Study Suggests Mental Health Conditions are Common among Patients Seeking and Undergoing Bariatric Surgery
Bariatric surgery is an accepted method of promoting weight loss and improving obesity-related physical comorbidities in severely obese individuals. Mental health conditions in this population have received considerably less attention. This systematic review had three aims: 1) to estimate the prevalence of mental health conditions among bariatric surgery candidates and recipients; 2) to evaluate the association between preoperative mental health conditions and weight loss after surgery; and 3) to evaluate the association between surgery and the clinical course of mental health conditions. Investigators searched the literature between January 1988 and November 2015, identifying 68 publications that met inclusion criteria. Mental health outcomes included suicide incidence as well as the prevalence, symptoms, and treatment of mental health conditions.
- Mental health conditions are common among patients seeking and undergoing bariatric surgery, particularly depression and binge-eating disorder (BED). Prevalence estimates for mood disorders (22%), depression (19%), and BED (17%) were higher than published rates for the general U.S. population, (10%, 8%, and 1-5%, respectively) suggesting that special attention should be paid to these conditions among bariatric patients.
- There was inconsistent evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Five studies on preoperative depression and five on preoperative binge eating disorder yielded mixed results.
- There was moderate-quality evidence to support an association between bariatric surgery and lower rates of depression post-operatively. Depression improved following surgery in 11 of the 12 studies, including two randomized controlled trials evaluating preoperative behavioral health interventions.
- Three studies reported on the incidence of suicide after bariatric surgery. Only one found higher rates of suicide among bariatric patients, although a fourth study found a higher rate of self-harm emergencies among patients compared to before surgery. All four studies relied on retrospective data and none accounted for potential differences in the prevalence of mental health conditions.
- Studies varied in their use of scales, thresholds, and definitions of outcomes. The diagnosis of binge eating disorder, for example, underwent significant redefinition during the study's search period and did not exist as a psychiatric disorder until 2013.
- Individuals with severe mental illness are often screened out prior to referral for surgery and, thus, may have been excluded from published studies.
- Subjects in the reviewed studies were predominantly female and middle aged, thus results may not be generalizable to Veteran population.
This review was funded through VA HSR&D's Evidence-based Synthesis Program. Dr. Shekelle is part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) in Los Angeles, CA, and the VA Greater Los Angeles Healthcare System.
Dawes AJ, Maggard-Gibbons M, Maher AR, Booth MJ, Miake-Lye I, Beroes JB, and Shekelle PG. Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis. JAMA. January 12, 2016;315(2):150-63.