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Bruze G, Järvholm K, Norrbäck M, Ottosson J, Näslund I, Söderling J, Reutfors J, Olbers T, Neovius M. Mental health from 5 years before to 10 years after bariatric surgery in adolescents with severe obesity: a Swedish nationwide cohort study with matched population controls. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:135-146. [PMID: 38159575 DOI: 10.1016/s2352-4642(23)00311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The long-term effects of bariatric surgery on the mental health of adolescents with severe obesity remain uncertain. We aimed to describe the prevalence of psychiatric health-care visits and filled prescription psychiatric drugs among adolescents with severe obesity undergoing bariatric surgery in the 5 years preceding surgery and throughout the first 10 years after surgery, and to draw comparisons with matched adolescents in the general population. METHODS Adolescents with severe obesity and who underwent bariatric surgery were identified through the Scandinavian Obesity Surgery Registry. We included adolescents who had bariatric surgery between 2007 and 2017 and were younger than 21 years at time of surgery. Each adolescent patient was matched with ten adolescents from the general population by age, sex, and county of residence. Specialist psychiatric care and filled psychiatric prescriptions were retrieved from nationwide data registers. FINDINGS 1554 adolescents (<21 years) with severe obesity underwent bariatric surgery between 2007 and 2017, 1169 (75%) of whom were female. At time of surgery, the mean age was 19·0 years [SD 1·0], and the mean BMI was 43·7 kg/m2 (SD 5·5). 15 540 adolescents from the general population were matched with adolescents in the surgery group. 5 years before the matched index date, 95 (6·2%) of 1535 surgery patients and 370 (2·5%) of 14 643 matched adolescents had a psychiatric health-care visit (prevalence difference 3·7%; 95% CI 2·4-4·9), whereas 127 (9·8%) of 1295 surgery patients and 445 (3·6%) of 12 211 matched adolescents filled a psychiatric drug prescription (prevalence difference 6·2%; 95% CI 4·5-7·8). The year before the matched index date, 208 (13·4%) of 1551 surgery patients and 844 (5·5%) of 15 308 matched adolescents had a psychiatric health-care visit (prevalence difference 7·9%; 95% CI 6·2-9·6), whereas 319 (20·6%) of 1551 surgery patients and 1306 (8·5%) of 15 308 matched adolescents filled a psychiatric drug prescription (prevalence difference 12·0%; 10·0-14·1). The prevalence difference in psychiatric health-care visits peaked 9 years after the matched index date (12·0%; 95% CI 9·0-14·9), when 119 (17·6%) of 675 surgery patients and 377 (5·7%) of 6669 matched adolescents had a psychiatric health-care visit. The prevalence difference in filled psychiatric drug prescription was highest 10 years after the matched index date (20·4%; 15·9-24·9), when 171 (36·5%) of 469 surgery patients and 739 (16·0%) of 4607 matched adolescents filled a psychiatric drug prescription. The year before the matched index date, 19 (1·2%) of 1551 surgery patients and 155 (1·0%) of 15304 matched adolescents had a health-care visit associated with a substance use disorder diagnosis (mean difference 0·2%, 95% CI -0·4 to 0·8). 10 years after the matched index date, the prevalence difference had increased to 4·3% (95% CI 2·3-6·4), when 24 (5·1%) of 467 surgery patients and 37 (0·8%) of 4582 matched adolescents had a health-care visit associated with a substance use disorder diagnosis. INTERPRETATION Psychiatric diagnoses and psychiatric drug prescriptions were more common among adolescents with severe obesity who would later undergo bariatric surgery than among matched adolescents from the general population. Both groups showed an increase in prevalence in psychiatric diagnoses and psychiatric drug prescriptions leading up to the time of surgery, but the rate of increase in the prevalence was higher among adolescents with severe obesity than among matched adolescents. With the exception of health-care visits for substance use disorders, these prevalence trajectories continued in the 10 years of follow-up. Realistic expectations regarding mental health outcomes should be set preoperatively. FUNDING Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare.
