In the last decade there has been a spurt in the number of cases of bariatric surgery. While a lot is said about the huge benefits of such procedures, the critics have also been pointing out the disadvantages of the procedure.
One such area of concern has been the depression and even suicidal tendencies seen in some cases after bariatric surgery. There are various case reports of depression and suicides after bariatric surgery in the literature 1-4.
Recently a paper published in a reputed journal made an attempt to analyse this rather alarming problem 5. After critically analyzing these papers it was suggested that some papers suffered from methodologic problems such as small sample size, failure to use validated assessments of psychopathology and absence of appropriate comparison groups (for example , how many candidates were already depressed and having suicidal ideation before bariatric surgery).
One study found out that many of the patients undergoing bariatric surgery already have psychiatric disorders in the form of anxiety , mood , and personality disorder 6. In another study the extremely obese subjects were found to experience increased suicidal ideation than their normal weight counterparts 7. This may be partly responsible for the increased negative psychosocial effects seen in patients after bariatric surgery.
On the other hand, there are many papers that suggest that Bariatric surgery is associated with significant improvements in psychosocial status. Most psychosocial characteristics, including symptoms of depression and anxiety, health-related quality of life, self-esteem, and body image, improve dramatically in the first postoperative year.8-13
Unfortunately, a minority of patients appears to struggle with numerous psychological issues postoperatively. Although the evidence submitted in the literature to prove the adverse psychosocial outcome arising as a direct result of bariatric surgery is far from convincing due to the reasons stated above, it is probably a good policy to involve a mental health professional in all cases before performing such surgery.
References:
1. Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients–what have we learned? Obes Surg. 2000;10(6):509-513.
2. Hsu LK, Benotti PN, Dwyer J, et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60(3):338-346.
3. Waters GS, Pories WJ, Swanson MS, Meelheim HD, Flickinger EG, May HJ. Long-term studies of mental health after the Greenville gastric bypass operation for morbid obesity. Am J Surg. 1991;161(1):154-157.
4. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753-761.
5. David B. Sarwer, Anthony N. Fabricatore, P et al. Primary Psychiatry. 2008;15(8):50-55
6. Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry. 2007;164(2)328-334.
7. Dong C, Li WD, Li D, Price RA. Extreme obesity is associated with attempted suicides: results from a family study. Int J Obes (Lond). 2006;30(2):388-390.
8. Bocchieri LE, Meana M, Fisher BL. A review of psychosocial outcomes of surgery for morbid obesity. J Psychosom Res. 2002;52(3):155-165.
9. Herpertz S, Kielmann R, Wolf AM, Langkafel M, Senf W, Hebebrand J. Does obesity surgery improve psychosocial functioning? A systematic review. Int J Obes Relat Metab Disord. 2003;27(11):1300-1314.
10. van Hout GC, van Oudheusden I, van Heck GL. Psychological profile of the morbidly obese. Obes Surg. 2004;14(5):579-588.
11. Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13(4):639-648.
12. Herpertz S, Kielmann R, Wolfe AM, Hebebrand J, Senf W. Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review. Obes Res. 2004;12(10):1554-1569.
13. van Hout GC, Boekestein P, Fortuin FA, Pelle AJ, van Heck GL. Psychosocial functioning following bariatric surgery. Obes Surg. 2006;16(6):787-794.
August 15, 2010 at 3:31 PM
THANX