Page 41 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Psychological evaluation
There were seven studies reporting on preoperative psychological evaluation and weight loss 46,48-53. Preoperative psychological evaluation was conducted by semi-structured interviews 48,50,51,53 or an interview in combination with validated ques- tionnaires 46,49,52. The definition of psychologic and/or psychiatric disturbances ranged from psychological disturbances to psychiatric disorders (Table 1). Included number of patients ranged from 65-485, follow-up was 6-24 months. In six studies weight loss was not influenced by the presence of psychological/psychiatric problems 46,48-50,52,53. In one study patients who had participated in mental health treatment before bariatric surgery had higher weight loss 51. Since definitions of psychologic evaluation varied greatly no meta-analysis was conducted.
Depressive symptoms
A total of 24 studies analyzed the effect of self-reported depressive symptoms on weight loss 25,29,30,34,36,40,41,43,44,54-68. Twelve studies used a validated questionnaire to measure symptoms of depression: the Beck Depression Inventory in eight 54,55,58-61,63- 67, the Hospital Anxiety and Depression Scale in two 36,57 and the Patient Health Ques- tionnaire in two studies 40,44. Other studies defined symptoms of depression by DSM- IV 30,56, preoperative questions about symptoms 25,34, frequency of symptoms 43, or antidepressant use 62 (Table 1). In three studies it was unclear how depression was determined 29,41,68. Number of patients ranged from 47-494 and maximum follow-up was 8.9 years. Depressive symptoms were measured preoperatively in 15 studies, postoperatively in 6 studies and both before and after surgery in 2 studies. In three studies the weight loss was negatively influenced by the preoperative symptoms of depression 30,41,60. In two studies postoperative symptoms of depression negatively correlated with %EWL 64,67. In all other studies neither pre- nor postoperative depres- sive symptoms were associated with weight loss.
Data of twelve studies with 24 follow-up moments could be pooled for meta-analysis (Table 4) 25,34,36,44,54-57,62,65,66,68. This included 3,701 patients with a mean pre-surgical BMI 48.4 kg/m2 (±2.8) in the group with depressive symptoms and 48.6 kg/m2 (±2.8) in the group without depressive symptoms (Figure 4). Mean weight loss was not signifi- cantly different between these groups, respectively 66.9% in the patients with symp- toms and 65.4% in the patients without symptoms (p=0.246).
At 12 months follow-up patients with depressive symptoms had higher weight loss, effect size 1.7% (p=0.036). This analysis included 595 patients of 4 studies with a mean baseline BMI of 48.6 kg/m2 in the depressive symptoms group and 49.0 kg/m2 in the non-depressive symptoms group 25,54,55,62. Four studies reported on 6 month fol- low-up, %EWL was not significant different (p=0.336) 54-56,62. Two studies reported on 24 and 36 months follow-up, weight loss was the same in the depressive symptoms and non-depressive symptoms group (p=0.276 and p=0.477) 54,55.
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