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Affiliation(s)
- Gustaf Bruze
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden; Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden.
| | - Mattias Norrbäck
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Söderling
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences and Wallenberg Centre for Molecular Medicine, Linköping University, Linköping, Sweden
| | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Food insecurity, weight-based discrimination, weight self-stigma, and mental health in post-bariatric surgery patients. Body Image 2023; 45:46-53. [PMID: 36773445 DOI: 10.1016/j.bodyim.2023.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
The United States Department of Agriculture defines food insecurity (FI) as reduced quality and variety of diet or overall reduced food intake. To date, limited research has investigated the relationship between FI, weight stigma, and bariatric surgery. The existing literature suggests that FI in bariatric surgery patients is significantly associated with being a person of color, depression, receiving Medicare or Medicaid, and higher eating disorder (ED) pathology. Research also suggests that weight stigma in bariatric surgery patients is associated with worsened weight loss outcomes. No research to our knowledge has investigated FI, internalized weight stigma, weight-based discrimination, and history of bariatric surgery in one sample. Bariatric surgery patients in this study (N = 266) reported elevated rates of FI relative to the general population, via an online questionnaire. Those with FI also reported higher rates of depression, anxiety, ED pathology, internalized weight stigma, and experiences of weight-based discrimination compared to those who were food secure. Given these findings, bariatric surgical centers should evaluate all potential patients for FI before surgery and, at the bare minimum, provide additional support before and post-surgery. The ethics of conducting bariatric surgery in those with FI who lack significant medical comorbidity also must be considered.
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The roles of weight stigma, emotion dysregulation, and eating pathology in suicide risk. Body Image 2021; 38:162-170. [PMID: 33892440 DOI: 10.1016/j.bodyim.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022]
Abstract
Using an interpersonal theory of suicide and affect regulation framework, we investigated the relationships between perceived burdensomeness, thwarted belongingness, weight stigmatization, emotion dysregulation, eating pathology, and suicide risk. Three main hypotheses were investigated. First, we predicted a positive linear relationship between weight stigmatization and risk. Second, an indirect effect of weight stigmatization on risk via perceived burdensomeness and thwarted belongingness was posited. Third, we hypothesized that weight stigmatization would indirectly affect suicide risk via emotion dysregulation and eating pathology. Undergraduates (N = 156) completed online surveys. Linear regressions and indirect effect analyses were performed. Weight stigmatization was directly, positively associated with increased suicide risk. Weight stigmatization indirectly affected suicide risk via perceived burdensomeness but not thwarted belongingness. Higher stigmatization was associated with higher levels of perceived burdensomeness, which was associated with higher risk. An indirect effect of weight stigmatization on suicide risk through emotional dysregulation emerged. Higher weight stigmatization was associated with higher emotional dysregulation, which was associated with higher suicide risk. When all models were combined, only an indirect effect via perceived burdensomeness remained. Our findings may have clinical and public health implications for suicide prevention among people with weight stigma-related risk factors.
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Siqueira BB, Assumpção MC, Barroso SM, Japur CC, Penaforte FRDO. Weight stigma and health – Repercussions on the health of adolescents and adults: integrative review of the literature. JORNAL BRASILEIRO DE PSIQUIATRIA 2021. [DOI: 10.1590/0047-2085000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To conduct an integrative review in order to understand the repercussions of the social stigma of overweight on the health of adults and adolescents. Methods The international protocol for systematic review and meta-analysis studies PRISMA was adopted to guide the writing of this review. The databases used were PubMed, Psycinfo, SciELO, Medline, Lilacs and Pepsic, considering studies published in the period from 2000 to 2020. Sixty-seven (67) articles were analyzed, and 4 categories emerged: repercussions on physical well-being; repercussions on social well-being; repercussions on mental well-being; and mixed category (physical and psychological impact). Results In the vast majority of studies analyzed, weight stigma had a negative impact on the different spheres that make up the health construct, that is, the physical, social and mental spheres. Conclusions The consequences of weight stigma are a source of intense suffering, with an impact that reduces the quality of life of individuals who experience stigmatization, involving physical, emotional and social aspects.
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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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Peterhänsel C, Nagl M, Wagner B, Dietrich A, Kersting A. Childhood maltreatment in bariatric patients and its association with postoperative weight, depressive, and eating disorder symptoms. Eat Weight Disord 2020; 25:999-1010. [PMID: 31154633 DOI: 10.1007/s40519-019-00720-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/23/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The present study aimed to compare prevalence rates of childhood maltreatment between patients with severe obesity undergoing bariatric surgery and patients without a surgical procedure. Second purpose was to calculate the association between childhood maltreatment and outcomes 6 and 12 months after a bariatric procedure. METHODS Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ) and compared between 120 bariatric surgery patients and 346 non-surgery patients with severe obesity. For the bariatric surgery subgroup, linear mixed models with repeated measures were used to analyze the predictive value of childhood maltreatment on weight outcomes and psychopathology. Additionally, between- and within-group comparisons were calculated to compare patients with and without childhood maltreatment regarding BMI and weight loss (%TWL, %EWL), depression severity (BDI-II), eating disorder psychopathology (EDE-Q), and suicidal ideation (BSS), at baseline, 6- and 12-month assessment. RESULTS Prevalence rates for childhood maltreatment, depression and suicidal ideation were significantly higher in non-surgery compared to bariatric surgery patients. Within the surgery group, no significant interaction effect between childhood maltreatment and time was found. Hence, childhood maltreatment did not impact the course of body weight, depression and eating disorder psychopathology from pre- to post-surgery. CONCLUSIONS Significantly higher rates of childhood maltreatment were found within non-surgery patients with obesity in comparison to bariatric surgery patients. Childhood maltreatment did not predict poorer outcomes after surgery. Since history of childhood maltreatment may increase the risk for psychological disturbances, regular screening and, if necessary, psychological support should be offered to both groups. LEVEL OF EVIDENCE Evidence obtained from well-designed cohort or case-control analytic studies, Level III. CLINICAL TRIAL REGISTRATION Deutsches Register Klinischer Studien-German Clinical Trials Register: DRKS00003976.
