Background Metabolic and bariatric surgery (MBS) and incretin-based pharmacotherapy (GLP-1 receptor agonists) cause substantial weight loss, but whether the accompanying psychological improvement is associated with the degree of weight loss or with treatment-specific mechanisms is unclear. Objective To compare changes in psychiatric symptoms, psychological well-being and quality of life after MBS and incretin-based therapy, and to examine the role of weight loss. Methods In this prospective, non-randomized cohort study, 207 adults with obesity (MBS, n = 97; incretin-based pharmacotherapy, n = 110 [tirzepatide 87, semaglutide 19, liraglutide 4]) completed 16 psychiatric and quality-of-life scales before treatment and at 6 months. Results Weight loss was 33.2 ± 9.9 kg with MBS and 16.8 ± 11.5 kg with pharmacotherapy. Both groups improved significantly on all 16 scales (r = 0.28–0.84; all p ≤ 0.02). With pharmacotherapy, improvement correlated with weight loss on all scales (all p ≤ 0.04; |r| = 0.20–0.45); after MBS, no association was observed (all p > 0.5). Crude between-group differences favoring MBS (5/16 scales) disappeared after adjustment for weight loss. Only emotion regulation difficulties showed a significant group × time interaction (coefficient 3.3, 95% CI 0.7–5.9). Conclusions Both groups showed improved psychological well-being and quality of life. Improvement tracked weight loss with pharmacotherapy but not after MBS, possibly reflecting less variable weight loss after surgery. The crude advantage of MBS was no longer evident after adjusting for weight loss, suggesting an association with greater weight loss rather than a modality-specific effect, with emotion regulation as a possible exception.
Objective To synthesize clinically distinct suicide-related outcomes in amyotrophic lateral sclerosis (ALS) and comparative suicide risk without pooling non-equivalent constructs. Methods We searched MEDLINE, Embase, Scopus, PsycINFO, the Virtual Health Library, and SciELO through March 17, 2026, and updated all searches for March 18 through October 9, 2026. We included observational reports of predefined suicide-related outcomes. Outcomes with at least 3 independent studies were pooled using random-effects generalized linear mixed models for proportions and a Hartung-Knapp model for comparative estimates. We used Joanna Briggs Institute tools and adapted GRADE. Results Twenty-eight reports representing 26 independent cohorts were included; 21 cohorts contributed quantitative data. Active suicidal ideation was 43% (23/53; 95% CI, 30%–58%) in an end-stage cohort and 14% (10/71; 95% CI, 7%–24%) in a general clinic cohort; these estimates were not pooled. Hypothetical consideration of assisted dying was 50% (95% CI, 41%–59%; I2 = 49%; 95% prediction interval, 21%–79%; 4 studies). Crude suicide mortality rates were 0.16 and 0.36 per 100 person-years in 2 cohorts. Three registry or administrative cohorts yielded a relative suicide-risk estimate of 4.6 (95% CI, 2.5–8.5; 95% prediction interval, 0.4–53.6). Certainty was low or very low. Conclusions Suicide-related experiences in ALS are clinically distinct. Clinicians should clarify meaning, assess intent and immediacy, evaluate decision-making capacity and treatable psychiatric symptoms, and address palliative and psychosocial needs. A death wish or assisted-dying preference should not be assumed to indicate active suicidal intent.
