Psychopathology before surgery in the Longitudinal Assessment of Bariatric Surgery-3 (LABS-3) Psychosocial Study

Abstract

Background Current and prior psychopathology in bariatric surgery candidates is believed to be common. Accurate prevalence estimates, however, are difficult to obtain given that bariatric surgery candidates often wish to appear psychiatrically healthy when they are undergoing psychiatric evaluation prior to being approved for the surgery. Also, structured diagnostic assessments have been utilized infrequently. Methods This report concerns the 199 patients who were enrolled in the Longitudinal Assessment of Bariatric Surgery (LABS) study who also participated in the LABS-3 Psychopathology sub-study. All were interviewed independent of the usual preoperative psychosocial evaluation process. Patients were explicitly told that the data would not be shared with the surgical team unless certain high risk behaviors such as suicidality that could lead to adverse peri-operative outcomes were reported. Results The majority of the sample was female (82.9%) and Caucasian (non-white 7.6%, Hispanic 5.0%). The median age was 46.0 years with a median body mass index (BMI) of 44.9 kg/m2; 33.7% had at least one current Axis I disorder and 68.8% at least one lifetime Axis I disorder. Of note, 38.7% had a lifetime history of major depressive disorder, and 33.2% had a lifetime diagnosis of alcohol abuse or dependence, all much higher than population-based prevalence rates obtained for this age group in the National Comorbidity Survey--Replication Study. With respect to binge eating disorder, 13.1% had a lifetime diagnosis, while 10.1% had a current diagnosis. Conclusion Current and lifetime rates of psychopathology are high in bariatric surgery candidates, and lifetime rates of affective disorder and alcohol use disorders are particularly prominent. Binge eating disorder is present in approximately 1 in 10 bariatric surgery candidates.

Role of Adiposity-Driven Inflammation in Depressive Morbidity

“…Usually greater in women (Carpenter et al, 2000;de Wit et al, 2010;Heo et al, 2006;Mitchell et al, 2012), depressive symptoms that develop in obese individuals often present atypical features such as increased appetite/weight gain, mood reactivity, and hypersomnia/fatigue (Chou and Yu, 2013;Levitan et al, 2012;Lojko et al, 2015). In agreement with this, overweight, obesity, and metabolic abnormalities, including leptin deregulation, appear to be more prevalent in atypical depression than in melancholic/typical depression (Chou and Yu, 2013;Cizza et al, 2012;Lamers et al, 2010;Lasserre et al, 2014;Levitan et al, 2012;Milaneschi et al, 2015).…”

Psychiatric Disorders and weight Change in a Prospective Study of Bariatric Surgery Patients: A 3-Year Follow-Up

“…Interviews were conducted independently of the routine pre-surgery screening process. Methods and baseline data on psychiatric disorders have been reported previously (5). Of note, the SCID screener for alcohol use disorder required reporting having drunk five or more drinks on one occasion, a threshold that might be too high after bariatric surgery given evidence that alcohol pharmacokinetics may be altered by some procedures, thereby decreasing tolerance (20)(21)(22)(23).…”

“…Studies employing structured clinical interviews have revealed high lifetime rates of mood disorders (range: 22.0 -54.8%) and anxiety disorders (range: 15.5 -37.5%) prior to surgery. Most also suggest high lifetime rates for alcohol abuse and dependence, but documented rates vary widely (range: 0.7 -33.2%) (3)(4)(5)(6)(7). Although bariatric surgery is the most effective treatment for severe obesity (8,9), post-surgery weight loss is highly variable, even among patients undergoing the same procedure.…”

Cambio en el patrón de consumo de sustancias posterior a cirugía bariátrica: presentación de un caso clínico

“…Al respecto, el abuso o dependencia activa de sustancias ha sido considerado como una de tan solo cuatro contraindicaciones claras para cirugía bariátrica de acuerdo a guías y consensos internacionales, recomendando además una evaluación psicológica rutinaria a los candidatos 5 . Aunque numerosos reportes han mencionado la alta probabilidad de psicopatología en pacientes en espera de resolución quirúrgica, los resultados tienden a ser dispares y son pocos los que han utilizado entrevistas estructuradas 6 . Trabajos recientes han sugerido que tener una historia previa de trastornos relacionados al consumo de sustancias es más frecuente en aquellos que consultan por cirugía bariátrica en comparación al resto de la población 7,8 .…”