Barbara Mühlhans

Anxiety and depression in bariatric surgery patients: A prospective, follow-up study using structured clinical interviews

BACKGROUND Candidates for bariatric surgery frequently have co-morbid psychiatric problems. METHODS This study investigated the course and the prognostic significance of preoperative and postoperative anxiety and depressive disorders in 107 extremely obese bariatric surgery patients in a prospective design with face-to-face interviews (SCID) conducted prior to the surgery and postoperatively after 6-12 months and 24-36 months. RESULTS The point prevalence of depressive disorders but not of anxiety disorders decreased significantly after surgery. Preoperative depressive disorders predicted depressive disorders 24-36 months but not 6-12 months after surgery, whereas preoperative anxiety significantly predicted postoperative anxiety disorders at both follow-up time points. Preoperative lifetime and current depressive disorders were unrelated to postoperative weight loss whereas preoperative lifetime, but not current anxiety disorders were of negative prognostic value for postoperative weight loss. Patients with both depressive and anxiety disorders at baseline (current and lifetime) lost significantly less weight after surgery. Postoperative anxiety disorder was not associated with the degree of weight loss at any follow-up time-point; however postoperative depressive disorder was negatively associated with weight loss at the 24-36 month follow-up assessment point. LIMITATIONS Missing data, limited statistical power, self-reported height and weight are the limitations of this study. CONCLUSIONS As opposed to anxiety disorders, the point prevalence of depressive disorders decreased significantly after bariatric surgery. However, the presence of depressive disorders after bariatric surgery significantly predicted attenuated post-surgical improvements and may signal a need for clinical attention.

Psychiatric disorders in bariatric surgery candidates: a review of the literature and results of a German prebariatric surgery sample

OBJECTIVE To investigate the prevalence of Axis I psychopathology in bariatric surgery candidates and to compare our results with the findings of the few studies published thus far. METHOD Structured clinical interviews (SCID) were conducted in 146 consecutive bariatric surgery candidates [71.9% women; mean age: 38.7 years (S.D.=10.0); mean BMI: 49.3 kg/m(2) (S.D.=7.8)] between September 2004 and January 2007 at the University Hospital of Erlangen. Assessments were administered independently of the preoperative screening and approval process. RESULTS The overall prevalence of current Axis I disorders was 55.5%; 72.6% had a lifetime history of at least one Axis I disorder. Axis I psychopathology was related to gender (with women reporting higher prevalence rates) and was positively associated with a lifetime history of any eating disorder. We compared our results with the findings of the three published studies having used structured clinical interviews to assess psychiatric comorbidity in bariatric surgery candidates. The authors provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries. CONCLUSION About one half of the bariatric surgery candidates in Germany presented with a current Axis I disorder. Prevalence rates reported in the literature so far are based on different premises. Details for example about the evaluation should be taken into account when interpreting the results.

Depression and anxiety: their predictive function for weight loss in obese individuals.

Objective: To investigate the impact of current mental disorders on weight loss with special consideration of depressive and/or anxiety disorders as well as binge eating behavior in obese individuals undergoing different weight loss treatments. Methods: Three different samples of obese individuals were investigated in a prospective, longitudinal study: participants in a conventional weight loss treatment program (CONV TREAT; n = 250), obesity surgery patients (OBES SURG; n = 153), and obese control individuals (OC; n = 128). Current mental disorders and BMI were assessed at baseline and at 4-year follow-up. Results: OBES SURG patients with a depressive and/or anxiety disorder lost significantly less weight compared with those without a comorbid mental diagnosis. This result was not detected for CONV TREAT participants. A trend to gain weight was seen in OC participants with a depressive and/or anxiety disorder, whereas OC participants without current mental disorders at baseline lost some weight. Binge eating behavior at baseline did not predict weight loss at 4-year followup. Conclusions: These results underline the importance of addressing current depressive and anxiety disorders in obese patients, especially when such patients are undergoing obesity surgery.

Pathologisches Kaufen und psychische Komorbidität

Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

Night eating, binge eating and related features in patients with obstructive sleep apnea syndrome.

