Obesity Surgery

, Volume 21, Issue 6, pp 730–737

Psychiatric Disorders and Participation in Pre- and Postoperative Counselling Groups in Bariatric Surgery Patients

  • Haldis Ø. Lier
  • Eva Biringer
  • Bjarte Stubhaug
  • Hege R. Eriksen
  • Tone Tangen
Clinical Research

Abstract

Background

Psychological and behavioural factors seem to influence the results of bariatric surgery and the ability to achieve sustained weight loss and subjective wellbeing after the operation. Adequate pre- and postoperative psychological counselling are suggested to improve the results of surgery. However, some patients are reluctant to participate in pre- and postoperative counselling. The aim of the present study was to investigate the possible influence of psychiatric disorders on willingness to participate in group counselling in patients accepted for bariatric surgery.

Methods

One hundred and forty-one patients referred to bariatric surgery (F/M: 103/38) with mean body mass index (BMI) of 45.2 kg/m2 (SD = 5.3) and mean age of 42.0 years (SD = 10.4) were interviewed with Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview (SCID-II) preoperatively.

Results

The overall prevalence of current psychiatric disorders was 49%. Thirty-one percent did not want to participate in counselling groups. Patients who were unwilling to participate in counselling groups had significantly higher prevalence of social phobia (32%/ 12%, p = 0.006) and avoidant personality disorder (27%/ 12%, p = 0.029) than patients who agreed to participate.

Conclusions

Psychiatric disorders are prevalent among candidates for bariatric surgery. Social phobia and avoidant personality disorder seem to influence the willingness to participate in counselling groups. Individual counselling and/or web-based counselling might be recommended for bariatric surgery patients who are reluctant to participate in group counselling.

