Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS‐2) study

Abstract

Objective To examine changes in depressive symptoms and treatment in the first three years following bariatric surgery. Design and Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study of adults (n=2,458) who underwent a bariatric surgical procedure at one of ten US hospitals between 2006–9. This study includes 2,148 participants who completed the Beck Depression Inventory (BDI) at baseline and ≥ one follow-up visit in years 1–3. Results At baseline, 40.4% self-reported treatment for depression. At least mild depressive symptoms (BDI score≥10) were reported by 28.3%; moderate (BDI score 19–29) and severe (BDI score ≥30) symptoms were uncommon (4.2% and 0.5%, respectively). Mild-to-severe depressive symptoms independently increased the odds (OR=1.75; p=.03) of a major adverse event within 30 days of surgery. Compared with baseline, symptom severity was significantly lower at all follow-up time points (e.g., mild-to-severe symptomatology was 8.9%, 6 months; 8.4%, 1yr; 12.2%, 2yrs; 15.6%, 3yrs; ps<.001), but increased between 1 and 3 years postoperatively (p<.01). Change in depressive symptoms was significantly related to change in body mass index (r=.42; p<0001). Conclusion Bariatric surgery has a positive impact on depressive features. However, data suggest some deterioration in improvement after the first postoperative year.

Psychiatric Disorders and weight Change in a Prospective Study of Bariatric Surgery Patients: A 3-Year Follow-Up

“…PMM also were used to estimate the remission and incidence rates of the more common psychiatric disorders at 2 and 3 years post-surgery and to determine factors related to having any mood disorder and any anxiety disorder at 2 and 3 years post-surgery; other disorders were too rare postsurgery to model. Based on prior research (15,18,26,27), pre-surgery psychiatric status, age, sex, race, pre-surgery BMI, surgical procedure, and percent weight change were included as independent variables, with control for study site to adjust for correlations among patients from the same site. Interactions between main effects were tested and included if they reached statistical significance.…”

“…For example, a recent report from the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study found that among participants who underwent Roux-en-Y gastric bypass (RYGB), one of the most common procedures, three year weight loss was more than 32% of initial weight for the top quartile of participants and less than 16% for the bottom quartile of participants (10). Psychopathology may account for some of the variability in post-surgery weight loss (11)(12)(13)(14)(15), but there are few methodologically rigorous studies.…”

Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records

“…18,148 However, evidence for an effect of bariatric surgery on depression is limited. Several longitudinal studies have explored the relationship between bariatric surgery and depression, identifying significant reductions in depression 149 and depressive symptoms 150,151 following surgery. One study found a decrease in depression from 32.7% at baseline, to 16.5% at 6-12 months, and 14.3% at 2-3 years following surgery.…”

“…One study found a decrease in depression from 32.7% at baseline, to 16.5% at 6-12 months, and 14.3% at 2-3 years following surgery. 152 However, other studies suggest that improvements following surgery may not be maintained after the first postoperative year 151 and depressive symptoms may deteriorate in some patients. 153 Previous reports have often drawn on data from hospital-based series that did not include control groups, often with short durations of follow-up.…”

The Epidemic of Depression With Obesity

“…However, improvement in depressive symptoms declines over time, and there is a subset of patients who do not experience improvement. 14 Moreover, depressive symptoms are associated with greater postoperative complications, less weight loss, and greater weight regain and have been hypothesized to contribute to the elevated risk of suicide observed among bariatric surgery recipients.…”