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Affiliation(s)
- C Peterhänsel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany.
| | - M Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - B Wagner
- MSB Medical School Berlin, Calandrellistraße 1 - 9, 12247, Berlin, Germany
| | - A Dietrich
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
- Department of Surgery, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - A Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
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Wnuk S, Parvez N, Hawa R, Sockalingam S. Predictors of suicidal ideation one-year post-bariatric surgery: Results from the Toronto Bari-Psych Cohort Study. Gen Hosp Psychiatry 2020; 63:39-45. [PMID: 30503220 DOI: 10.1016/j.genhosppsych.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 11/16/2018] [Accepted: 11/25/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous studies have shown higher rates of death by suicide, suicide attempts, suicidal ideation and non-suicidal self-directed violence (NS-SDV) in bariatric surgery patients. METHODS Data came from the Toronto Bari-Psych Cohort study of adult patients who underwent bariatric surgery between 2010 and 2016. The MINI International Neuropsychiatric Interview was used to obtain lifetime psychodiagnostic data. Information about lifetime suicidal ideation, suicide attempts, NS-SDV and hospitalizations related to any of these phenomena was collected during clinical interview. Pre-surgery sociodemographic data, lifetime psychiatric disorders, mental health symptoms, mental health treatment, suicidal ideation and surgical complications were covariates. Logistic regression analyses were used to examine the relationship between these variables and suicidal ideation one-year post-surgery. RESULTS Among a total of 284 participants, 4.2% reported a past suicide attempt and 15.1% reported past suicidal ideation. One-year post-surgery, no suicide attempts were reported. In the multivariate regression model, a history of suicidal ideation was the strongest predictor of suicidal ideation one-year post-surgery (p < 0.01), followed by younger age (p = 0.05). Mental health symptoms decreased from pre to post-surgery. CONCLUSION One-year post-surgery, a history of suicidal ideation was the strongest predictor of post-surgery suicidal ideation. Results should be interpreted with caution given the short duration of follow-up.
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Affiliation(s)
- Susan Wnuk
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada.
| | - Neha Parvez
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Raed Hawa
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada
| | - Sanjeev Sockalingam
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada
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Geller S, Levy S, Hyman O, L. Jenkins P, Abu-Abeid S, Goldzweig G. Body Image, Emotional Eating and Psychological Distress among Bariatric Surgery Candidates in Israel and the United States. Nutrients 2020; 12:nu12020490. [PMID: 32075087 PMCID: PMC7071170 DOI: 10.3390/nu12020490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The present study aimed to examine the relations between body image dissatisfaction (BID) and psychological distress variables among bariatric surgery candidates from two distinct cultures in Israel and in the United States. METHODS A sample of consecutive pre-surgical bariatric candidates was recruited from a Bariatric Center in Israel (N = 114) and a Bariatric Center in the Unites States (N = 81). Body image dissatisfaction (BID-BSQ8), suicidal ideation (SBQ-R), depressive symptoms (PHQ-9), anxious symptoms (PHQ-7), and emotional eating behaviors (EES), were measured. Mediation models were assessed using path analysis. RESULTS BID was positively correlated with suicidality, depression, and anxiety in both samples. The relations between BID depression and anxiety were mediated by emotional eating in both cultures. However, the relation between BID and suicidality that was mediated by emotional eating in the Israeli sample, was reflected in a direct link between BID and suicidality in the US sample. CONCLUSION Our findings confirm the adverse effect of BID on psychological distress among surgery candidates in both cultures, emphasizing the intercultural similarities related to emotional eating behavior. Physicians and other health professionals are encouraged to be more attentive to this specific behavior.
