Depression Before Bariatric Surgery Predicts Subsequent Health-Related QOL
Depression screening is important for patients undergoing bariatric surgery.
A new prospective study reported in Obesity Surgery points to depression severity as a predictor of patients' health-related quality of life (HRQoL) following bariatric surgery.1
Obesity is increasing globally at a rapid rate and is associated with numerous diseases and high economic cost. Bariatric surgery is one existing treatment approach that has been found to result in weight loss while improving the prognosis of comorbid illnesses as well as HRQoL.2,3 Some findings suggest that the amount of weight lost after surgery predicts such improvements in HRQoL, and studies have implicated psychological factors as predictors, although results have been mixed and more research is needed.4,5
The researchers in the new research investigated the predictive value of multiple variables on the physical and mental HRQoL in 154 patients (69.5% women) 6 and 12 months after undergoing either a laparoscopic Roux-en-Y gastric bypass (LRYGB; 88.3%) or a laparoscopic sleeve gastrectomy (LSG; 11.7%). Before surgery and at the 6-month and 12-month marks after surgery, patient demographics and comorbid conditions were recorded, along with scores on the Short Form Health Survey-12 (to assess HRQoL), the Beck Depression Inventory-II, and the Eating Disorder Examination-Questionnaire.
The results show that the combination of demographic, physiological, and psychological variables explored in the study explained 50% of the variance in patients' physical HRQoL and 58% of the variance in their mental HRQoL following surgery. The strongest predictive factor was depression: higher BDI-II scores at baseline were linked with lower postoperative HRQoL, and changes in BDI-II scores from baseline to postsurgery positively predicted HRQoL scores. Other positive predictors were female sex, employment, and living in a partnership. The persistence of diseases such as hypertension and diabetes 12 months after surgery was found to negatively influence physical HRQoL.
Although patients with psychiatric disorders should not be ruled out for bariatric surgery, these results and the “fact that mood disorders are the most frequent psychiatric co-morbid disorders in patients undergoing bariatric surgery,” indicate that routine depression screening in this population is important, the researchers wrote. Treatment for depression should be offered to patients who undergo bariatric surgery to help support their weight loss and improve their HRQoL. “Recent studies on pre-operative supportive therapeutic programmes for patients with obesity and those undergoing bariatric surgery were shown to reduce depressive symptoms,” they noted.6,7
- Peterhänsel C, Nagl M, Wagner B, Dietrich A, Kersting A. Predictors of changes in health-related quality of life 6 and 12 months after a bariatric procedure [published online February 28, 2017]. Obes Surg. 2017. doi:10.1007/s11695-017-2617-6
- Picot J, Jones J, Colquitt J, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess Winch Engl. 2009;13(41):1-190, 215-357, iii-iv. doi:10.3310/hta13410
- Driscoll S, Gregory DM, Fardy JM. Long-term health-related quality of life in bariatric surgery patients: a systematic review and meta-analysis. Obesity (Silver Spring). 2016;24(1):60-70. doi:10.1002/oby.21322
- Sarwer DB, Lavery M, Spitzer JC. A review of the relationships between extreme obesity, quality of life, and sexual function. Obes Surg. 2012; 22(4):668-676. doi:10.1007/s11695-012-0588-1
- Wimmelmann CL, Dela F, Mortensen EL. Psychological predictors of mental health and health-related quality of life after bariatric surgery: a review of the recent research. Obes Res Clin Pract. 2014; 8(4):e314-e324. doi:10.1016/j.orcp.2013.11.002
- Wild B, Herzog W, Wesche D, et al. Development of a group therapy to enhance treatment motivation and decision-making in severely obese patients with a comorbid mental disorder. Obes Surg. 2011;21:588-594. doi:10.1007/s11695-009-0025-2
- Cassin SE, Sockalingam S, Du C, et al. A pilot randomized controlled trial of telephone-based cognitive behavioural therapy for preoperative bariatric surgery patients. Behav Res Ther. 2016;80:17-22. doi:10.1016/j.brat.2016.03.001