There is a high prevalence of depression after bariatric surgery among adults in Saudi Arabia indicating an urgent need for comprehensive mental health evaluation and support for individuals undergoing this procedure, according to researchers from Alrayan National Colleges, Al Madinah, Saudi Arabia. They stressed that the substantial proportion of participants experiencing depression underscores the importance of integrating mental healthcare into bariatric surgery programmes.
The study authors noted that depression is a common concern among individuals undergoing bariatric surgery with previous studies reporting varying prevalence rates of depression post-bariatric surgery ranging from 15% to 31.3%. Furthermore, preoperative depression has been associated with increased severity of medical comorbidities in bariatric surgery candidates and may impact postoperative weight loss.
They write that the prevalence and consequences of depression after bariatric surgery among adults are multifaceted, necessitating a comprehensive approach to patient care that addresses mental health alongside surgical outcomes. Therefore, they designed a study to assess the prevalence and consequences of depression in this population.
Outcomes
The study included 366 participants, with a majority of females (63.93%) with the largest proportion falling within the age group of less than 30 years (39.07%), followed by those aged 30-39 years (27.60%), 40-49 years (23.77%), and finally, participants aged 50 years or older (9.56%). In terms of marital status, the majority of participants were married (64.21%), while the remaining proportion was unmarried (35.79%). Educational backgrounds varied among participants, with the majority (68.03%) holding a university degree, followed by those with high school or less education (14.75%), diploma degree (11.48%), and master's and PhD degrees (5.74%).
Participants' employment status showed diversity, with a notable proportion being employed in the governmental sector (41.80%), followed by those who were unemployed or housewives (33.06%), and those employed in the private sector (25.14%). The majority of participants were nonsmokers (64.48%), followed by smokers (24.59%) and ex-smokers (10.93%).
Regarding obesity-related health problems, a significant proportion of participants (51.37%) reported experiencing sleep breathing disorders, with the majority (51.37%) noting improvement post-surgery. In terms of oesophageal reflux, 39.07% of participants reported its presence, with notable improvements post-surgery observed in 39.07% of cases.
The vast majority (93.72%) reported improvement in body mass index following surgery. Sleeve gastrectomy surgery emerged as the predominant surgical intervention (85.52%), followed by gastric bypass surgery (14.48%). Despite the effectiveness of bariatric surgery, a notable proportion (21.04%) reported experiencing problems or complications post-surgery. These insights shed light on the complexities of bariatric surgery and underscore the importance of considering individual variations in surgical outcomes when assessing their potential impact on perceived depression scores.
A minority of participants (12.84%) reported being diagnosed with a mental illness before surgery, with panic attacks and social phobia (2.73%), personality disorders (3.01%), and other psychiatric illnesses (4.10%) being the most commonly reported diagnoses. Furthermore, 19.40% of participants reported having close family members diagnosed with a psychological/mental illness, with schizophrenia (5.19%) and panic attacks (4.92%) being the most prevalent diagnoses among family members. Regarding substance use, the majority of participants (93.72%) reported not using medications or illegal drugs before surgery, while 6.28% reported using them frequently. Furthermore, about half of the participants (51.37%) reported encountering recent family, social, economic or work problems.
The mean PHQ-9 score among participants was 6.80±4.96 suggesting that, on average, participants reported experiencing mild to moderate levels of depression symptoms, as scores below 5 typically indicate minimal or no depression, scores between 5 and 9 suggest mild depression, scores between 10 and 14 indicate moderate depression, and scores above 15 indicate severe depression.
The chi-square tests revealed significant associations between the severity of depression symptoms, as measured by PHQ-9 categories, and various demographic and lifestyle factors among bariatric surgery patients. Females exhibited a higher prevalence of moderate to severe depression compared to males (p< 0.001). Younger age groups, particularly those under 30 years old, reported elevated levels of depression severity (p<0.001). Marital status also played a significant role, with unmarried individuals demonstrating higher severity levels compared to married counterparts (p<0.001).
In addition, smokers displayed higher severity levels compared to non-smokers (p<0.001). These findings underscore the importance of considering demographic and lifestyle factors when assessing and addressing depression among bariatric surgery patients, highlighting the need for tailored interventions that account for these variables. Furthermore, while there was no significant association between the severity of depression and the presence of chronic diseases overall (p=0.099), there was evidence of an association between the severity of depression and specific chronic diseases (p=0.003), indicating potential differences in mental health status based on the type of chronic illness.
Additionally, the analysis revealed that participants who reported a history of obesity-related health problems, such as sleep breathing disorders, displayed varying levels of depression severity (p=0.029). Those who experienced improvements in these health issues post-surgery tended to report lower levels of depression, suggesting a potential link between physical health improvements and mental well-being. Similarly, participants with oesophageal reflux showed varying levels of depression severity (p<0.001), with those experiencing worsened reflux post-surgery reporting higher levels of depression.
Moreover, the severity of depression symptoms significantly differed across different categories of body mass index (BMI) levels before obesity surgery (p<0.001) and postoperative BMI levels (p<0.001), indicating a potential association between BMI changes and mental health outcomes post-bariatric surgery.
The type and timing of bariatric surgery also exhibited significant associations with depression severity. Participants who underwent sleeve gastrectomy surgery showed varying levels of depression severity compared to those who underwent gastric bypass surgery (p=0.00906), suggesting that different surgical procedures may have differential impacts on mental health outcomes.
Similarly, the time passed since surgery showed significant associations with depression severity (p<0.001), with individuals undergoing surgery within the past six months reporting higher levels of depression compared to those with longer postoperative periods. Furthermore, participants who experienced problems or complications related to bariatric surgery tended to report higher levels of depression severity (p=0.000252), highlighting the potential psychological impact of surgical complications.
Moreover, participants diagnosed with mental illnesses or reporting family members with psychiatric diagnoses exhibited varying levels of depression severity (p=0.003; p=0.003, respectively). Those with diagnosed mental illnesses tended to report higher levels of depression, highlighting the importance of addressing comorbid psychiatric conditions in bariatric surgery patients. Similarly, participants with family members diagnosed with psychiatric illnesses showed elevated levels of depression, suggesting potential familial influences on mental health outcomes.
The authors noted that these outcomes highlight the necessity of implementing strategies to identify and address depression in the postoperative period to optimise the overall well-being and long-term success of bariatric surgery patients. Furthermore, the significant consequence of depression after bariatric surgery emphasizes the imperative for healthcare providers to prioritise mental health screening, intervention, and follow-up care within the bariatric surgery framework.
“Addressing the psychological impact of bariatric surgery can potentially improve outcomes and enhance the overall quality of life for individuals undergoing this weight loss intervention,” they concluded. “Further research and multifaceted interventions are warranted to better understand the underlying mechanisms and risk factors associated with depression after bariatric surgery and to develop tailored approaches for prevention and management. Integrating mental health support as an integral component of bariatric care may lead to improved patient experiences and long-term physical and psychological well-being.”
The findings were reported in the paper, ‘The Prevalence and Consequence of Depression After Bariatric Surgery Among Adults in Saudi Arabia’ published in Cureus. To access this paper, please click here
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