · PMID 39516067 · DOI 10.1016/j.soard.2024.10.014

Suicide was about twice as frequent after surgery, though still rare (about 2 in 1000).

Does the study support the specific claim? Yes · Methodological quality: moderate

Study explained simply

What did the researchers want to find out?: Suicide risk after MBS
How was the study done?: Meta-analysis
How many people, animals or samples were studied?: 667,257
What was actually found?: HR 2.12
How large was the observed effect?: HR 2.12 (1.54-2.92)
What do the results mean in everyday life?: Mental-health follow-up is important
What are the study's limitations?: Few, overlapping studies
What does it say about Elawady's specific claim?: Supports the claim
Do the results apply to Germany and Europe?: Applicable
What can explicitly not be concluded from this study?: Cause

Authors: Cui et al.
Journal: Surg Obes Relat Dis
Year: 2025
Identifier: PMID 39516067 DOI 10.1016/j.soard.2024.10.014
Verification: verified – PubMed efetch 2026-10-26 + Crossref API
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: COI statement (PubMed record): Disclosures The authors have no commercial associations that might be a conflict of interest in relation to this article.

Is the risk of suicide higher in adults treated with metabolic bariatric surgery than without?

Study design: Meta-analysis – Meta-analysis of matched cohort and population-based studies
Population: Adults with obesity
Country: Multinational
Period: Search to 30 April 2024
Sample size: 5 studies (3 matched cohorts with 4 cohorts, 2 population-based); 114,615 MBS (272 suicides) vs 552,642 non-surgery (622 suicides)
Inclusion and exclusion criteria: Matched cohort and population-based studies

Results: Pooled HR 2.12 (1.54-2.92; I2 24%); pooled RR 2.32 (1.55-3.45; I2 58%). Matched cohorts HR 2.64 (1.84-3.77) vs population-based 1.67 (1.32-2.12).
Absolute risks: Crude: about 2.4 vs 1.1 suicides per 1000 patients (computed from abstract counts).
Authors' conclusion: Suicide risk more than doubled after MBS, but absolute risk was low and does not warrant general discouragement of MBS.

Orienting tool: AMSTAR 2
Type of assessment: simplified assessment (abstract only)
Full formal assessment: no
Overall risk of bias: some concerns
Rationale: Includes overlapping Nordic/Swedish data; counts are not independent confirmations of A-BAR-16.

Crude RR 2.11 matches pooled estimates (stats/I-BAR-128_cui_2025_suicide.py).

Most recent pooled estimate confirming increased suicide risk after surgery, with low absolute risk.

Authors state it does not warrant discouraging surgery.

Includes European data.

Supports C-BAR-07.

Multidimensional assessment
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	high
Adequacy of the interpretation (by the archive)	not applicable

Mechanisms; procedure-specific risk.