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Clinical versus patient-reported measures of depression in bariatric surgery

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Abstract

Background

Bariatric surgery patients with mental illness may experience worse surgical outcomes compared to those without. Depression is the most prevalent mental health diagnosis amongst Americans with obesity. Accurate diagnosis and treatment is of paramount importance to mitigate perioperative risk. Unfortunately, there is no standard method to screen patients for depression prior to surgery. Our goal was to understand the relationship between traditional clinical screening tools and a novel patient-reported depression screening survey, Patient Health Questionnaire 8 (PHQ-8), in the setting of the bariatric surgery preoperative assessment.

Methods

The study included all adult bariatric surgery patients from January 2014 through June 2016. Patients who were not assessed using both the PHQ-8 and a traditional clinical depression screening were excluded from the study. There were a total of 4486 patients who met the eligibility criteria and were included in analysis. We used comparative statistics to examine the association between these screening tools and to test for contributing demographic, surgical, and socioeconomic factors.

Results

The overall rate of clinically diagnosed depression in the study cohort was 45.6%. In comparison, 14.8% of all patients screened positive for depression using the PHQ-8. Of the patients without a traditional clinical diagnosis of depression, 10.2% screened positive for depression using the PHQ-8. This subset of undiagnosed patients was more likely to be non-white, employed, and had a higher BMI than their clinically diagnosed counterparts.

Conclusions and Relevance

We found a higher rate of clinically diagnosed depression in our cohort compared to the general population. However, when using the validated PHQ-8 survey, the rate of depression more closely approximated the national incidence. Further, a significant proportion of patients were undiagnosed and/or misdiagnosed by current clinical assessments. Standardizing preoperative depression screening using validated patient-centered tools may prevent the consequences of untreated depression.

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References

  1. Sarwer DB, Cohn NI, Gibbons LM, Magee L, Crerand CE, Raper SE, Rosato EF, Williams NN, Wadden TA (2004) Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obes Surg 14:1148–1156. https://doi.org/10.1381/0960892042386922

    Article  PubMed  Google Scholar 

  2. McGuire S Shields M, Carroll MD, Ogden CL (2011) Adult obesity prevalence in Canada and the United States. NCHS Data Brief no. 56, Hyattsville, MD: National Center for Health Statistics, 2011. Adv Nutr 2:368–369. https://doi.org/10.3945/an.111.000497

    Article  PubMed  PubMed Central  Google Scholar 

  3. Luppino FS, Wit LM de, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH., Zitman FG (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 67:220–229. https://doi.org/10.1001/archgenpsychiatry.2010.2

    Article  PubMed  Google Scholar 

  4. Colquitt JL, Clegg AJ, Loveman E, Royle P, Sidhu MK (2005) Surgery for morbid obesity. Cochrane Database Syst Rev https://doi.org/10.1002/14651858.CD003641.pub2

    Article  PubMed  Google Scholar 

  5. Consortium TLA of BS (LABS) (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454. https://doi.org/10.1056/NEJMoa0901836

    Article  Google Scholar 

  6. Kuruba R, Koche LS, Murr MM (2007) Preoperative assessment and perioperative care of patients undergoing bariatric surgery. Med Clin North Am 91:339–351. https://doi.org/10.1016/j.mcna.2007.01.010

    Article  PubMed  Google Scholar 

  7. Grundy SM, Barondess JA, Bellegie NJ, Fromm H, Greenway F, Halsted CH, Huth EJ, Kumanyika SK, Reisin E, Robinson MK, Stevens J, Twomey PL, Viederman M, Zipf W (1991) Gastrointestinal surgery for severe obesity. Ann Intern Med 115:956–961

    Article  Google Scholar 

  8. Fabricatore AN, Crerand CE, Wadden TA, Sarwer DB, Krasucki JL (2006) How do mental health professionals evaluate candidates for bariatric surgery? survey results. Obes Surg 16:567–573. https://doi.org/10.1381/096089206776944986

    Article  PubMed  Google Scholar 

  9. Sclar DA, Robison LM, Schmidt JM, Bowen KA, Castillo LV, Oganov AM (2012) Diagnosis of depression and use of antidepressant pharmacotherapy among adults in the United States: does a disparity persist by ethnicity/race? Clin Drug Investig 32:139–144. https://doi.org/10.2165/11598950-000000000-00000

    Article  PubMed  Google Scholar 

  10. Stockdale SE, Lagomasino IT, Siddique J, McGuire T, Miranda J (2008) Racial and ethnic disparities in detection and treatment of depression and anxiety among psychiatric and primary health care visits, 1995–2005. Med Care 46:668–677. https://doi.org/10.1097/MLR.0b013e3181789496