The aim of the study was to explore the nature and extent of the association between night eating, other forms of disordered eating and obstructive sleep apnea (OSAS).Eighty-one participants (20 women and 61 men), mean age 53.7 years diagnosed with OSAS were assessed prior to starting treatment. Using a cut-off of > or =25 on the Night Eating Questionnaire (NEQ), 8.6% of the participants screened positive for night eating syndrome (NES). In addition, 7.5% met criteria for a daytime eating disorder. NES was significantly associated with diagnoses of depression, anxiety and eating disorders and was significantly correlated with an impairment of mental quality of life. No associations were found between NES and gender, BMI and the severity of the OSAS. NES does not appear to be closely linked to OSAS; however, in patients with OSAS and NES a significant co-morbidity with psychiatric disorders can be expected which might require additional treatment.

Do mental disorders and eating patterns affect long-term weight loss maintenance?

OBJECTIVE This study aimed to assess the impact of mental disorders on weight loss maintenance among initially successful weight losers who participated in a very-low-calorie diet program. METHOD A total of 251 obese individuals were assessed in a prospective longitudinal study over a period of 4 years. Mental disorders and eating patterns were assessed by structured interviews at baseline and by standardized questionnaires at baseline (T(1)), after 1 year (T(2)) and on 3-year follow-up (T(3)). Analyses were performed with an intention-to-treat method. RESULTS Based on the intention-to-treat sample, 166 successful weight losers at T(2) (weight loss > or = 10%) were identified. Of those, 47 (28.3%) maintained a weight loss of > or = 5% of their pretreatment weight, whereas 119 (71.7%) maintained a loss of less than 5% of their pretreatment weight at T(3). History of substance abuse/dependence disorder and grazing prior to treatment increased the likelihood of successful weight loss maintenance. High levels of cognitive control, low levels of disinhibition on 3-year follow-up and initial body mass index also were associated with successful weight loss maintenance. CONCLUSION Strategies that helped individuals overcome earlier mental disorders might help to establish better self-regulation and maintain high cognitive control of eating and subsequently increase the possibility of maintaining weight loss in the long run.

Psychometric evaluation of the German version of the impact of weight on Quality of Life-Lite (IWQOL-Lite) questionnaire.

OBJECTIVE To evaluate the psychometric properties of a German version of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. METHOD IWQOL-Lite scores were obtained from 351 overweight/obese individuals and 127 lean adult volunteers. In addition, a subgroup of 126 obese subjects completed also the German versions of the 36-item short-form health survey (SF-36), the Beck Depression Inventory (BDI), the Eating Disorder Examination-Questionnaire (EDE-Q), and the German validated version of the Three-Factor Eating Questionnaire (TFEQ). RESULTS The German version of the IWQOL-Lite has psychometric properties comparable to those found for the original version and demonstrates high internal consistency and excellent construct validity. Furthermore, the German IWQOL-Lite clearly discriminates between groups based on BMI on all subscales and the total score. CONCLUSION The results of the present study suggest that the German IWQOL-Lite is a psychometrically validated instrument with which to measure weight-specific health related quality of life.

[Agreement between clinical evaluation and structured clinical interviews (SCID for DSM-IV) in morbidly obese pre-bariatric surgery patients].

The goal of the study was to determine the concordance between mental disorder assessed during clinical evaluation and those independently obtained by a SCID interview in morbidly obese patients prior to bariatric surgery. In 116 patients a SCID interview was conducted. The agreement was moderate for any current diagnosis (kappa 0.43) current affective disorder (kappa 0.41) and current eating disorders (kappa 0.47). For current anxiety disorders agreement was poor wit a kappa of 0.11. For anxiety disorders and eating disorders the use of SCID resulted in more diagnoses than did standard clinical evaluation. Generally, the SCID produced more current axis 1 diagnoses than the clinical evaluation. When conducting a clinical evaluation prior to bariatric surgery a structured clinical interview should be used to assess mental co-mobidity.