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Affiliation(s)
- Shulamit Geller
- School of Behavioral Sciences, the Academic College of Tel Aviv-Yaffo, 14, Rabenu Yeruham St, Tel Aviv-Yaffo 6818543, Israel;
- Correspondence: ; Tel.: +97-236-802-533
| | - Sigal Levy
- Statistics Education Unit, the Academic College of Tel Aviv, Tel Aviv-Yaffo 6818543, Israel;
| | - Ofra Hyman
- Outpatient Psychiatry, Bassett Medical Center, Cooperstown, NY 13326-1394 USA;
| | - Paul L. Jenkins
- Bassett Healthcare Research Institute, Bassett Medical Center, Cooperstown, NY 13326-1394, USA;
| | - Subhi Abu-Abeid
- Bariatric Surgery Unit, General Surgery Division, the Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo 6423906, Israel;
| | - Gil Goldzweig
- School of Behavioral Sciences, the Academic College of Tel Aviv-Yaffo, 14, Rabenu Yeruham St, Tel Aviv-Yaffo 6818543, Israel;
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Lent MR, Avakoff E, Hope N, Festinger DS, Still CD, Cook AM, Petrick AT, Benotti PN, Craig Wood G. Clinical Characteristics of Roux-en-Y Gastric Bypass Patients with Death from Accidental Overdose or Intentional Self-Harm: a Descriptive Study. Obes Surg 2019; 28:3531-3537. [PMID: 29982972 DOI: 10.1007/s11695-018-3379-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The objective of this descriptive study was to identify clinical characteristics of Roux-en-Y gastric bypass (RYGB) patients who died from intentional self-harm or accidental overdose postoperatively. MATERIALS AND METHODS This retrospective, descriptive study included RYGB patients from a large rural medical center that completed surgery between January 2004 and December 2014 and died from intentional self-harm or accidental overdose through December 2015. Specific causes of death were obtained from the National Death Index and clinical data from electronic health records. Clinical characteristics explored were age, sex, time to surgery, weight loss expectations, postoperative weight loss, medication, diagnoses, psychiatric histories (diagnoses, self-harm, suicidal ideation and behaviors, medications, substance use, preoperative Beck Depression Inventory-II scores), pain, social support, and reported life stressors. RESULTS Overall, 22 patients of 146 total deceased patients died from intention self-harm (n = 6) or accidental overdose (n = 16) over the study period (77.3% female, mean age at time of surgery = 38.4 ± 9.1 years). Younger age (< 40 years), history of self-harm or depression, preoperative pain, and use of opioids at the time of surgery emerged as common characteristics in weight loss surgery patients who died from intentional self-harm or accidental overdose. No trends regarding social support, life stressors, or actual or expected weight loss were identified. CONCLUSION Certain weight loss surgery patients may be at risk for death from self-harm or overdose and may benefit from greater surveillance postoperatively.
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Affiliation(s)
- Michelle R Lent
- Department of Psychology, Philadelphia College of Osteopathic Medicine (PCOM), 4190 City Avenue, Philadelphia, PA, 19131, USA. .,Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA.
| | - Elizabeth Avakoff
- Department of Psychology, Philadelphia College of Osteopathic Medicine (PCOM), 4190 City Avenue, Philadelphia, PA, 19131, USA
| | - Nicholas Hope
- Department of Psychology, Philadelphia College of Osteopathic Medicine (PCOM), 4190 City Avenue, Philadelphia, PA, 19131, USA
| | - David S Festinger
- Department of Psychology, Philadelphia College of Osteopathic Medicine (PCOM), 4190 City Avenue, Philadelphia, PA, 19131, USA
| | - Christopher D Still
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Adam M Cook
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Anthony T Petrick
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Peter N Benotti
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - G Craig Wood
- Geisinger Clinic, Obesity Institute, 100 N. Academy Avenue, Danville, PA, 17822, USA
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Geller S, Levy S, Goldzweig G, Hamdan S, Manor A, Dahan S, Rothschild E, Stukalin Y, Abu-Abeid S. Psychological distress among bariatric surgery candidates: The roles of body image and emotional eating. Clin Obes 2019; 9:e12298. [PMID: 30708399 DOI: 10.1111/cob.12298] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 01/21/2023]
Abstract
The increased risk of psychological distress among bariatric surgery candidates may be attributed, at least in part, to body image dissatisfaction (BID). The aim of the present study was to test the hypotheses that body image could be correlated with the psychological distress variables, and that emotional eating behaviours could mediate the relationship between body image and psychological distress. A sample of consecutive participants seeking bariatric surgery (N = 169, 67% females, mean age, 41.8 years [SD = 11.46], mean body mass index 42.0 kg/m2 [SD = 11.0]) was recruited from a university-based bariatric centre, a week prior to scheduled surgery. Results showed that BID was positively correlated with suicidality (r = 0.18, P < 0.05), depression (r = 0.39, P < 0.01) and anxiety (r = 0.20, P < 0.05). The relation between BID and depression was partially mediated by emotional eating, whereas the relation between BID and suicidality was fully mediated by emotional eating. Physicians and other health professionals who treat bariatric surgery patients should be encouraged to detect behaviours indicating emotional eating, as these could be an indicator of psychological distress resulting from poor body image.
