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Ngenge S, Xie L, McAdams C, Almandoz JP, Mathew MS, Schellinger JN, Kapera O, Marroquin E, Francis J, Kukreja S, Schneider BE, Messiah SE. Depression and Anxiety as Predictors of Metabolic and Bariatric Surgery Completion Among Ethnically Diverse Patients. Obes Surg 2023; 33:2166-2175. [PMID: 37217806 PMCID: PMC10202355 DOI: 10.1007/s11695-023-06652-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Mental health conditions including depression and anxiety are often prevalent among metabolic and bariatric surgery (MBS) patients, but it is not known if these conditions predict the decision to complete the procedure and if this varies by race and ethnicity. This study aimed to determine if depression and anxiety are associated with MBS completion among a race/ethnically diverse sample of patients. METHODS This prospective cohort study included participants who were referred to an obesity program or two MBS practices between August 2019 and October 2022. Participants completed the Mini International Neuropsychiatric Interview (MINI) instrument to determine history of anxiety and/or depression, as well as MBS completion status (Y/N). Multivariable logistic regression models determined the odds of MBS completion by depression and anxiety status adjusting for age, sex, body mass index, and race/ethnicity. RESULTS The sample consisted of 413 study participants (87 % women, 40% non-Hispanic White, 39% non-Hispanic Black, and 18% Hispanic). Participants with a history of anxiety were less likely to complete MBS (aOR = 0.52, 95% CI = 0.30-0.90, p = 0.020). Women had increased odds of a history of anxiety (aOR = 5.65, 95% CI = 1.64-19.49, p = 0.006) and of concurrent anxiety and depression (aOR = 3.07, 95% CI = 1.39-6.79, p = 0.005) compared to men. CONCLUSIONS Results showed that participants with anxiety were 48% less likely to complete MBS compared to those without anxiety. Additionally, women were more likely to report a history of anxiety with and without depression versus men. These findings can inform pre-MBS programs about risk factors for non-completion.
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Affiliation(s)
- Sophia Ngenge
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Luyu Xie
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Sunil Mathew
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olivia Kapera
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- University of Texas Health Science Center, School of Public Health, Austin, TX, USA
| | - Elisa Marroquin
- Department of Nutritional Sciences, Texas Christian University, Fort Worth, TX, USA
| | - Jackson Francis
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | | | - Benjamin E Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA.
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA.
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Dahlberg K, Jaensson M, Cao Y, Näslund E, Stenberg E. Incidence of self-harm after bariatric surgery: A nationwide registry-based matched cohort study. Clin Obes 2023; 13:e12576. [PMID: 36610057 DOI: 10.1111/cob.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/02/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023]
Abstract
The aims of this study were to evaluate the longitudinal risk of self-harm and the risk factors for self-harm after bariatric surgery in patients and control subjects without prior self-harm. This observational cohort study was based on prospectively registered data. Patients 18-70 years at time of surgery, body mass index (BMI) > 30 kg/m2 , who underwent a primary Roux-en-Y gastric bypass (RYGB) procedure or a primary sleeve gastrectomy between 2007 and 2019 were considered for inclusion. All patients who met the inclusion criteria were matched 1:10 to the general population in Sweden (69 492 patients vs. 694 920 controls). After excluding patients and controls with previous self-harm, a self-harm event occurred in 1408 patients in the surgical group (incidence rate (IR) 3.54/1000 person-years, 95% confidence interval (CI) 3.36-3.73) versus in 3162 patients in the control group (IR 0.81/1000 person-years, 95% CI 0.78-0.84), with a hazard ratio (HR) of 4.38 (95% CI 4.11-4.66, p < .001). Median follow-up time was 6.1 years. Risk factors were younger age, lower BMI, cardiovascular, and chronic obstructive pulmonary disease, all aspects of psychiatric comorbidities (except neuropsychiatric disorder), lower socioeconomic status, RYGB, lower health-related quality of life, lower postoperative weight loss, and not attending postoperative follow-up visits. Self-harm is clearly higher after bariatric surgery than in the general population. A qualitative follow-up may be particularly important for patients at increased risk.
