Sudarshan Srivatsan, Vinay Guduguntla, Kelly Young, Aliasghar Arastu, Cameron Strong, Ruth Cassidy, Amir A Ghaferi, MD, MS. University of Michigan
Introduction: The rate of obesity in the United States has more than doubled in the last 50 years. Bariatric surgery has an excellent safety profile and is the most effective approach to weight loss. Additionally, advances in the preoperative assessment have played an important role in the detection of high risk patients. For example, depression is the most prevalent mental health diagnosis amongst the 15 million morbidly obese Americans today. There is significant evidence showing poorer surgical outcomes in high risk patients with mental health illness. To improve these outcomes, mental health assessments are now standard of care and are required preoperatively for patients considering bariatric surgery. However, there remains a wide range of practices on how to best screen patients for depression. In this study, we sought to understand the relationship between traditional clinical practice and a patient-reported depression screening tool, Patient Health Questionnaire 8 (PHQ-8).
Methods: We used prospectively collected data from the Michigan Bariatric Surgery Collaborative (MBSC) to assess the overall rate of patients with a preoperative diagnosis of depression during the study period (January 2014 – June 2016). This diagnosis is based on clinically audited chart review. The definition of depression includes “clinical depression and depressive disorder, treated with medication, electroconvulsive therapy, and/or psychotherapy.” We then surveyed a sample of patients in the immediate preoperative period (n=4486) using the validated PHQ-8. A PHQ-8 score of > 10 was diagnostic for depression. We examined the association between results PHQ-8 screening and of traditional depression diagnosis methods, determining the proportion of patients with undiagnosed depression. Next, we conducted a chi-squared test for socioeconomic factors such as race, gender, income level, type of insurance, and employment status for this undiagnosed population.
Results: The overall rate of clinically diagnosed of depression in the study cohort is 45.6% and 14.8% of all patients screened positive for depression using PHQ-8. Of the patients without a traditional clinical diagnosis of depression, 10.2% screened positive for depression using the PHQ-8. This subset of undiagnosed patients was more likely to be male, non-white, of higher BMI, and employed than their clinically diagnosed counterparts.
Conclusions: Despite significant efforts to ensure the timely and accurate diagnosis of depression in bariatric surgery patients, a large proportion of patients may undergo surgery undiagnosed by current clinical assessments. Mandatory inclusion of patient self-screening tools may be a key component of preoperative mental health evaluations moving forward.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78280
Program Number: P576
Presentation Session: Poster (Non CME)
Presentation Type: Poster