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Affiliation(s)
- Shulamit Geller
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel-Aviv, Israel
| | - Sigal Levy
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Tel-Aviv, Israel
| | - Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel-Aviv, Israel
| | - Sami Hamdan
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel-Aviv, Israel
| | - Anat Manor
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel-Aviv, Israel
| | - Shiran Dahan
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel-Aviv, Israel
| | - Eyal Rothschild
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel-Aviv, Israel
| | - Yelena Stukalin
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Tel-Aviv, Israel
| | - Subhi Abu-Abeid
- Bariatric Surgery Unit, General Surgery Division, The Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Jung FU, Luck-Sikorski C. Overweight and Lonely? A Representative Study on Loneliness in Obese People and Its Determinants. Obes Facts 2019; 12:440-447. [PMID: 31315116 PMCID: PMC6758716 DOI: 10.1159/000500095] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/02/2019] [Indexed: 01/03/2023] Open
Abstract
Obesity is associated with physical and medical restrictions and comorbidities, but it also entails psychosocial effects such as social isolation and feelings of rejection. The aim of this study was to investigate the link between loneliness and weight stigma in a large sample of obese individuals. Results were derived from a large representative sample (n = 1,000). The survey included the 3-item version of the UCLA loneliness scale, the Patient Health Questionnaire (PHQ-9) as well as the Weight Bias Internalization scale (WBIS). The mean UCLA score was 1.943 (SD = 0.771). Respondents with higher levels of depression (B = 0.176), higher internalized weight bias (B = 0.435), and the experience of discrimination (B = 0.286) reported higher levels of loneliness. Future studies should investigate the mediation pathways between obesity, loneliness, and its determinants to provide a framework for successful interventions as part of obesity management programs.
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Affiliation(s)
- Franziska U Jung
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Hospital Leipzig, Leipzig, Germany,
- SRH University of Applied Health Sciences, Gera, Germany,
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany,
| | - Claudia Luck-Sikorski
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Hospital Leipzig, Leipzig, Germany
- SRH University of Applied Health Sciences, Gera, Germany
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Gordon KH, King WC, White GE, Belle SH, Courcoulas AP, Ebel FE, Engel SG, Flum DR, Hinojosa MW, Pomp A, Pories WJ, Spaniolas D, Wolfe BM, Yanovski SZ, Mitchell JE. A longitudinal examination of suicide-related thoughts and behaviors among bariatric surgery patients. Surg Obes Relat Dis 2018; 15:269-278. [PMID: 31010651 DOI: 10.1016/j.soard.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Past research suggests self-harm/suicidality are more common among adults who have undergone bariatric surgery than the general population. OBJECTIVES To compare prevalence of self-harm/suicidal ideation over time and identify presurgery risk factors for postsurgery self-harm/suicidal ideation. SETTING The Longitudinal Assessment of Bariatric Surgery-2 is a cohort study with presurgery and annual postsurgery assessments conducted at 10 U.S. hospitals. METHODS Adults with severe obesity undergoing bariatric surgery between March 2006 and April 2009 (n = 2458). Five-year follow-up is reported. Self-reported history of suicidality assessed retrospectively via the Suicide Behavior Questionnaire-Revised (SBQ-R) and self-reported self-harm/suicidal ideation assessed prospectively via the Beck Depression Inventory-Version 1 (BDI-1). RESULTS The SBQ-R was completed by 1540 participants; 2217 completed the BDI-1 pre- and postsurgery. Over 75% of participants were female, with a median age of 46 years and body mass index of 45.9 kg/m2. Approximately one fourth of participants (395/1534) reported a presurgery history of suicidal thoughts or behavior (SBQ-R). The prevalence of self-harm/suicidal ideation (BDI-1) was 5.3% (95% confidence interval [CI], 3.7-6.8) presurgery and 3.8% (95% CI, 2.5-5.1) at year 1 postsurgery (P = .06). Prevalence increased over time postsurgery to 6.6% (95% CI, 4.6-8.6) at year 5 (P = .001) but was not significantly different than presurgery (P = .12). CONCLUSIONS A large cohort of adults with severe obesity who underwent bariatric surgery had a prevalence of self-harm/suicidal ideation that may have decreased in the first postoperative year but increased over time to presurgery levels, suggesting screening for self-harm/suicidality is warranted throughout long-term postoperative care. Several risk factors were identified that may help with enhanced monitoring.
