Ryan J. Marek

Assessing Psychosocial Functioning of Bariatric Surgery Candidates with the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF)

BackgroundPsychological comorbidity is common in bariatric surgery candidates. Many multidisciplinary teams incorporate psychometric testing to screen for psychological factors that, if left unattended, may negatively impact surgical results. Here, we report descriptive findings and empirical correlates of Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) scales among of bariatric surgery candidates undergoing a pre-surgical psychological evaluation.MethodsThe sample consisted of male (n = 324) and female (n = 658) patients seeking bariatric surgery who were administered the MMPI-2-RF at their psychological evaluation. Psychosocial and medical variables were retrospectively coded from the patients’ medical records. These criteria included history/current mental health diagnoses and treatments, maladaptive eating behaviors/diagnoses, past/current substance use, abuse history, sleep apnea, and denial of surgery.ResultsDescriptive analyses demonstrated similar findings for male and female candidates and replicated previous reports. MMPI-2-RF scales measuring emotional dysfunction were associated with maladaptive eating patterns, a history of Major Depressive Disorder, and previous suicide attempts. Scale scores measuring behavioral dysfunction were associated with current/past substance use and previous physical abuse. MMPI-2-RF scale scores measuring somatic problems were associated with a higher BMI at the time of surgery, sleep apnea diagnosis/adherence, physical/sexual abuse history, active mood disorder, previous mental health diagnoses, and maladaptive eating patterns.ConclusionsThe MMPI-2-RF can aid in identifying a broad range of psychological comorbidity among bariatric surgery candidates. When used in conjunction with a pre-surgical psychological interview, it can aid in the assessment of psychological factors relevant to pre-surgical psychological assessment of bariatric surgery candidates.

Psychological Risk Factors for Poor Outcome of Spine Surgery and Spinal Cord Stimulator Implant: A Review of the Literature and Their Assessment With the MMPI-2-RF

Back pain is experienced by up to of 85% of the United States population. Most often it resolves with minimal to no medical treatment. For those whose pain endures, worsens, or becomes protracted, conservative care is typically first attempted. Individuals who continue to experience significant back pain are often considered for surgical procedures, the results of which are not uniformly positive. The consequences of failed surgical intervention can be quite devastating, and psychosocial factors have been found to predict poor outcome. The literature on psychosocial risk factors for failed back surgery is reviewed first, identifying psychological dysfunction in the domains of emotions, cognitions, behavior, and interpersonal processes as increasing the risk for failed back surgery. Empirical findings with the MMPI-2 Restructured Form (MMPI-2-RF) are presented next, including descriptive analyses with a sample of 1341 individuals assessed as part of a pre-surgical psychological screening. Correlations between MMPI-2-RF scale scores and measures of the primary risk factors identified in this review are reported for a smaller sample of 197 pre-surgical candidates. Interpretive implications of the MMPI-2-RF findings are discussed along with suggestions for further research in this area.

Impact of using DSM-5 criteria for diagnosing binge eating disorder in bariatric surgery candidates: Change in prevalence rate, demographic characteristics, and scores on the minnesota multiphasic personality inventory – 2 restructured form (MMPI-2-RF)

OBJECTIVE Binge eating disorder (BED) was recently included in the DSM-5. The prevalence rate for BED using the DSM-IV-TR research criteria tends to be higher in bariatric surgery candidates than the normative population; however, no studies have examined how many more bariatric surgery candidates will meet the new, less conservative criteria of DSM-5. We explore the current BED prevalence rate change in a sample of bariatric surgery candidates. METHOD Data were obtained for 1,283 bariatric surgery candidates. 84 men and 213 women were diagnosed with current BED using DSM-IV-TR research criteria. A semi-structured interview, the binge eating scale (BES), and a Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) were given to every patient as part of standard procedures mandated by the facility. RESULTS AND DISCUSSION An additional 3.43% (p < .001) of bariatric surgery candidates met the diagnostic threshold for BED when using DSM-5 criteria. These individuals were demographical similar and produced similar MMPI-2-RF and BES scores when compared with patients who met DSM-IV-TR criteria for BED. Thus, the current investigation indicates that individuals meeting BED criteria based on DSM-5 are similar to those meeting the more conservative diagnostic threshold outlined in DSM-IV-TR in a sample of bariatric surgery candidates.

