OBES SURG DOI 10.1007/s11695-014-1464-y
ORIGINAL CONTRIBUTIONS
Psychiatric Disorders Among Obese Patients Seeking Bariatric Surgery: Results of Structured Clinical Interviews Leorides Severo Duarte-Guerra & Bruno Mendonça Coêlho & Marco Aurélio Santo & Yuan-Pang Wang
# Springer Science+Business Media New York 2014
Abstract Background Obesity and psychiatric disorders are burdensome health problems commonly observed in general population and clinical samples. However, non-standardized assessment and small size of the sample might hamper conclusions of the investigations. The objective of this study is to replicate previous findings on frequency of psychiatric disorders and associated factors among obese patients seeking bariatric surgery, assessed through standardized interview. Material and Method The sample was comprised of 393 treatment-seeking obese patients (79.1 % women; mean age 43.0 years, mean BMI 47.8 kg/m2) recruited from a universitybased bariatric center. Trained clinicians ascertained the psychiatric diagnosis of the participants through structured clinical interview for DSM-IV Axis I diagnosis (SCID-I). Results The current rate of any psychiatric disorders was 57.8 % (58.5 % men vs. 57.6 % women). The current anxiety disorders were the most frequent diagnosis (46.3 %) among those participants with current disorder. Age and educational level were associated with the likelihood of presenting current psychiatric disorders. The lifetime rate of any psychiatric disorders was 80.9 % (81.7 men vs. 80.7% women). Lifetime affective disorders were the most frequent diagnosis (total 64.9%; bipolar disorders 35.6% and depressive disorders 29.3%). About half of the sample presented 3 or more Parts of this investigation were presented during the 18th World Congress of International Federation for the Surgery of Obesity & Metabolic Disorders, Istanbul, Turkey (28–31 August, 2013). L. S. Duarte-Guerra : B. M. Coêlho : Y.12 years
OBES SURG Table 2 Frequency of current SCID-I psychiatric disorders in bariatric surgery candidates (n=393) Psychiatric disorder
Total (N=393) n (%)
Women (N=311) n (%)
Men (N=82) n (%)
p
Any psychiatric disorder Any affective disorder Any bipolar disorder Bipolar disorder I
227 (57.8) 85 (21.6) 54 (13.7) 8 (2.0)
179 (57.6) 68 (21.9) 41 (13.2) 6 (1.9)
48 (58.5) 17 (20.7) 13 (15.9) 2 (2.4)
0.87 0.83 0.53 0.67
Bipolar disorder II Bipolar disorder NOS Any depressive disorder Major depression Dysthymia Any anxiety disorder Panic disorder Agoraphobia Social phobia Specific phobia PTSD Obsessive-compulsive Generalized anxiety Anxiety NOS Any substance use disorder Alcohol use disorder Drug use disorder Any eating disorder
29 (7.4) 17 (4.3) 31 (7.9) 27 (6.9) 4 (1.0) 182 (46.3) 9 (2.3) 22 (5.6) 36 (9.2) 67 (17.0) 10 (2.5) 14 (3.6) 94 (23.9) 21 (5.3) 12 (3.1) 12 (3.1) 2 (0. 5) 79 (20.1)
21 (6.8) 14 (4.5) 27 (8.7) 23 (7.4) 4 (1.3) 147 (47.3) 8 (2.6) 21 (6.8) 28 (9.0) 55 (17.7) 8 (2.6) 13 (4.2) 79 (25.4) 17 (5.5) 6 (1.9) 6 (1.9) 1 (0.3) 62 (19.9)
8 (9.8) 3 (3.7) 4 (4.9) 4 (4.9) – 35 (42.7) 1 (1.2) 1 (1.2) 8 (9.8) 12 (14.6) 2 (2.4) 1 (1.2) 15 (18.3) 4 (4.9) 6 (7.3) 6 (7.3) 1 (1.2) 17 (20.7)
0.51 1.00 0.36 0.62 – 0.65 0.69 0.06 0.90 0.45 1.00 0.32 0.11 1.00 0.01 0.01 0.37 0.87
Binge eating disorder Bulimia nervosa Any disorder (N, %) No disorder 1 disorder 2 disorders 3+ disorders GAF (mean, SD) BMI, kg/m2 (mean, SD)