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Affiliation(s)
- Kathryn H Gordon
- Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Psychology, North Dakota State University, Fargo, North Dakota.
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Gretchen E White
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Dave R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | | | | | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Dino Spaniolas
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon
| | - Susan Z Yanovski
- Office of Obesity Research, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, Hjelmesæth J, Kinzl J, Leitner DR, Makaronidis JM, Schindler K, Toplak H, Yumuk V. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes Facts 2017; 10:597-632. [PMID: 29207379 PMCID: PMC5836195 DOI: 10.1159/000481825] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/21/2017] [Indexed: 12/17/2022] Open
Abstract
Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.
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Affiliation(s)
- Luca Busetto
- Department of Internal Medicine, University of Padova, Padova, Italy
- *Prof. Dr. Luca Busetto, Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy,
| | - Dror Dicker
- Department of Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Carmil Azran
- Clinical Pharmacy, Herzliya Medical Center, Herzliya, Israel
| | - Rachel L. Batterham
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- University College London Hospital Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, UK
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK
| | - Nathalie Farpour-Lambert
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Martin Fried
- OB Klinika, Centre for Treatment of Obesity and Metabolic Disorders, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Vestfold Hospital Trust and Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johann Kinzl
- Department of Psychiatry and Psychotherapy II, Medical University Innsbruck, Innsbruck, Austria
| | | | - Janine M. Makaronidis
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK
| | - Karin Schindler
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Graz, Austria
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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14
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Carpiniello B, Pinna F. The Reciprocal Relationship between Suicidality and Stigma. Front Psychiatry 2017; 8:35. [PMID: 28337154 PMCID: PMC5340774 DOI: 10.3389/fpsyt.2017.00035] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/22/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although suicidality is frequently the cause of stigma, it is conversely true that stigma may be the cause of suicidality. The present paper focuses on the complex relationships that exist between suicidal behavior and stigmatizing attitudes. METHODS A narrative review of the topic will be presented on the basis of the relevant literature collected from an electronic search of PubMed, ISI Web of Knowledge, and Scopus databases, using stigma, public stigma, structural stigma, perceived stigma, self-stigma, suicide, attempted suicide, and suicidality as key words. RESULTS A negative perception is frequently held of suicidal people, labeling them as weak and unable to cope with their problems, or selfish. Individuals who have attempted suicide are subject to similar processes of stigmatization and "social distancing"; insurance policies include an exclusion clause against death by suicide. Subjects with a direct personal experience of depression or suicide strongly endorse a feeling of self-stigma; those who have attempted suicide are often ashamed and embarrassed by their behavior and tend to hide the occurrence as much as possible. Similar processes are observed among family members of subjects who have committed suicide or made a suicide attempt, with a higher perceived stigma present in those bereaved by suicide. Perceived or internalized stigma produced by mental or physical disorders, or through belonging to a minority group, may represent a significant risk factor for suicide, being severely distressing, reducing self-esteem and acting as a barrier in help-seeking behaviors. CONCLUSION With the aim of preventing suicide, greater efforts should be made to combat the persisting stigmatizing attitudes displayed toward mental disorders and suicide itself. Indeed, the role of stigma as a risk factor for suicide should further motivate and spur more concerted efforts to combat public stigma and support those suffering from perceived or internalized stigma. Experts and scientific societies should form an alliance with the media in an effort to promote a marked change in the societal perception of mental health issues and suicide. As stigma may result in severe consequences, specialist care and psychological interventions should be provided to populations submitted to stigma.
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Affiliation(s)
- Bernardo Carpiniello
- Department of Medical Sciences and Public Health, University of Cagliari and Psychiatric Clinic, University Hospital , Cagliari , Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari and Psychiatric Clinic, University Hospital , Cagliari , Italy
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15
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Perera S, Eisen RB, Dennis BB, Bawor M, Bhatt M, Bhatnagar N, Thabane L, de Souza R, Samaan Z. Body Mass Index Is an Important Predictor for Suicide: Results from a Systematic Review and Meta-Analysis. Suicide Life Threat Behav 2016; 46:697-736. [PMID: 27094229 DOI: 10.1111/sltb.12244] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 01/12/2016] [Indexed: 12/21/2022]
Abstract
Public health concerns for the independent management of obesity and suicidal behavior are rising. Emerging evidence suggests body weight plays an important role in quantifying the risk of suicide. In light of these findings, we aimed to clarify the association between body mass index (BMI) and suicidal behavior by systematically reviewing and evaluating the literature. Studies were identified by searching MEDLINE, EMBASE, PsycINFO, and CINAHL from inception to January 2015, supplemented by hand and grey literature searches. Study screening, data extraction, and risk of bias assessment were conducted in duplicate. We included 38 observational studies. Meta-analyses supported an inverse association between BMI and completed suicide. Pooled summary estimates demonstrated that underweight was significantly associated with an increased risk of completed suicide (HR = 1.21, 95% CI 1.07 to 1.36, p = .002), and obesity (HR = 0.71, 95% CI 0.56 to 0.89, p = .003) and overweight (HR = 0.78, 95% CI 0.75 to 0.82, p < .0001) were significantly associated with a decreased risk of completed suicide relative to normal weight. A qualitative summary of the literature demonstrated conflicting evidence regarding the association between BMI and attempted suicide and revealed no association between BMI and suicidal ideation. BMI may be used to aid the assessment of suicide risk, especially that of completed suicide. However, unmeasured confounders and systematic biases of individual studies limit the quality of evidence.
