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Mental disorders and bariatric surgery

Most bariatric patients have at least one mental disorder

25 candidates (15.7%) showed no disorder, 27 candidates (17.0%) were screened positive for a single syndrome, 17.0% for two syndromes, and 50.3% for three or more

According to a study carried out by researchers in Germany 84% of the patients seeking bariatric treatment screened positive for at least one mental health disorder. Utilising a computerised Patient Health Questionnaire (PHQ), the researchers from RWTH Aachen University Hospital and St Elisabeth Hospital Geilenkirchen, Germany, found that the automated reporting system “appears to be a useful instrument for pre-surgical assessment of bariatric patients in routine medical settings”.

Reporting their outcomes online in Health Quality life Outcomes, they conclude that “Morbidly obese individuals seeking bariatric treatment are known to have high prevalence rates of mental health disorders. Our data suggest the PHQ be suited as a screening instrument for clinically relevant mental health disorders.”

It has been theorised that psychopathological predisposing factors could possibly responsible for poorer treatment outcomes suggests employing a reliable mental health screening in bariatric surgery. However, the diagnosis of frequent mental health conditions such as depression, anxiety, eating or somatoform disorders is difficult for surgeons compared to mental health care professionals. The aim of the study was to assess the frequency of common psychiatric syndromes in bariatric surgery candidates using a computerized version of the Patient Health Questionnaire (PHQ) - a standardised self-report instrument which was designed to screen for the most frequent mental health disorders in primary health care.

Bariatric surgery candidates (n=292) attended an interdisciplinary information meeting in order to obtain comprehensive information on the medical backgrounds of morbid obesity and its bariatric treatment. Following each meeting, attendants were given the opportunity of computerised mental health screening. One hundred eighty-three individuals decided to participate in this mental health screening.

The researchers employed the full version of the PHQ which contains 78 items allowing screening of the following mental health disorders: major and other depressive syndromes (9 items), panic and other anxiety syndromes (15, resp. 7 items), somatic symptom burden (13 items), bulimia nervosa and binge eating disorder (8 items), alcohol abuse and alcohol dependency (6 items), and psychosocial functioning and stressors (10, resp. 10 items).


From a total of 292 individuals who had attended the information meeting about bariatric surgery, 183 (62.7%) decided to participate in the digital mental health screening. One hundred fifty-nine candidates (54.5%) completed the informed written consent permitting evaluation of their digital psychometric and sociodemographic data in this study. Completion of the electronic version of the PHQ test took on average 8.5 ± 3.2 min (range 4–20.5 min). Due to filter items, 60 items (range 47–78) were answered on average.

The participants were aged 42 ± 11 years (range 19–68 years), 65.4% of which were females. The mean BMI of the participants was 49±8. Sociodemographic data showed for the educational background that 3.1% of candidates had not completed secondary education, 61.0% were secondary school graduates, 25.2% had completed high school, and 10.7% were university graduates.

With regards to family status, 50.3% of candidates were married, 17.6% lived in a partnership, 8.8% were divorced or widowed, and 22.6% were single. The vocational status showed that 39.0% of candidates were unemployed, 14.5% were early retired, 8.2% were workers, 34.0% were employees, and 4.4% were self-employed.

Using the PHQ, the following distribution of psychiatric syndromes was observed: 25 candidates (15.7%) showed no disorder, 27 candidates (17.0%) were screened positive for a single syndrome, 17.0% for two syndromes, and 50.3% for three or more (Figure 1). Some 84.3% of the participants were screened positive for at least one mental health disorder. The mental health status exhibited in 58.5% a high somatic symptom burden, panic disorders in 18.2%, major depressive syndromes in 26.4%, other depressive disorders in 44.7%, bulimia nervosa in 10.7%, binge eating syndrome in 20.8%, anxiety disorders in 45.3%, and alcohol syndrome in 6.3%.

Figure 1: Distribution of psychiatric syndromes: no disorder (15.7%), a single disorder (17.0%), two (17.0%), three (13.2%), four or more than four psychiatric syndromes (37.1%). About half of the patients (50.3%) applying for bariatric surgery exhibited mental health problems in at least three areas

The researcher also noted that the median number of “PHQ diagnoses” was gender dependent and significantly different: three for women and one for men (p=0.007). A high somatic symptom burden and anxiety disorders were detected significantly more often in women (p=0.015 and p=0.003). No correlation between BMI and a single syndrome or the sum of syndromes was observed.

The distribution of syndromes and employment status found that unemployed participants (39.0%) and early retirees (14.5%) were subsumed as ‘unemployed’. Somatic symptom burden (p=0.019), other depressive disorder (p=0.024) and panic disorder (p=0.024) were significantly more often in the unemployed group.

“More than 50% of the tested candidates exhibited three or more mental health disorders, which underlines the need for a differentiated psychological evaluation,” they note. “In particular, obese patients seeking bariatric surgery are known to have markedly higher prevalence rates of psychopathologies than normal weight individuals.”

“There is no doubt that results obtained with this test will need to be complemented by additional social and physical assessments to respect the broad scope of the complex health situation governing morbid obesity,” they conclude.

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