65 (16.5) 14 (3.6) 227 (57.8) 166 (42.2) 105 (26.7) 61 (15.5) 61 (15.5) 76.8 (12.3)
48 (15.4) 14 (4.5) 179 (57.6) 132 (42.4) 80 (25.7) 48 (15.4) 51 (16.4) 77.3 (11.7)
17 (20.7) – 48 (58.5) 34 (41.5) 25 (30.5) 13 (15.9) 10 (12.2) 74.6 (14.4)
0.65 – 0.87
0.73 t=0.155
−0.07
47.8 (7.5) 43.0 (11.5)
46.4 (6.6) 43.9 (11.4)
50.2 (9.6) 42.7 (12.0)
t=−3.406 t=0.269
0.01 0.79
Age, year (mean, SD)
Cells with less than five were used Fisher’s statistics for p value NOS not otherwise specified, PTSD post-traumatic stress disorder, GAF global assessment functioning, BMI body mass index
widely accepted as the gold standard to make diagnosis of psychiatric disorders listed in DSM-IV [38]. After screening for the presence of core psychopathology, the interviewer should investigate if the respondents meet the criteria for affective disorders (section A, D), psychotic disorders (C, D), substance use disorders (SUD) (E), anxiety disorders (F), somatoform disorders (G), eating disorder (H), and adjustment disorders (I). The diagnostic strategy adopted by SCID-I is topdown, i.e., the presence of symptoms should be checked for the criteria for the suspected psychiatric diagnosis. Considerable evidence of reliability and validity was reported in several patient samples [39].
We used the patient version of SCID-I, which allow recording disorders for both current and lifetime period. The sections of psychotic disorders and somatoform disorders were omitted to shorten the time of application. Additionally, psychotic patients are routinely excluded as candidate for bariatric surgery. Before finishing the interview, the interviewer also scored the global assessment functioning (GAF) of the patients, as their best role functioning in the past year [40, 41]. Six clinical psychologists with previous experience in obesity and bariatric surgery were trained in a 3-day standard course of SCID-I, followed by a 60-h calibration practice. Arbitrary pairs of researchers assessed the first 15 patients in
OBES SURG Table 3 Frequency of lifetime SCID-I psychiatric disorders in bariatric surgery candidates (n=393) Psychiatric disorder
Total (N=393) n (%)
Women (N=311) n (%)
Men (N=82) n (%)
Any psychiatric disorder Any affective disorder Any bipolar disorder Bipolar disorder I
318 (80.9) 255 (64.9) 140 (35.6) 20 (5.1)
251 (80.7) 200 (64.3) 103 (33.1) 13 (4.2)
67 (81.7) 55 (67.1) 37 (45.1) 7 (8.5)
0.84 0.64 0.04 0.11
Bipolar disorder II Bipolar disorder NOS Any depressive disorder Major depressive disorder Minor depressive disorder Dysthymia Any anxiety disorder Panic disorder Agoraphobia Social phobia Specific phobia PTSD Obsessive-compulsive Anxiety NOS Any substance use disorder Alcohol use disorder Drug use disorder Any eating disorder
55 (14) 65 (16.5) 115 (29.3) 108 (27.5) 2 (0.5) 5 (1.3) 215 (54.7) 35 (8.9) 42 (10.7) 50 (12.7) 92 (23.4) 12 (3.1) 25 (6.4) 21 (5.3) 69 (17.6) 57 (14.5) 27 (6.9) 138 (35.1)
42 (13.5) 48 (15.4) 97 (31.2) 90 (28.9) 2 (0.6) 5 (1.6) 177 (56.9) 29 (9.3) 41 (13.2) 41 (13.2) 77 (24.8) 8 (2.6) 22 (7.1) 17 (5.5) 39 (12.5) 30 (9.6) 17 (5.5) 109 (35.0)
13 (15.9) 17 (20.7) 18 (22.0) 18 (22.0) – – 38 (46.3) 6 (7.3) 1 (1.2) 9 (11.0) 15 (18.3) 4 (4.9) 3 (3.7) 4 (4.9) 30 (36.6) 27 (32.9) 10 (12.2) 29 (35.4)
0.59 0.25 0.10 0.21 – – 0.09 0.57 0.001 0.59 0.22 0.28 0.32 1.00
