Psychiatric Disorder Comorbidity and Association With Eating Disorders in Bariatric Surgery Patients: A Cross -Sectional Study Using Structured Interview-Based Diagnosis

Department of Epidemiology & Public Health, Yale University School of Medicine, New Haven, CT 06519, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 08/2006; 67(7):1080-5. DOI: 10.4088/JCP.v67n0710
Source: PubMed


This study examined the prevalence of DSM-IV Axis I psychiatric disorders in severely obese bariatric surgery candidates and explored whether eating disorders were associated with psychiatric comorbidity.
The Structured Clinical Interview for DSM-IV Axis I Disorders was administered to a study group of 174 consecutively evaluated bariatric surgery candidates. All evaluations were completed between September 2002 and November 2004.
Overall, 36.8% of the participants met criteria for at least one lifetime psychiatric disorder, with 24.1% meeting criteria for a current disorder. The most commonly observed lifetime psychiatric diagnoses were affective disorders (22.4%), anxiety disorders (15.5%), and eating disorders (13.8%). Participants with eating disorders were significantly more likely than those without eating disorders to meet criteria for psychiatric disorders overall (66.7% vs. 26.7%) and specifically for anxiety disorders (45.8% vs. 10.7%).
Psychiatric disorders are not uncommon among severely obese patients who present for bariatric surgery. The observed prevalence rates based on structured diagnostic interviews are lower than previously reported based on questionnaire, clinical, and chart review methods but are similar to those reported for nationally representative samples. Among bariatric surgery candidates, the presence of eating disorders is associated with higher rates of other psychiatric disorders. The findings highlight the importance of systematic diagnostic assessment using a structured diagnostic interview for determining the full spectrum of Axis I disorders.

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    • "They found high prevalence rates of lifetime psychiatric disorders (66.3%) in these patients, even before surgery; 37.8% of patients had at least one psychiatric disorder. Rosenburger et al. [24] in the US and Muhlhans et al. [12] in Germany also found that patients had a high prevalence of psychiatric disorders before bariatric surgery (36.8%, and 72.6%, respectively). Our prevalence of any psychiatric disorder (54.1%) in the surgical group was lower than that of Kalarchian and Muhlhans, but higher than that of Rosenberger. "
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    ABSTRACT: Background Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment. Methods Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment. Results Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group. Conclusion A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.
    Full-text · Article · Jan 2013 · BMC Psychiatry
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    • "ORCP-337; No. of Pages 15 xxx.e4 C.L. Wimmelmann et al. conditions has been found in patients with binge eating disorder (BED) [40] [41] and especially in patients with the most severe obesity [33] [42]. "
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    ABSTRACT: Background Morbid obesity is the fastest growing BMI group in the U.S. and the prevalence of morbid obesity worldwide has never been higher. Bariatric surgery is the most effective treatment for severe forms of obesity especially with regard to a sustained long-term weight loss. Psychological factors are thought to play an important role for maintaining the surgical weight loss. However, results from prior research examining preoperative psychological predictors of weight loss outcome are inconsistent. The aim of this article was to review more recent literature on psychological predictors of surgical weight loss. Methods We searched PubMed, PsycInfo and Web of Science, for original prospective studies with a sample size >30 and at least one year follow-up, using a combination of search terms such as ‘bariatric surgery’, ‘morbid obesity’, ‘psychological predictors’, and ‘weight loss’. Only studies published after 2003 were included. Results 19 eligible studies were identified. Psychological predictors of surgical weight loss investigated in the reviewed studies include cognitive function, personality, psychiatric disorder, and eating behaviour. Conclusion In general, recent research remains inconsistent, but the findings suggest that pre-surgical cognitive function, personality, mental health, composite psychological variables and binge eating may predict post-surgical weight loss to the extent that these factors influence post-operative eating behaviour.
    Full-text · Article · Jan 2013 · Obesity Research & Clinical Practice
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    • "Obese pre-surgery patients with eating disorders show Axis I comorbidity more often than those without eating disorders 10—12. The diagnostic criteria for other psychiatric disorders are met among 66.7% of patients with eating disorders compared to 26.7% among those without eating disorders [4]. More concern about shape, weight and unfavorable treatment outcomes have been reported from binge eaters than from non-binge eaters 10—13. "
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    ABSTRACT: Objective This study investigated self-reported levels of depression, anxiety and neuroticism in obese patients waiting for bariatric surgery. The patients who indicated that they might have eating disorders (ED) or subthreshold binge eating disorders (SBED) were compared with those without. Method The design was cross sectional. Obese patients (n=160, 117 women, 43 men) returned self-report questionnaires: Eating Disorders in Obesity (EDO) indicated eating disorder status; Hospital Anxiety and Depression Scale (HADS) assessed symptoms and caseness of depression and anxiety; and the Eysenck Personality Questionnaire (EPQ-12) captured neuroticism. Age, BMI and gender were also recorded. Results Patients with ED (n=28) presented significantly higher levels of depression, anxiety and neuroticism as well as more HADS-cases for depression and anxiety than those without ED (n=109). Patients with sub-diagnostic binge eating disorders (SBED, n=23) also reported significantly more depression symptom levels, and number of HADS-cases of depression, than those without ED. In addition, the SBED group showed significantly more neuroticism than patients without ED. No significant differences were found between men and women, for high/low age, or for high/low BMI. Conclusion The data displayed that obese pre-surgery patients with eating disorders have more psychological problems than those without. Patients with SBED were more similar to those with full scale eating disorders in their level of depression and neuroticism than those without ED. Clinically, obese patients with SBED should probably be regarded as those who have full scale ED.
    Full-text · Article · Apr 2012 · Obesity Research & Clinical Practice
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