Patients seeking bariatric surgery may be suffering from depression.
Bariatric surgery is an accepted method of promoting weight loss in severely obese individuals and of decreasing the risk of obesity-related conditions such as heart disease, stroke, type 2 diabetes and certain types of cancer, which are some of the leading causes of preventable death.
It has been suggested that mental health conditions may be prevalent among patients involved in such interventions.
Dr. Aaron J. Dawes, of the David Geffen School of Medicine at the University of California-Los Angeles, and colleagues wanted to find out how common mental health conditions were in patients seeking and undergoing bariatric surgery.
The team also set out to see if there was a link between preoperative mental health conditions and weight loss after surgery.
In addition, they wanted to evaluate the association between surgery and the outcome of mental health conditions.
Mental illness is prevalent, but depression can improve after surgery
The team conducted a meta-analysis of 59 publications reporting the prevalence of mental health conditions before surgery in 65,363 patients and 27 studies reporting associations between preoperative mental health conditions and postoperative outcomes in 50,182 patients.
The findings indicated that 23% of patients for bariatric surgery were affected by a current mood disorder. Depression was most common, seen in 19% of participants, while 17% were diagnosed with a binge-eating disorder. Anxiety affected 12% of the subjects.
Rates for depression and eating disorders are higher in bariatric patients than in the general US population; 19% of bariatric patients have a mental health condition, including 8% with depression and 1-5% with a binge-eating disorder. This discrepancy suggests a need to focus on these conditions when treating patients for bariatric surgery, say the researchers.
After surgery, a fall in the rate of depression was noted. Seven of the studies reviewed indicated an 8-74% decrease in the rate of depression after bariatric surgery, and six studies reflected a 40-70% drop in the severity of depressive symptoms.
The association between preoperative mental health conditions and postoperative weight loss was less clear. Neither depression nor binge eating disorder was consistently associated with differences in weight outcomes.
The authors write:
"Previous reviews have suggested that self-esteem, mental image, cognitive function, temperament, support networks and socioeconomic stability play major roles in determining outcomes after bariatric surgery."
The researchers suggest incorporating these factors into future studies. They also call for clear eligibility criteria, standardized instruments, regular measurement intervals and transparency regarding time-specific follow-up rates when dealing with patients for bariatric surgery.
These measures, they say, would help to create "an optimal strategy for evaluating patients' mental health prior to bariatric surgery."
Limitations include the fact that different scales and methods were used in the original studies, and that the results of the meta-analysis do not address the severity or chronicity of mental health conditions.
Medical News Today recently reported on research indicating that bariatric surgery might decrease the brain's craving for sugar.