ORIGINAL CONTRIBUTIONS
Psychiatric Disorders Among Obese Patients Seeking Bariatric Surgery: Results of Structured Clinical Interviews Leorides Severo Duarte-Guerra & Bruno Mendonça Coêlho & Marco Aurélio Santo & Yuan-Pang Wang
# Springer Science+Business Media New York 2014
Abstract Background Obesity and psychiatric disorders are burdensome health problems commonly observed in general population and clinical samples. However, non-standardized assessment and small size of the sample might hamper conclusions of the investigations. The objective of this study is to replicate previous findings on frequency of psychiatric disorders and associated factors among obese patients seeking bariatric surgery, assessed through standardized interview. Material and Method The sample was comprised of 393 treatment-seeking obese patients (79.1 % women; mean age 43.0 years, mean BMI 47.8 kg/m2) recruited from a universitybased bariatric center. Trained clinicians ascertained the psychiatric diagnosis of the participants through structured clinical interview for DSM-IV Axis I diagnosis (SCID-I). Results The current rate of any psychiatric disorders was 57.8 % (58.5 % men vs. 57.6 % women). The current anxiety disorders were the most frequent diagnosis (46.3 %) among those participants with current disorder. Age and educational level were associated with the likelihood of presenting current psychiatric disorders. The lifetime rate of any psychiatric disorders was 80.9 % (81.7 men vs. 80.7% women). Lifetime affective disorders were the most frequent diagnosis (total 64.9%; bipolar disorders 35.6% and depressive disorders 29.3%). About half of the sample presented 3 or more Parts of this investigation were presented during the 18th World Congress of International Federation for the Surgery of Obesity & Metabolic Disorders, Istanbul, Turkey (28–31 August, 2013). L. S. Duarte-Guerra : B. M. Coêlho : Y.12 years
OBES SURG Table 2 Frequency of current SCID-I psychiatric disorders in bariatric surgery candidates (n=393) Psychiatric disorder
Total (N=393) n (%)
Women (N=311) n (%)
Men (N=82) n (%)
p
Any psychiatric disorder Any affective disorder Any bipolar disorder Bipolar disorder I
227 (57.8) 85 (21.6) 54 (13.7) 8 (2.0)
179 (57.6) 68 (21.9) 41 (13.2) 6 (1.9)
48 (58.5) 17 (20.7) 13 (15.9) 2 (2.4)
0.87 0.83 0.53 0.67
Bipolar disorder II Bipolar disorder NOS Any depressive disorder Major depression Dysthymia Any anxiety disorder Panic disorder Agoraphobia Social phobia Specific phobia PTSD Obsessive-compulsive Generalized anxiety Anxiety NOS Any substance use disorder Alcohol use disorder Drug use disorder Any eating disorder
29 (7.4) 17 (4.3) 31 (7.9) 27 (6.9) 4 (1.0) 182 (46.3) 9 (2.3) 22 (5.6) 36 (9.2) 67 (17.0) 10 (2.5) 14 (3.6) 94 (23.9) 21 (5.3) 12 (3.1) 12 (3.1) 2 (0. 5) 79 (20.1)
21 (6.8) 14 (4.5) 27 (8.7) 23 (7.4) 4 (1.3) 147 (47.3) 8 (2.6) 21 (6.8) 28 (9.0) 55 (17.7) 8 (2.6) 13 (4.2) 79 (25.4) 17 (5.5) 6 (1.9) 6 (1.9) 1 (0.3) 62 (19.9)
8 (9.8) 3 (3.7) 4 (4.9) 4 (4.9) – 35 (42.7) 1 (1.2) 1 (1.2) 8 (9.8) 12 (14.6) 2 (2.4) 1 (1.2) 15 (18.3) 4 (4.9) 6 (7.3) 6 (7.3) 1 (1.2) 17 (20.7)
0.51 1.00 0.36 0.62 – 0.65 0.69 0.06 0.90 0.45 1.00 0.32 0.11 1.00 0.01 0.01 0.37 0.87
Binge eating disorder Bulimia nervosa Any disorder (N, %) No disorder 1 disorder 2 disorders 3+ disorders GAF (mean, SD) BMI, kg/m2 (mean, SD)