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Affiliation(s)
- Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Pekin C, McHale M, Seymour M, Strodl E, Hopkins G, Mitchell D, Byrne GJ. Psychopathology and eating behaviour in people with type 2 diabetes referred for bariatric surgery. Eat Weight Disord 2022; 27:3627-3635. [PMID: 36495463 PMCID: PMC9803743 DOI: 10.1007/s40519-022-01502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Psychopathology and disordered eating behaviours are putative pre-operative risk factors for suboptimal outcomes post-bariatric surgery. Documented psychopathology prevalence rates vary in bariatric candidate samples. Further, less attention has been paid to vulnerable subgroups such as people with diabetes who might be at an elevated risk. For these reasons, this study aimed to investigate the rates of psychopathology and disordered eating in pre-surgical candidates with type 2 diabetes mellitus (T2DM). METHODS Participants were 401 consecutive patients from a state-wide bariatric surgery service for people with T2DM. Psychopathology was measured using multi-modal assessment including diagnostic interview and battery of validated questionnaires. The mean age of the sample was 51 years with a mean BMI of 46 kg/m2. The majority of the sample was female (60.6%), born in Australia (87%) and 18.2% identified as Aboriginal and/or Torres Strait Islander. RESULTS Rates of current psychopathology in this sample included: major depressive disorder (MDD; 16.75%), generalised anxiety disorder (GAD; 20.25%), insomnia (17.75%) and binge eating disorder (BED; 10.75%). There were no significant differences on measures between people who endorsed Aboriginal and/or Torres Strait Islander status compared to those who did not endorse. The mean total score on the BES was 21.82 ± 10.40 (range 0-39), with 8.2% of participants meeting criteria for severe binge eating. Presence of an eating disorder was not significantly associated with degree of glycemic compensation. Average emotional eating scores were significantly higher in this study, compared to reference samples. Significantly increased binge eating severity and emotional eating severity was revealed for people with T2DM and comorbid MDD, social anxiety and eating disorders. Binge eating severity was associated with GAD, food addiction, substance use disorders, and history of suicide attempt but not emotional eating severity. CONCLUSION Amongst people with T2DM seeking bariatric surgery, MDD, GAD and emotional eating were common. Psychopathology in a sample of people with T2DM seeking bariatric surgery was significantly associated with severity of disordered eating. These findings suggest people with T2DM seeking bariatric surgery may be vulnerable to psychopathology and disordered eating with implications for early identification and intervention. LEVEL OF EVIDENCE Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- C Pekin
- Faculty of Medicine, Academy of Psychiatry, University of Queensland, Brisbane, QLD, Australia.
- Department of Psychology, Royal Brisbane & Women's Hospital and School of Psychology, University of Queensland, Brisbane, QLD, Australia.
| | - M McHale
- Department of Psychology, Royal Brisbane & Women's Hospital and School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - M Seymour
- Faculty of Medicine, Department of Endocrinology and Diabetes, Royal Brisbane & Women's Hospital, University of Queensland, Brisbane, QLD, Australia
| | - E Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - G Hopkins
- Division of Surgery Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - D Mitchell
- Division of Surgery Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - G J Byrne
- Faculty of Medicine, Academy of Psychiatry, University of Queensland, Brisbane, QLD, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
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Fipps DC, Sinha S, Diwan TS, Clark MM. Psychosocial considerations in the combined bariatric surgery and organ transplantation population: a review of the overlapping pathologies and outcomes. Curr Opin Organ Transplant 2022; 27:514-522. [PMID: 36103143 DOI: 10.1097/mot.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW This review highlights the salient data of the psychosocial concerns that influence outcomes of bariatric surgery and organ transplantation. RECENT FINDINGS Bariatric surgery has emerged as an important intervention with data supporting substantial and sustained weight loss, enhanced quality of life, remission of obesity-related medical comorbidities, and improved long-term patient and graft survival in transplant patients. Depression, suicide, anxiety, posttraumatic stress disorder, alcohol use, adherence, and psychopharmacology considerations can influence outcomes of both these surgeries. SUMMARY Obesity is increasingly prevalent among patients pursuing transplantation surgery, and it is often a factor in why a patient needs a transplant. However, obesity can be a barrier to receiving a transplant, with many centers implementing BMI criteria for surgery. Furthermore, obesity and obesity-related comorbidities after transplant can cause poor outcomes. In this context, many transplant centers have created programs that incorporate interventions (such as bariatric surgery) that target obesity in transplant candidates. A presurgery psychosocial assessment is an integral (and required) part of the process towards receiving a bariatric surgery and/or a transplantation surgery. When conducting a dual (bariatric and transplantation surgery) psychosocial assessment, it is prudent to understand the overlap and differentiation of specific psychosocial components that influence outcomes in these procedures.