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Affiliation(s)
- Stefan Perera
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Rebecca B Eisen
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Meha Bhatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Neera Bhatnagar
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON, Canada
| | - Russell de Souza
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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16
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Adamowicz JL, Salwen JK, Hymowitz GF, Vivian D. Predictors of suicidality in bariatric surgery candidates. J Health Psychol 2016; 21:1992-8. [DOI: 10.1177/1359105315569618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Risk for suicidality (current or past suicidal ideation or attempt) increases after bariatric surgery; however, there is a paucity of research investigating suicidality predictors in this population. This study involved a retrospective chart review of individuals seeking psychological clearance for bariatric surgery. In total, 32 participants (15.8%) were classified as reporting suicidality. These participants endorsed greater depressive symptomatology and hopelessness, and hopelessness and mood disorder diagnosis each uniquely predicted whether or not a patient was classified as reporting suicidality. The findings within suggest that increased attention to the relationship among these variables may improve methods for identification of high-risk patients. Implications for clinical practiced are discussed.
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17
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Petitte T, Mallow J, Barnes E, Petrone A, Barr T, Theeke L. A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults. ACTA ACUST UNITED AC 2015; 8:113-132. [PMID: 26550060 PMCID: PMC4636039 DOI: 10.2174/1874350101508010113] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.
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Affiliation(s)
- Trisha Petitte
- West Virginia University School of Nursing, United State of America
| | - Jennifer Mallow
- West Virginia University School of Nursing, United State of America ; Robert Wood Johnson Nurse Faculty Scholar, United State of America
| | - Emily Barnes
- West Virginia University School of Nursing, United State of America
| | - Ashley Petrone
- Department of Neurobiology and Anatomy, Center for Neuroscience, West Virginia, United State of America ; Center for Basic and Translational Stroke Research, West Virginia, United State of America
| | - Taura Barr
- West Virginia University School of Nursing, United State of America ; Department of Neurobiology and Anatomy, Center for Neuroscience, West Virginia, United State of America ; Center for Basic and Translational Stroke Research, West Virginia, United State of America ; Robert Wood Johnson Nurse Faculty Scholar, United State of America
| | - Laurie Theeke
- West Virginia University School of Nursing, United State of America ; Robert Wood Johnson Nurse Faculty Scholar, United State of America
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18
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Abstract
PURPOSE OF REVIEW Bariatric surgery has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities such as metabolic syndrome. Empirical data suggest a high prevalence of psychiatric disorders among bariatric surgery candidates. In this review, we focus on the studies published recently with a high impact on our understanding of the role of psychiatry in bariatric surgery. RECENT FINDINGS This article reviews the specific psychopathologies before surgery, changes in psychopathologies after surgery, suicide risk related to bariatric surgery, factors associated with weight loss, and recommendations for presurgical and postsurgical assessment and management. Research indicates a decrease in certain psychiatric symptoms after weight loss with bariatric surgery. However, the risk of suicide and unsuccessful weight loss in some bariatric surgery patients make monitoring following surgery as important as careful assessment and management before surgery. Specific considerations for youth and older populations and future potential research foci are discussed. SUMMARY Recent publications suggest new directions for psychiatric evaluation and interventions for bariatric surgery patients. Future research on outcomes of specific populations, effectiveness of psychopharmacotherapy, and underlying pathophysiology are warranted for the advancement of treating bariatric surgery patients.
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Abstract
Purpose
– The purpose of this paper is to assess multidimensional body image concerns in a sample of obese women seeking bariatric surgery at an outpatient hospital clinic in Hamilton, Ontario, Canada.