65 (16.5) 14 (3.6) 227 (57.8) 166 (42.2) 105 (26.7) 61 (15.5) 61 (15.5) 76.8 (12.3)
48 (15.4) 14 (4.5) 179 (57.6) 132 (42.4) 80 (25.7) 48 (15.4) 51 (16.4) 77.3 (11.7)
17 (20.7) – 48 (58.5) 34 (41.5) 25 (30.5) 13 (15.9) 10 (12.2) 74.6 (14.4)
0.65 – 0.87
0.73 t=0.155
−0.07
47.8 (7.5) 43.0 (11.5)
46.4 (6.6) 43.9 (11.4)
50.2 (9.6) 42.7 (12.0)
t=−3.406 t=0.269
0.01 0.79
Age, year (mean, SD)
Cells with less than five were used Fisher’s statistics for p value NOS not otherwise specified, PTSD post-traumatic stress disorder, GAF global assessment functioning, BMI body mass index
widely accepted as the gold standard to make diagnosis of psychiatric disorders listed in DSM-IV [38]. After screening for the presence of core psychopathology, the interviewer should investigate if the respondents meet the criteria for affective disorders (section A, D), psychotic disorders (C, D), substance use disorders (SUD) (E), anxiety disorders (F), somatoform disorders (G), eating disorder (H), and adjustment disorders (I). The diagnostic strategy adopted by SCID-I is topdown, i.e., the presence of symptoms should be checked for the criteria for the suspected psychiatric diagnosis. Considerable evidence of reliability and validity was reported in several patient samples [39].
We used the patient version of SCID-I, which allow recording disorders for both current and lifetime period. The sections of psychotic disorders and somatoform disorders were omitted to shorten the time of application. Additionally, psychotic patients are routinely excluded as candidate for bariatric surgery. Before finishing the interview, the interviewer also scored the global assessment functioning (GAF) of the patients, as their best role functioning in the past year [40, 41]. Six clinical psychologists with previous experience in obesity and bariatric surgery were trained in a 3-day standard course of SCID-I, followed by a 60-h calibration practice. Arbitrary pairs of researchers assessed the first 15 patients in
OBES SURG Table 3 Frequency of lifetime SCID-I psychiatric disorders in bariatric surgery candidates (n=393) Psychiatric disorder
Total (N=393) n (%)
Women (N=311) n (%)
Men (N=82) n (%)
Any psychiatric disorder Any affective disorder Any bipolar disorder Bipolar disorder I
318 (80.9) 255 (64.9) 140 (35.6) 20 (5.1)
251 (80.7) 200 (64.3) 103 (33.1) 13 (4.2)
67 (81.7) 55 (67.1) 37 (45.1) 7 (8.5)
0.84 0.64 0.04 0.11
Bipolar disorder II Bipolar disorder NOS Any depressive disorder Major depressive disorder Minor depressive disorder Dysthymia Any anxiety disorder Panic disorder Agoraphobia Social phobia Specific phobia PTSD Obsessive-compulsive Anxiety NOS Any substance use disorder Alcohol use disorder Drug use disorder Any eating disorder
55 (14) 65 (16.5) 115 (29.3) 108 (27.5) 2 (0.5) 5 (1.3) 215 (54.7) 35 (8.9) 42 (10.7) 50 (12.7) 92 (23.4) 12 (3.1) 25 (6.4) 21 (5.3) 69 (17.6) 57 (14.5) 27 (6.9) 138 (35.1)
42 (13.5) 48 (15.4) 97 (31.2) 90 (28.9) 2 (0.6) 5 (1.6) 177 (56.9) 29 (9.3) 41 (13.2) 41 (13.2) 77 (24.8) 8 (2.6) 22 (7.1) 17 (5.5) 39 (12.5) 30 (9.6) 17 (5.5) 109 (35.0)
13 (15.9) 17 (20.7) 18 (22.0) 18 (22.0) – – 38 (46.3) 6 (7.3) 1 (1.2) 9 (11.0) 15 (18.3) 4 (4.9) 3 (3.7) 4 (4.9) 30 (36.6) 27 (32.9) 10 (12.2) 29 (35.4)
0.59 0.25 0.10 0.21 – – 0.09 0.57 0.001 0.59 0.22 0.28 0.32 1.00