Predicting One and Three Month Postoperative Somatic Concerns, Psychological Distress, and Maladaptive Eating Behaviors in Bariatric Surgery Candidates with the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF)

BackgroundPresurgical psychological screening of bariatric surgery candidates includes some form of standardized psychological assessment. However, associations between presurgical psychological screening and postoperative outcome have not been extensively studied. Here, we explore associations between presurgical Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) scores and early postoperative Somatic Concerns, Psychological Distress, and Maladaptive Eating Behaviors.MethodsThe sample consisted of male (n = 238) and female (n = 621) patients who were administered the MMPI-2-RF at their presurgical psychological evaluation and received bariatric surgery. Patients were evaluated at their 1- and 3-month postoperative appointments.ResultsConfirmatory factor analysis indicated that three latent constructs—somatic concerns, psychological distress, and maladaptive eating behaviors—were represented by responses to a postoperative assessment and that these constructs could be measured consistently over time. Presurgical scores on MMPI-2-RF scales measuring internalizing dysfunction were associated with more psychological distress at postoperative follow-ups, scores on scales measuring somatization were associated with more postoperative somatic concerns, and scores on scales assessing emotional/internalizing, behavioral/externalizing, cognitive complaints, and thought dysfunction prior to surgery were associated with maladaptive eating behaviors after surgery.ConclusionsIn conjunction with a presurgical psychological interview, the MMPI-2-RF provides information that can assist in anticipating postoperative outcomes and inform efforts to prevent them.

Using presurgical psychological testing to predict 1-year appointment adherence and weight loss in bariatric surgery patients: predictive validity and methodological considerations

BACKGROUND Previous studies suggest that presurgical psychopathology accounts for some of the variance in suboptimal weight loss outcomes among Roux-en-Y gastric bypass (RYGB) patients, but research has been equivocal. OBJECTIVES The present study seeks to extend the past literature by examining associations between presurgical scale scores on the broadband Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and suboptimal weight loss and poor adherence to follow-up 1 year postoperatively after accounting for several methodologic considerations. SETTING Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, Ohio, USA. METHODS The sample consisted of 498 RYGB patients, who produced a valid presurgical MMPI-2-RF protocol at program intake. The sample was primarily female (72.9%), Caucasian (64.9%), and middle-aged (mean = 46.4 years old; standard deviation [SD] = 11.6). The mean presurgical body mass index (BMI) was 47.4 kg/m(2) (SD = 8.2) and mean percent weight loss (%WL) at 1 year postoperatively was 31.18 %WL (SD = 8.44). RESULTS As expected, scales from the Behavioral/Externalizing Dysfunction (BXD) domain of the MMPI-2-RF were associated with worse weight loss outcomes and poor adherence to follow-up, particularly after accounting for range restriction due to underreporting. Individuals producing elevated scores on these scales were at greater risk for achieving suboptimal weight loss (<50% excess weight loss) and not following up with their appointment compared with those who scored below cut-offs. CONCLUSIONS Patients who are more likely to engage in undercontrolled behavior (e.g., poor impulse control), as indicated by presurgical MMPI-2-RF findings, are at greater risk for suboptimal weight loss and poor adherence to follow-up following RYGB. Objective psychological assessments should also be conducted postoperatively to ensure that intervention is administered in a timely manner. Future research in the area of presurgical psychological screening should consider the impact of underreporting and other discussed methodologic issues in predictive analyses.

Minnesota multiphasic personality inventory‐2 restructured form (MMPI‐2‐RF) scale score differences in bariatric surgery candidates diagnosed with binge eating disorder versus BMI‐matched controls

OBJECTIVE Binge Eating Disorder (BED) is among the most common psychiatric disorders in bariatric surgery candidates. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) is a broadband, psychological test that includes measures of emotional and behavioral dysfunction, which have been associated with BED behaviors in bariatric surgery candidates; however these studies have lacked appropriate controls. In the current study, we compared MMPI-2-RF scale scores of bariatric surgery patients diagnosed with BED (BED+) with BMI-matched controls without BED (BED-). METHOD Three-hundred and seven BED+ participants (72.64% female and 67.87% Caucasian; mean BMI of 51.36 kg/m(2) [SD = 11.94]) were drawn from a large, database (N = 1304). Three-hundred and seven BED- participants were matched on BMI and demographics (72.64% female, 68.63% Caucasian, and mean BMI of 51.30 kg/m(2) [SD = 11.70]). RESULTS The BED+ group scored significantly higher on measures of Demoralization, Low Positive Emotions, and Dysfunctional Negative Emotions and scored lower on measures of Antisocial Behaviors, reflecting behavioral constraint. Optimal T-Score cutoffs were below the traditional 65 T score for several MMPI-2-RF scales. MMPI-2-RF externalizing measures also added incrementally to differentiating between the groups beyond the Binge Eating Scale (BES). DISCUSSION BED+ individuals produced greater elevations on a number of MMPI-2-RF internalizing scales and externalizing scales. Use of the test in conjunction with a clinical interview and other self-report data can further aid the clinician in guiding patients to appropriate treatment to optimize outcome.