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Affiliation(s)
| | - Shirshendu Sinha
- Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Matthew M Clark
- Department of Psychiatry and Psychology
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Mabey JG, Kolotkin RL, Crosby RD, Crowell SE, Hunt SC, Davidson LE. Mediators of suicidality 12 years after bariatric surgery relative to a nonsurgery comparison group. Surg Obes Relat Dis 2020; 17:121-130. [PMID: 33036940 DOI: 10.1016/j.soard.2020.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals undergoing bariatric surgery report higher levels of suicidality than the general population, but it is unknown what mediates this phenomenon or how this compares with individuals with severe obesity not receiving surgery. OBJECTIVES We evaluated suicidality in 131 individuals 12 years post surgery compared with 205 individuals with severe obesity who did not undergo surgery. Changes in health-related quality of life (HRQOL) and metabolic health were assessed as mediators of suicidality. SETTING University. METHODS Suicidality was assessed with the Suicide Behaviors Questionnaire-Revised at 12 years. Metabolic health and HRQOL (Short Form-36 [SF-36] Mental Component Summary score, Physical Component Summary score, and Impact of Weight on Quality of Life-Lite) were assessed at baseline and 2 and 6 years. The effects of bariatric surgery on suicidality at 12 years were assessed through univariate and multivariate sequential moderated mediation models, with changes in metabolic health and HRQOL from 0-2 years and 2-6 years as mediators. RESULTS Suicidality was higher in the surgery group versus the nonsurgery group (estimate [est.] = .708, SE = .292, P < .05). Only the indirect pathways at 2 years after surgery for SF-36 Mental Component Summary in the univariate models (est. = -.172, SE = .080, P < .05) and for SF-36 Physical Component Summary in the multivariate model (est. = .593, SE = .281, P < .05) were significant. CONCLUSION Individuals undergoing bariatric surgery reported higher levels of suicidality at 12 years, which was mediated by less improvement in the mental and physical components of HRQOL in the first 2 years after surgery, suggesting the need for additional clinical monitoring.
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Affiliation(s)
- Jacob G Mabey
- Department of Exercise Sciences, Brigham Young University, Provo, Utah.
| | - Ronette L Kolotkin
- Quality of Life Consulting, Durham, North Carolina; Duke Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway; Centre of Health Research, Førde Hospital Trust, Førde, Norway; Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, Utah; Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah; Department of Obstetrics & Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Steven C Hunt
- Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar; Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Lance E Davidson
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
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Abstract
PURPOSE OF REVIEW Individuals with morbid obesity benefit from bariatric surgery with respect to weight loss and decreases in obesity-related somatic disorders. This paper focuses on psychosocial outcomes and provides a narrative review of recent meta-analyses and controlled studies concerning postoperative depression and suicide. RECENT FINDINGS Considerable evidence shows short- and medium-term improvement in depressive symptoms after surgery. However, a subgroup of patients exhibits erosion of these improvements or new onset of depression in the long run. Some studies have found an increased risk for suicide among postoperative patients. Prospective longitudinal examinations of factors contributing to the increased risk for postoperative depression and suicide and the interaction between these factors are warranted. The inclusion of mental health professionals in bariatric teams would help to monitor patients for negative psychosocial outcomes and to identify those patients who are vulnerable to depression, suicide, and any other forms of deliberated self-harm following surgery.
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