Influence of Depression On Bariatric Surgery Outcomes

Tara Mokhtari, Archana Nair, Sophia Koontz, Eric Luedke, John Morton. Stanford University

INTRODUCTION: Morbid obesity is a leading public health concern in the United States and predisposes to the development of numerous comorbid conditions. Additionally, depression is commonly seen in the obese. The development of depression in this population, while complex and multifactorial, has also been attributed to poor body image, low self-esteem, and discrimination. This study examines the occurrence and time-course of depression in a bariatric population and explores the impact of depression on bariatric surgery outcomes utilizing the Beck Depression Inventory-II (BDI-II) questionnaire.

METHODS AND PROCEDURES: Demographic, anthropometric, and standard lab data were prospectively collected for 231 consecutive bariatric patients undergoing either laparoscopic Roux-en-Y gastric bypass (LRYGB), sleeve gastrectomy (LSG), or adjustable gastric banding (LAGB) at a single academic institution preoperatively and 12-months postoperatively. Prior to surgery and at all postoperative follow-up clinic visits, study participants completed the BDI-II questionnaire, a 21 item self-reported, multiple-choice questionnaire validated to assess depression (sensitivity 81%, specificity 92%). BDI-II scores range from 0 to 63, with scores from 0-10 considered normal mood variation and scores ≥11indicating mood disturbance and depression (higher scores demonstrate greater depression). Preoperative participant characteristics and postoperative weight-loss outcomes were compared to BDI-II scores with one-way ANOVA for continuous variables, chi-squared analysis for categorical variables, and regression analysis using STATA software release 12.

RESULTS: At the time of data analysis, 51.2% of participants at the 6-month time point had completed their 6-month BDI-II questionnaire. Study participant demographics preoperatively showed an average age of 47.8 years, 55% Caucasian, and 72.9% female. Among the three bariatric procedures, surgical cases were 51.4% LRYGB, 40.0% LSG, and 8.6% LAGB. Average BDI-II scores were 10.89±0.82 preoperatively, 5.71±0.58 at 3-months, and 6.15±0.97 at 6-months postop. Preoperatively, 59.3% of participants had normal BDI-II scores while 40.7% had elevated scores indicating some degree of depression. BDI-II scores revealed that preoperatively, 19.9% of patients had mild mood disturbance (11≤BDI-II≥16), 9.1% had borderline clinical depression (17≤BDI-II≥20), and 11.7% had moderate, severe, or extreme depression (BDI-II≥21). By 6-months postop, participants with normal BDI-II scores jumped to 81.0%. In analyzing the predictive nature of BDI-II scores on weight loss following bariatric surgery, BDI-II scores at 3-months and 6-months did not predict patients’ percent excess weight loss (%EWL) at the corresponding time points. Similarly, preoperative BDI-II scores were not significant predictors of %EWL at 3-months (β=0.0746, p=0.597, R2=0.5971) or at 6-months postop (β=-0.109, p=0.598, R2=0.0034).

CONCLUSIONS: BDI-II scores identified depression to be a considerable concern among the obese population seeking bariatric surgery. However, BDI-II scores were not found to be significantly predictive of %EWL in this analysis. Therefore, while bariatric clinicians and surgeons should be vigilant of depression in their patients, its negative effects on post-surgical outcomes may not pose a significant concern. Additional investigation is warranted to determine the predictive nature of the BDI-II questionnaire on surgical outcomes.

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