Suicidal thoughts and behaviors in adolescents who underwent bariatric surgery

BACKGROUND

Extant literature warns of elevated suicide risks in adults postbariatric surgery, making understanding risks for adolescent patients imperative.

OBJECTIVES

To examine prevalence and predictors/correlates of suicidal thoughts and behaviors (STBs) in adolescents with severe obesity who did/did not undergo bariatric surgery from presurgery/baseline to 4 years postsurgery.

SETTING

Five academic medical centers.

METHODS

Using a prospective observational design, surgical adolescents (n = 153; 79% female, 65% white, mean [M]_age = 17 yr, M_{body mass index[BMI]} = 52 kg/m²) and nonsurgical comparators (n = 70; 80% female, 54% white, M_age = 16 yr, M_BMI = 47 kg/m²) completed psychometrically sound assessments at presurgery/baseline and postsurgery years 2 and 4 (year 4: n = 117 surgical [M_BMI = 38 kg/m²], n = 56 nonsurgical [M_BMI = 48 kg/m²]).

RESULTS

For the surgical group, rates of STBs were low (year 2 [1.3%-4.6%]; year 4 [2.6%-7.9%], similar to national base rates. Groups did not differ on a year 4 postsurgical STBs (post-STBs) composite (post-STBs: ideation/plan/attempt; n = 18 surgical [16%], n = 10 nonsurgical [18%]; odds ratio = .95, P = .90). For the surgical group, predictors/correlates identified within the broader suicide literature (e.g., psychopathology [P < .01], victimization [P < .05], dysregulation [P < .001], drug use [P < .05], and knowing an attemptor/completer [P < .001]) were significantly associated with post-STBs. Surgery-specific factors (e.g., percent weight loss, weight satisfaction) were nonsignificant. Of those reporting a lifetime attempt history at year 4, only a minority (4/13 surgical, 3/9 nonsurgical) reported a first attempt during the study period. Of 3 decedents (2 surgical, 1 nonsurgical), none were confirmed suicides.

CONCLUSIONS

The present study indicates that undergoing bariatric surgery in adolescence does not heighten (or lower) risk of STB engagement across the initial 4 years after surgery. Suicide risks present before surgery persisted, and also newly emerged in a subgroup with poorer psychosocial health.

Alcohol use risk in adolescents 2 years after bariatric surgery

BACKGROUND

Problematic alcohol use and increased sensitivity postoperatively in adult weight loss surgery patients heightens concerns. No data have characterized these behaviors in adolescents-a gap, given adolescent alcohol use and heavy drinking are public health concerns.

OBJECTIVE

To examine alcohol use behavior in adolescents who underwent weight loss surgery across the first two post-operative years in comparison to nonsurgical adolescents.

SETTING

Five academic medical centers.

METHODS

Utilizing a prospective controlled design, adolescents undergoing weight loss surgery (n = 242) and nonsurgical adolescents with severe obesity (n = 83) completed the Alcohol Use Disorders Test. Analyses included 216 surgical (M_age = 17.1 ± 1.5, M_BMI = 52.9 ± 9.3, 91.8% female, 67.6% white) and 79 nonsurgical participants (M_age = 16.2 ± 1.4, M_BMI = 46.9 ± 6.1, 82.3% female, 53.2% white), with baseline data and at 12 or 24 months postoperatively.

RESULTS

The majority reported never consuming alcohol within the year before surgery (surgical, 92%; nonsurgical, 91%) or by 24 months (surgical, 71%; nonsurgical, 74%), when alcohol use disorder approached 9%. Among alcohol users at 24 months (n = 52 surgical, 17 nonsurgical), 35% surgical and 29% nonsurgical consumed 3+drinks on a typical drinking day; 42% surgical and 35% nonsurgical consumed 6+drinks on at least 1 occasion. For the surgical group, alcohol use changed as a function of older age (odds ratio [OR] = 2.47, P = .01) and lower body mass index (OR = .94, P<.001). Greater percent change in weight (0-24 mo) was associated with increased odds of alcohol use at 24 months (OR = 1.01, 95% confidence interval: 1.002-1.02).

CONCLUSION

Alcohol use was lower than national base rates. Alcohol use disorder rates and harmful consumption raise concerns given extant adult literature. Alcohol education focused on harm reduction (i.e., lower consumption, managing situations conducive to alcohol-related harm) and monitoring by healthcare providers as patients mature is indicated.

Information needs among adolescent bariatric surgery patients and their caregivers

BACKGROUND

Bariatric surgery is an invasive medical treatment for morbid obesity that requires behavioral maintenance for physical success. Patient knowledge, motivation, and adherence are important factors in optimizing results.

OBJECTIVES

The purpose of the present study was to identify perceived informational gaps of adolescent and young adult bariatric surgery patients with morbid obesity (body mass index≥40 kg/m(2)).

SETTING

This study took place in a pediatric tertiary care academic medical center.

METHODS

Thirty-one adolescents/young adults who had undergone Roux-en-Y gastric bypass surgery at the authors' institution were recruited to complete questionnaires at their postsurgical visits (≥3 months postsurgery). Seventeen caregivers also participated in this study. The questionnaire used in the present study prompted patients and caregivers to reflect on information they wish they had known before surgery; questionnaire items included multiple choice and open-ended questions.

RESULTS

Participants indicated that their informational needs were generally well met before surgery, although there were more needs noted by patients than by caregivers. Adolescent/young adult participants expressed a desire to have had more information about the necessity of taking vitamins daily and about having more gas. An association between informational needs and satisfaction was also found. Qualitative data revealed the importance of conveying cognitive-behavioral aspects of surgery to families (e.g., adherence, motivation).

CONCLUSION

Despite most patients and caregivers being satisfied with the adolescent bariatric surgery program at the authors' institution, informational gaps exist. Teen-friendly ways to disseminate information would be helpful in influencing patients' satisfaction.

Improved technique for developing creatine kinase isoenzyme bands by using a substrate in gelatin matrix

We describe a simple technique for reacting CK isoenzymes with a substrate in gelatin to make them visible after they have been separated by cellulose acetate electrophoresis. The electrophoresed strip requires only 5 min of contact with the substrate in gelatin and about 12 min of drying in an oven at 55 degrees C. The developed isoenzyme bands are discrete, intense, and rectangular in shape. The technique has a sensitivity of 2 to 5 U/liter, and results for isoenzyme MB can be reported about 30 min from the time a specimen is received.

Improved technique for developing creatine kinase isoenzyme bands by using a substrate in gelatin matrix

We describe a simple technique for reacting CK isoenzymes with a substrate in gelatin to make them visible after they have been separated by cellulose acetate electrophoresis. The electrophoresed strip requires only 5 min of contact with the substrate in gelatin and about 12 min of drying in an oven at 55 degrees C. The developed isoenzyme bands are discrete, intense, and rectangular in shape. The technique has a sensitivity of 2 to 5 U/liter, and results for isoenzyme MB can be reported about 30 min from the time a specimen is received.