Presurgical assessment of bariatric patients with the Patient Health Questionnaire (PHQ)—A screening of the prevalence of psychosocial comorbidity

Abstract

BackgroundBariatric surgery has gained increasing relevance due to the dramatic rise in morbid obesity prevalence. A sound body of scientific literature demonstrates positive long-term outcome of bariatric surgery in decreasing mental and physical health morbidity. Still, there is a need for a manageable presurgical screening to assess major mental disorders. The aim of this study was to assess the frequency of common psychiatric syndromes in bariatric surgery candidates using a computerized version of the Patient Health Questionnaire (PHQ).MethodsIn a prospective cohort study from August 2009 to July 2011 morbidly obese individuals seeking bariatric treatment were evaluated for mental health disorders using the PHQ (computerized German version).ResultsA total of 159 patients were included in this study. The median age of participants was 42 years, the median BMI was 49 kg/m2. The PHQ revealed a prevalence of 84 % for mental health disorders, 50 % of the participants had three or more mental health disorders. A high somatic symptom burden (46 %), depressive syndromes (62 %) and anxiety disorders (29 %) were the most frequent psychiatric syndromes. The median number of psychiatric syndromes was 3 for women and 1 for men (p = 0.007). No correlation between BMI and a single syndrome or the sum of syndromes was observed.Conclusion84 % of the patients seeking bariatric treatment were screened positive for at least one mental health disorder. The computerized PHQ with automated reporting appears to be a useful instrument for presurgical assessment of bariatric patients in routine medical settings.

Gender-based differences in host behavior and gut microbiota composition in response to high fat diet and stress in a mouse model

“…Obesity, in turn, is associated with a high prevalence of mood disorders such as anxiety and depression 7 , 8 . The association of mood disorders with obesity has been replicated in several rodent models, and proposed pathophysiological mechanisms for the connection include excessive production of proinflammatory cytokines that indirectly affect serotonin production 9 , elevated leptin levels acting on leptin receptors in the brain 10 , neuroinflammation as an extension of the systemic inflammation that commonly accompanies obesity 11 , and high fat diet-induced alterations in glucocorticoid signaling in the hippocampus 12 .…”

Agreement of screening tools with established questionnaires used in psychological assessment of bariatric patients

“…12,35 Results from our study extend previous research by exploring the use of PHQ-2, an even shorter screening tool of depression developed from PHQ-9, for bariatric surgery patients. 29 The results of the current study also contribute to a previous study that uses PHQ-2 on the bariatric population but did not examine its agreement with an established questionnaire. 47 PHQ-Binge has not been validated in the bariatric surgery population, even though it has been used in previous studies.…”

“…However, there are limited studies on screening questions used in the bariatric surgery population. 29,34,35 Previous studies only examined the correlation of screening questions Patient Health Questionnaire (PHQ) and PHQ-9 with established questionnaires. 12,29,34,35 Only one other study used, but did not examine, the psychometric properties of a shorter screening instrument, PHQ-2, in the bariatric population.…”

“…29,34,35 Previous studies only examined the correlation of screening questions Patient Health Questionnaire (PHQ) and PHQ-9 with established questionnaires. 12,29,34,35 Only one other study used, but did not examine, the psychometric properties of a shorter screening instrument, PHQ-2, in the bariatric population. 35 To establish the psychometric relevance of screening questions, there is a need to investigate their agreement with established questionnaires used in the bariatric population.…”

“…PHQ-Binge has been used to establish the prevalence of binge eating in bariatric patients but its agreement with standard measure, the BES, has not yet been established. 29 RAND 36 is used to assess QoL and has been used with bariatric surgery population previously. 43 RAND 36 measures eight health concepts relating to QoL: physical functioning; role functioning affected by physical health; role functioning affected by emotional health; energy/fatigue; emotional wellbeing; social functioning; pain; and general health and health change.…”