Risk of suicide among operated and non-operated patients hospitalised for peptic ulcers.

BACKGROUND: Some small studies have reported high risk of suicide after surgical treatment for peptic ulcer. The aim of the present study was to explore the risk of suicide in hospitalised gastric ulcer and duodenal ulcer patients separately among operated and non-operated cohorts. METHODS: Retrospective cohorts of 163,579 non-operated patients with gastric ulcer or duodenal ulcer and 28,112 patients with surgical treatment for ulcer, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalisation, or operation for the surgery cohort, until death, any cancer, emigration, or 31 December 2003. Standardised mortality ratios (SMRs) were calculated, and Poisson regression produced adjusted relative risk estimates among operated and non-operated patients. RESULTS: Non-operated patients hospitalised for peptic ulcer showed a 70% excess risk of suicide (SMR 1.7, 95% CI 1.6 to 1.9) and those who underwent operation had a 60% increased risk (SMR 1.6, 95% CI 1.4 to 1.8). The risk of suicide was very high during the first year after hospitalisation (SMR 4.0, 95% CI 3.4 to 4.7) and more marked among women, patients under 70 and patients hospitalised without complications of ulcer. Both gastric ulcer and duodenal ulcer patients had high risk of suicide completion. CONCLUSION: Hospitalised patients with gastric ulcer or duodenal ulcer have an increased risk of suicide regardless of surgical treatment. These patients, especially women, are at very high risk during the first year after first hospitalisation/operation. The evaluation and management of suicidal thoughts in patients in medical settings should be further considered.

Fatigue and anxiety in surgical patients.

In 15 patients fatigue was assessed by an arbitrary scale, anxiety by the State-Trait Anxiety Inventory and concentration by various concentration tests before and 10 and 30 days after uncomplicated elective, abdominal surgery. Preoperatively, fatigue correlated to state-anxiety (r = 0.68) and trait-anxiety (r = 0.66). From pre- to postoperatively, fatigue had increased on both day 10 and day 30. State-anxiety decreased, while trait-anxiety was unchanged. Increase in fatigue 30 days after surgery correlated to increased state-anxiety (r = 0.65), but not significantly to trait-anxiety (r = 0.38). No correlation was found between increase in fatigue 30 days after surgery and the preoperative degree of state- and trait-anxiety, (r = -0.09, r = -0.29); respectively. Neither pre- nor postoperative performance during concentration tests correlated to postoperative fatigue. It is concluded that preoperative anxiety may not be decisive for the development of postoperative fatigue. Postoperative fatigue may be considered a symptom of deterioration in cardiovascular function, neuro-muscular performance and nutritional status rather than psychological factors.