Design/methodology/approach
– A sample of obese adult women seeking bariatric surgery at an outpatient medical clinic in Hamilton, Ontario, Canada (n=148) completed various self-report measures of body image concerns, including body image dysphoria, body image quality of life, body image investment, and appearance satisfaction. Participant scores were compared to normative data. Correlations between body image concern measures and body mass index (BMI) were examined.
Findings
– Participants endorsed more body image dysphoria, more negative body image quality of life, and less appearance satisfaction than normative samples. BMI was not correlated with body image concern scores.
Practical implications
– Interventions aimed at reducing body image disturbance in obese women should target multiple components of body image concern. Decisions about who should receive interventions should not be based on BMI status.
Originality/value
– The majority of research on body image concerns focuses exclusively on evaluative constructs such as body image dissatisfaction. The current study examined affective, cognitive, and behavioural body image constructs. A better understanding of the multidimensional nature of body image concerns in obese women seeking bariatric surgery informs the development of effective, targeted interventions.
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20
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Salwen JK, Hymowitz GF, Vivian D, O'Leary KD. Childhood abuse, adult interpersonal abuse, and depression in individuals with extreme obesity. CHILD ABUSE & NEGLECT 2014; 38:425-433. [PMID: 24412223 DOI: 10.1016/j.chiabu.2013.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 12/03/2013] [Accepted: 12/11/2013] [Indexed: 06/03/2023]
Abstract
This study sought to examine (a) a mediational model of childhood abuse, adult interpersonal abuse, and depressive symptoms and (b) the impact of weight-related teasing on rates and correlates of childhood abuse. Charts of 187 extremely obese individuals seeking psychological clearance for bariatric (weight-loss) surgery were retrospectively examined. Among the participants, 61% reported a history of childhood abuse, 30.5% reported adult interpersonal abuse, and 15% reported clinically significant depressive symptoms. Initially, the relationship between childhood abuse and current depressive symptoms was significant (p<.001). However, the introduction of adult interpersonal abuse as a mediator in the model reduced the magnitude of its significance (Sobel's test p=.01). The associations between childhood abuse and adult interpersonal abuse and between adult interpersonal abuse and depressive symptoms were significant (p<.001 and p=.002, respectively), and the model showed a good fit across multiple indices. Finally, weight-related teasing was a significant moderator in the relationship between childhood and adult interpersonal abuse. Bariatric surgery patients report elevated rates of childhood abuse that are comparable to rates in psychiatric populations (e.g., eating disorders, depression), and higher than those in community samples and other medical populations. The relationship between child abuse and depressive symptomatology may be partially explained by the presence of adult interpersonal abuse; additionally, the relationship between childhood and adult interpersonal abuse was stronger for those who did not endure weight-related teasing than for those who did.
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Affiliation(s)
- Jessica K Salwen
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
| | - Genna F Hymowitz
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
| | - Dina Vivian
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
| | - K Daniel O'Leary
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
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21
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Peterhänsel C, Petroff D, Klinitzke G, Kersting A, Wagner B. Risk of completed suicide after bariatric surgery: a systematic review. Obes Rev 2013; 14:369-82. [PMID: 23297762 DOI: 10.1111/obr.12014] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/06/2012] [Accepted: 12/06/2012] [Indexed: 12/15/2022]
Abstract
Bariatric surgery is one of the most effective treatments for morbid obesity, and a large body of research indicates significant long-term weight loss. While overall mortality decreases in patients who received bariatric surgery, a number of studies have shown that suicide rates are higher in bariatric patients than in control groups. The objective of this study was to present a systematic review of suicide mortality after bariatric surgery and calculate an estimate for the suicide rate. Literature researches of the databases PubMed, Web of Knowledge, PsychInfo, ScienceDirect and Google Scholar were conducted. Thirty studies concerning bariatric surgery and completed suicides met the inclusion criteria. We included 28 studies in the estimation of a suicide rate for the bariatric population. Only one study (Tindle et al.) put a main focus on suicide after bariatric surgery; this was therefore chosen as an adequate reference figure for comparison. The other 27 chosen studies were compared with World Health Organization data and the suicide rate reported by Tindle et al. Twenty-three thousand eight hundred eighty-five people were included in the analysis. In the literature, we found a total of 95 suicides when examining 190,000 person-years of post-bariatric surgery data. Little information was provided describing the reasons for suicide and the time-point of these events after surgery. We estimated a suicide rate of 4.1/10,000 person-years (95% confidence interval [3.2, 5.1]/10,000 person-years). A comparison with Tindle et al. demonstrates that their rate is significantly higher than our estimate (P = 0.03). Bariatric surgery patients show higher suicide rates than the general population. Therefore, there is a great need to identify persons at risk and post-operative psychological monitoring is recommended.
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Affiliation(s)
- C Peterhänsel
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany.
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