Keywords

Bariatric surgery Psychiatric disorders Social phobia Counselling 

References

  1. 1.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  2. 2.
    Karlsson J, Taft C, Ryder A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31:1248–61.CrossRefGoogle Scholar
  3. 3.
    Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg. 1995;169:361–7.PubMedCrossRefGoogle Scholar
  4. 4.
    de Zwaan M, Lancaster KL, Mitchell JE, et al. Health-related quality of life in morbidly obese patients: effect of gastric bypass surgery. Obes Surg. 2002;12:773–80.PubMedCrossRefGoogle Scholar
  5. 5.
    Clark MM, Balsiger BM, Sletten CD, et al. Psychosocial factors and 2-year outcome following bariatric surgery for weight loss. Obes Surg. 2003;13:739–45.PubMedCrossRefGoogle Scholar
  6. 6.
    van Hout GCM, Hagendoren CAJ, Verschure SKM, et al. Psychosocial predictors of success after vertical banded gastroplasty. Obes Surg. 2009;19:701–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Herpertz S, Kielman R, Wolf AM, et al. Do psychosocial variables predict weight loss or mental health after obesity surgery? a systematic review. Obes Res. 2004;12:1554–69.PubMedCrossRefGoogle Scholar
  8. 8.
    Heo M, Pietrobelli A, Fontaine K, et al. Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race. Int J Obes. 2006;30:513–9.CrossRefGoogle Scholar
  9. 9.
    Scott KM, McGee MA, Wells JE, et al. Obesity and mental disorders in the adult general population. J Psychosom Res. 2008;64:97–105.PubMedCrossRefGoogle Scholar
  10. 10.
    Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry. 2007;164:328–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Rosenberger P, Henderson KE, Grilo CM. Psychiatric disorder comorbidity and association with eating disorders in bariatric surgery patients: a cross -sectional study using structured interview-based diagnosis. J Clin Psychiatry. 2006;67:1080–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Stunkard AJ, Wadden TA. Psychological aspects of severe obesity. Am J Clin Nutr. 1992;55(2 Suppl):524S–32S.PubMedGoogle Scholar
  13. 13.
    Fitzgibbon ML, Stolley MR, Kirschenbaum DS. Obese people who seek treatment have different characteristics than those who do not seek treatment. Health Psychol. 1993;12:342–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Higgs ML, Wade T, Cesato M, et al. Differences between treatment seekers in an obese population: medical intervention vs. dietary restriction. J Behav Med. 1997;20:391–405.PubMedCrossRefGoogle Scholar
  15. 15.
    Guisado JA, Vaz FJ. Personality profiles of the morbidly obese after vertical banded gastroplasty. Obes Surg. 2003;13:394–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16:1609–14.PubMedCrossRefGoogle Scholar
  17. 17.
    Kalarchian MA, Marcus MD, Levine MD, et al. Relationship of psychiatric disorders to 6-month outcomes after gastric bypass. Surg Obes Relat Dis. 2008;4:544–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Black DW, Goldstein RB, Mason EE, et al. Psychiatric diagnosis and weight loss following gastric surgery for obesity. Obes Surg. 2003;13:746–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Sarwer DB, Cohn NI, Gibbons LM, et al. Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obes Surg. 2004;14:1148–56.PubMedCrossRefGoogle Scholar
  20. 20.
    Colles SL, Dixon JB, O’Brien PE, et al. Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Obesity. 2008;16:615–22.PubMedCrossRefGoogle Scholar
  21. 21.
    Niego SH, Kofman MD, Weiss JJ, et al. Binge eating in the bariatric surgery population: a review of the literature. Int J Eat Disord. 2007;40:349–59.PubMedCrossRefGoogle Scholar
  22. 22.
    Saunders R. “Grazing”: a high-risk behavior. Obes Surg. 2004;14:98–102.PubMedCrossRefGoogle Scholar
  23. 23.
    de Zwaan M, Hilbert A, Swan-Kremeier L, et al. Comprehensive interview assessment of eating behavior 18-35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Diseas. 2009 Sep 3 [Epub ahead of print].Google Scholar
  24. 24.
    Canetti L, Berry EM, Elizur Y. Psychosocial predictors of weight loss and psychological adjustment following bariatric surgery and a weight-loss program: the mediating role of emotional eating. Int J Eat Disord. 2009;42:109–17.PubMedCrossRefGoogle Scholar
  25. 25.
    Busetto L, Segato G, De Luca M, et al. Weight loss and postoperative complications in morbidly obese patients with binge eating disorder treated by laparoscopic adjustable gastric banding. Obes Surg. 2005;15:195–201.PubMedCrossRefGoogle Scholar
  26. 26.
    Kalarchian MA, Wilson GT, Brolin RE, et al. Effects of bariatric surgery on binge eating and related psychopathology. Eat Weight Disord. 1999;4:1–5.PubMedGoogle Scholar
  27. 27.
    Alger-Mayer S, Rosati C, Polimeni JM, et al. Preoperative binge eating status and gastric bypass surgery: a long-term outcome study. Obes Surg. 2009;19:139–45.PubMedCrossRefGoogle Scholar
  28. 28.
    van Hout GCM, Verschure SKM, van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg. 2005;15:552–60.PubMedCrossRefGoogle Scholar
  29. 29.
    Buddeberg-Fischer B, Klaghofer R, Sigrist S, et al. Impact of psychosocial stress and symptoms on indication for bariatric surgery and outcome in morbidly obese patients. Obes Surg. 2004;14:361–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Dziurowicz-Kozlowska AH, Wierzbicki Z, Lisik W, et al. The objective of psychological evaluation in the process of qualifying candidates for bariatric surgery. Obes Surg. 2006;16:196–202.PubMedCrossRefGoogle Scholar
  31. 31.