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ghoneim MM, O’Hara MW (2016) Depression and postoperative complications: an overview. BMC Surg 16:5. https://doi.org/10.1186/s12893-016-0120-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kroenke K, Strine TW, Spitzer RL, Williams JBW, Berry JT, Mokdad AH (2009) The PHQ-8 as a measure of current depression in the general population. J Affect Disord 114:163–173. https://doi.org/10.1016/j.jad.2008.06.026

    Article  PubMed  Google Scholar 

  13. Allison DB, Newcomer JW, Dunn AL, Blumenthal JA, Fabricatore AN, Daumit GL, Cope MB, Riley WT, Vreeland B, Hibbeln JR, Alpert JE (2009) Obesity among those with mental disorders: a national institute of mental health meeting report. Am J Prev Med 36:341–350. https://doi.org/10.1016/j.amepre.2008.11.020

    Article  PubMed  Google Scholar 

  14. Sysko R, Zandberg LJ, Devlin MJ, Annunziato RA, Zitsman JL, Walsh BT (2013) Mental health evaluations for adolescents prior to bariatric surgery: a review of existing practices and a specific example of assessment procedures. Clin Obes 3:62–72. https://doi.org/10.1111/cob.12019

    Article  PubMed  PubMed Central  Google Scholar 

  15. Magallares A, Schomerus G (2015) Mental and physical health-related quality of life in obese patients before and after bariatric surgery: a meta-analysis. Psychol Health Med 20:165–176. https://doi.org/10.1080/13548506.2014.963627

    Article  PubMed  Google Scholar 

  16. Herget S, Rudolph A, Hilbert A, Blüher S (2014) Psychosocial status and mental health in adolescents before and after bariatric surgery: a systematic literature review. Obes Facts 7:233–245. https://doi.org/10.1159/000365793

    Article  PubMed  PubMed Central  Google Scholar 

  17. Spitznagel MB, Alosco M, Galioto R, Strain G, Devlin M, Sysko R, Crosby RD, Mitchell JE, Gunstad J (2014) The role of cognitive function in postoperative weight loss outcomes: 36-month follow-up. Obes Surg 24:1078–1084. https://doi.org/10.1007/s11695-014-1205-2

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bhatti JA, Nathens AB, Thiruchelvam D, Grantcharov T, Goldstein BI, Redelmeier DA (2016) Self-harm emergencies after bariatric surgery: a Population-Based Cohort Study. JAMA Surg 151:226–232. https://doi.org/10.1001/jamasurg.2015.3414

    Article  PubMed  Google Scholar 

  19. Rutledge T, Braden AL, Woods G, Herbst KL, Groesz LM, Savu M (2012) Five-year changes in psychiatric treatment status and weight-related comorbidities following bariatric surgery in a veteran population. Obes Surg 22:1734–1741. https://doi.org/10.1007/s11695-012-0722-0

    Article  PubMed  Google Scholar 

  20. Inge TH, Zeller MH, Jenkins TM, Helmrath M, Brandt ML, Michalsky MP, Harmon CM, Courcoulas A, Horlick M, Xanthakos SA, Dolan L, Mitsnefes M, Barnett SJ, Buncher R (2014) Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study. JAMA Pediatr 168:47–53. https://doi.org/10.1001/jamapediatrics.2013.4296

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kudsi OY, Huskey K, Grove S, Blackburn G, Jones DB, Wee CC (2013) Prevalence of preoperative alcohol abuse among patients seeking weight-loss surgery. Surg Endosc 27:1093–1097. https://doi.org/10.1007/s00464-012-2568-x

    Article  PubMed  Google Scholar 

  22. Kubik JF, Gill RS, Laffin M, Karmali S (2013) The impact of bariatric surgery on psychological health. J Obes 2013:e837989. https://doi.org/10.1155/2013/837989

    Article  Google Scholar 

  23. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity 21:S1–S27. https://doi.org/10.1002/oby.20461

    Article  PubMed  CAS  Google Scholar 

  24. Tiemens BG, VonKorff M, Lin EHB (1999) Diagnosis of depression by primary care physicians versus a structured diagnostic interview: understanding discordance. Gen Hosp Psychiatry 21:87–96. https://doi.org/10.1016/S0163-8343(98)00077-2