Use of the MMPI-2-RF Suicidal/Death Ideation and Substance Abuse Scales in Screening Bariatric Surgery Candidates

Bariatric surgery patients are at increased risk for suicide and lifetime substance abuse problems, and these risks are surgical contraindications. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has scales to screen for these risks factors, among others. We seek to evaluate the classification accuracy of the MMPI-2-RF Suicidal/Death Ideation (SUI) and Substance Abuse (SUB) scales to optimize their use in bariatric surgery settings. Data were collected from 1,311 (72.1% female; 65.5% Caucasian) bariatric surgery candidates from the Cleveland Clinic as well as 295 (94.1% female; 85.9% Caucasian) bariatric surgery candidates from a private practice in St. Paul, Minnesota. Classification accuracies were calculated at original and revised SUI and SUB interpretative cutoffs in the Cleveland Clinic sample and replicated in the St. Paul sample. Significant and meaningful classification accuracy gains were demonstrated by excluding a death ideation item from the SUI scale and lowering the interpretive cutoff on the SUB scale. Practical implications and study limitations are discussed.

Understanding the role of psychopathology in bariatric surgery outcomes.

Bariatric surgery is the most effective treatment for morbid obesity; however, a subset of patients who undergo this procedure regain weight or achieve suboptimal weight loss results. A large number of studies have examined whether psychological variables play a role in weight loss surgery outcome. Although presurgical psychopathology has been found to be associated with suboptimal results in some studies, this literature is equivocal. These inconsistent findings are reviewed and considered in the context of contemporary models of psychopathology. More specifically, the review focuses on the limitations of atheoretical, descriptive diagnostic systems and examines whether comorbidity within the mood/anxiety disorders, impulse control/substance use disorders and thought disorders can account for the inconsistent findings reported to date. Contemporary models of psychopathology are highlighted and linked to the Research Domain Criteria, which have been advanced by the National Institute of Health. Means for assessing psychological constructs congruent with these models are reviewed. Recommendations are made for standardizing approaches to investigating how psychopathology contributes to suboptimal bariatric surgery outcomes.

Graze eating among bariatric surgery candidates: prevalence and psychosocial correlates

BACKGROUND Graze eating is defined as repetitive, unplanned eating of small amounts of food throughout the day. Little consensuses exist regarding whether graze eating, like binge eating disorder (BED), is characterized by feelings of loss of control (LOC). Furthermore, little is known about how patients who graze eat with and without LOC differ psychologically. OBJECTIVES The present study seeks to better characterize graze eating by examining differences between graze eating with LOC (+LOC) and without LOC (-LOC) among presurgical bariatric patients. SETTING A large, Midwestern academic medical center. METHODS The sample consisted of 288 adult bariatric surgery candidates (mean age 45.8, standard deviation [SD] 12.57) who underwent a presurgical psychological evaluation. Graze eating, BED, and other mental health diagnoses were evaluated using a semistructured interview. Participants were also administered the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and binge eating scale (BES). Data were collected using a retrospective chart review. RESULTS Among the 33% (n = 95) of the sample who reported preoperative graze eating, 32% (n = 30) also endorsed LOC. Graze eating, particularly with LOC, was associated with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) diagnoses of anxiety disorders and BED, and multiple measures of internalizing dysfunction on the MMPI-2-RF. CONCLUSIONS Bariatric surgery candidates who graze eat experience a greater degree of overall distress and psychopathology including anxiety and depression. The minority who experience grazing+LOC appear to have even greater risk of psychopathology. Moreover, there appears to be significant overlap with BED. Future research should explore whether these 2 maladaptive eating patterns benefit from similar treatment.

Associations Between Pre-Implant Psychosocial Factors and Spinal Cord Stimulation Outcome Evaluation Using the MMPI-2-RF

Spinal cord stimulation (SCS) has variable effectiveness in controlling chronic pain. Previous research has demonstrated that psychosocial factors are associated with diminished results of SCS. The objective of this investigation is to examine associations between pre-implant psychological functioning as measured by the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) and SCS outcomes. SCS candidates at two sites (total N = 319) completed the MMPI-2-RF and measures of pain, emotional distress, and functional ability as part of a pre-implant psychological evaluation. At an average of 5 months post-implant, patients completed the measures of pain and emotional distress a second time. Poorer SCS outcomes and poorer patient satisfaction were associated with higher pre-implant MMPI-2-RF scores on scales used to assess emotional dysfunction, somatic/cognitive complaints, and interpersonal problems. Ways through which pre-implant psychological evaluations of spinal cord stimulator candidates can be informed by MMPI-2-RF findings are discussed.