    Article  PubMed  CAS  Google Scholar 

  25. Ambwani S, Boeka AG, Brown JD, Byrne TK, Budak AR, Sarwer DB, Fabricatore AN, Morey LC, O’Neil PM (2013) Socially desirable responding by bariatric surgery candidates during psychological assessment. Surg Obes Relat Dis 9:300–305. https://doi.org/10.1016/j.soard.2011.06.019

    Article  PubMed  Google Scholar 

  26. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K (2004) Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care 42:1194–1201. https://doi.org/10.1097/00005650-200412000-00006

    Article  PubMed  Google Scholar 

  27. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289:3095–3105. https://doi.org/10.1001/jama.289.23.3095

    Article  PubMed  Google Scholar 

  28. Alegría M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G (2007) Prevalence of psychiatric disorders across latino subgroups in the United States. Am J Public Health 97:68–75. https://doi.org/10.2105/AJPH.2006.087205

    Article  PubMed  PubMed Central  Google Scholar 

  29. Williams DR, Haile R, González HM, Neighbors H, Baser R, Jackson JS (2007) The mental health of black Caribbean immigrants: results from the National Survey of American Life. Am J Public Health 97:52–59. https://doi.org/10.2105/AJPH.2006.088211

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB (1993) Sex and depression in the National Comorbidity Survey I: lifetime prevalence, chronicity and recurrence. J Affect Disord 29:85–96. https://doi.org/10.1016/0165-0327(93)90026-G

    Article  PubMed  CAS  Google Scholar 

  31. Bebbington PE (1998) Sex and depression. Psychol Med 28:1–8

    Article  PubMed  CAS  Google Scholar 

  32. Bertakis KD, Helms LJ, Callahan EJ, Azari R, Leigh P, Robbins JA (2001) Patient gender differences in the diagnosis of depression in primary care. J Women’s Health Gend-Based Med 10:689–698. https://doi.org/10.1089/15246090152563579

    Article  CAS  Google Scholar 

  33. Martin LA, Neighbors HW, Griffith DM (2013) The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. JAMA Psychiatry 70:1100–1106. https://doi.org/10.1001/jamapsychiatry.2013.1985

    Article  PubMed  Google Scholar 

  34. Mustard CA, Kaufert P, Kozyrskyj A, Mayer T (1998) Sex differences in the use of health care services. N Engl J Med 338:1678–1683. https://doi.org/10.1056/NEJM199806043382307

    Article  PubMed  CAS  Google Scholar 

  35. Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA (2000) Gender differences in the utilization of health care services. J Fam Pract 49:147–152. http://link.galegroup.com/apps/doc/A60039859/AONE?sid=googlescholar. Accessed 16 Dec 2017

  36. Longitudinal Assessment of Bariatric Surgery (LABS) (2017) https://www.niddk.nih.gov/health-information/health-topics/weight-control/longitudinal-assessment-bariatric-surgery/Pages/labs.aspx. Accessed 2 Jan 2017

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Acknowledgements

Sudarshan Srivatsan had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Support for the MBSC is provided by Blue Cross Blue Shield of Michigan; however, the opinion beliefs, and viewpoints expressed by the author do not necessarily reflect those of BCBSM or any of its employees.

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Authors and Affiliations

  1. University of Michigan Medical School, Ann Arbor, MI, USA

    Sudarshan Srivatsan, Vinay Guduguntla, Kelly Z. Young, Aliasghar Arastu, Cameron R. Strong & Amir A. Ghaferi

  2. Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Ruth Cassidy & Amir A. Ghaferi

  3. Department of Surgery, Center for Health Outcomes and Policy, Ann Arbor, MI, USA

    Amir A. Ghaferi

  4. Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, NCRC B016/Rm140-E, Ann Arbor, MI, 48109, USA

    Amir A. Ghaferi

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  1. Sudarshan Srivatsan
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Correspondence to Amir A. Ghaferi.

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Disclosures

Dr. Ghaferi receives research funding from the Agency for Healthcare Research and Quality (K08 HS023621, P30 HS024403), the National Institute of Aging (R01 AG042340), and the Patient Centered Outcomes Research Institute (CE-1304-6596). He also receives salary support from Blue Cross Blue Shield of Michigan as the Director of the Michigan Bariatric Surgery Collaborative. Sudarshan Srivatsan, Vinay Guduguntla, Kelly Z. Young, Aliasghar Arastu, Cameron R. Strong, Ruth Cassidy have no conflicts of interest or financial ties to disclose.

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Srivatsan, S., Guduguntla, V., Young, K.Z. et al. Clinical versus patient-reported measures of depression in bariatric surgery. Surg Endosc 32, 3683–3690 (2018). https://doi.org/10.1007/s00464-018-6101-8

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