    Welch G, Wesolovski C, Piepul B, et al. Physical activity predicts weight loss following gastric bypass surgery: findings from a support group survey. Obes Surg. 2008;18:517–24.PubMedCrossRefGoogle Scholar
  32. 32.
    Silver HJ, Torquati A, Jensen GL, et al. Weight, dietary and physical activity behaviors two years after gastric bypass. Obes Surg. 2006;16:859–64.PubMedCrossRefGoogle Scholar
  33. 33.
    Dixon JB, Laurie CP, Anderson ML, et al. Motivation, readiness to change, and weight loss following adjustable gastric band surgery. Obesity. 2009;17:698–705.PubMedCrossRefGoogle Scholar
  34. 34.
    Lanyon RI, Maxwell BM, Kraft AJ, et al. Prediction of long-term outcome after gastric bypass surgery. Obes Surg. 2009;19:439–45.PubMedCrossRefGoogle Scholar
  35. 35.
    Faria SL, Kelly EO, Faria OP, et al. Snack-eating patients experience lesser weight loss after Roux-en-Y gastric bypass surgery. Obes Surg. 2009;19:1293–6.CrossRefGoogle Scholar
  36. 36.
    Faria SL, Faria OP, Lopes TC, et al. Relation between carbohydrate intake and weight loss after bariatric surgery. Obes Surg. 2009;19:708–16.PubMedCrossRefGoogle Scholar
  37. 37.
    Marcus MD, Kalarchian MA, Courcoulas AP, et al. Psychiatric evaluation and follow-up of bariatric surgery patients. Am J Psychiatry. 2009;166:285–91.PubMedCrossRefGoogle Scholar
  38. 38.
    Powell LH, Calcin JE, Calcin JE Jr, et al. Effective obesity treatments. Am Psychol. 2007;62:234–46.PubMedCrossRefGoogle Scholar
  39. 39.
    Steffen R, Potoczna N, Bieri N, et al. Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96% follow-up. Obes Surg. 2009;19:3–12.PubMedCrossRefGoogle Scholar
  40. 40.
    Oria HE, Moorehead MK. Bariatric analysis and reporting outcome system (BAROS). Obes Surg. 1998;8:487–99.PubMedCrossRefGoogle Scholar
  41. 41.
    Batsis JA, Clark MM, Grothe K, et al. Self-efficacy after bariatric surgery for obesity. A population-based cohort study. Appetite. 2009;52:637–45.PubMedCrossRefGoogle Scholar
  42. 42.
    Wild B, Herzog W, Wesche D, et al. Development of a group therapy to enhance treatment motivation and decision making in severely obese patients with a comorbid mental disorder. Obes Surg. 2009 Dec 1 [Epub ahead of print].Google Scholar
  43. 43.
    Kreft JS, Montebelo J, Fogaca KC, et al. Gastric bypass: post-operative complications in individuals with and without preoperative dietary guidance. J Eval Clin Pract. 2008;14:169–71.PubMedCrossRefGoogle Scholar
  44. 44.
    American Psychiatric Assosiation. Diagnostic and statistical manual of mental disorders. Washington DC: American Psychiatric Association; 1994. Author.Google Scholar
  45. 45.
    Lecrubier Y, Sheehan D, Hergueta T, et al. The mini international neuropsychiatric interview. Eur Psychiatr. 1998;13:198s.CrossRefGoogle Scholar
  46. 46.
    Sheehan DV, Lecrubier Y, Harnett-Sheehan K, et al. The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview. J Clin Psychiatr. 1998;59:22–33.Google Scholar
  47. 47.
    First MB, Gibbon M, Spitzer RL, et al. Structured clinical interview for DSM-IV axis II personality. Biometrics research. New York, NY: New York State Psychiatric Institute; 1997.Google Scholar
  48. 48.
    First MB, Gibbon M, Spitzer RL, et al. User’s guide for the structured clinical interview for DSM-IV Axis II personality disorders [SCID-II]. American Psychiatric Press; 1997.Google Scholar
  49. 49.
    Nangle DW, Johnson WG, Carr-Nangle RE, et al. Binge eating disorder and the proposed DSM-IV criteria: psychometric analysis of the Questionnaire of Eating and Weight Patterns. Int J Eat Disord. 1994;16:147–57.PubMedCrossRefGoogle Scholar
  50. 50.
    Beck AT, Steer RA, Brown GK. Manual for Beck Depression Inventory—II. San Antonio, TX: Psychological Corp; 1996.Google Scholar
  51. 51.
    Dozois DJA, Dobson KS, Ahnberg JL. A psychometric evaluation of the Beck Depression Inventory-II. Psychol Assess. 1998;10:83–9.CrossRefGoogle Scholar
  52. 52.
    Beck AT, Epstein N, Brown G, et al. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Beck AT, Steer RA. Beck Anxiety Inventory Manual. San Antonio: The Psychology Corporation, Harcourt Brace; 1993.Google Scholar
  54. 54.
    Fydrich T, Dowdall D, Chambless DL. Reliability and validity of the Beck Anxiety Inventory. J Anxiety Disord. 1992;6:55–61.CrossRefGoogle Scholar
  55. 55.
    Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–27.PubMedCrossRefGoogle Scholar
  56. 56.
    Kringlen E, Torgersen S, Cramer V. A Norwegian psychiatric epidemiological study. Am J Psychiatry. 2001;158:1091–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Kringlen E, Torgersen S, Cramer V. Mental illness in a rural area: a Norwegian psychiatric epidemiological study. Soc Psychiatry Psychiatr Epidemiol. 2006;41:713–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Mauri M, Rucci P, Calderone A, et al. Axis I and II disorders and quality of life in bariatric surgery candidates. J Clin Psychiatry. 2008;69:295–301.PubMedCrossRefGoogle Scholar
  59. 59.
    Wadden TA, Butryn ML, Sarwer DB, et al. Comparison of psychosocial status in treatment-seeking women with class III vs. class I–II obesity. Obesity. 2006;14 Suppl 2:90S–8S.PubMedCrossRefGoogle Scholar
  60. 60.
    Kim RJ, Langer JM, Baker AW, et al. Psychosocial status in adolescents undergoing bariatric surgery. Obes Surg. 2008;18:27–33.PubMedCrossRefGoogle Scholar
  61. 61.
    Zeller MH, Roehrig HR, Modi AC, et al. Health-related quality of life and depressive symptoms in adolescents with extreme obesity presenting for bariatric surgery. Pediatrics. 2006;117:1155–61.PubMedCrossRefGoogle Scholar
  62. 62.
    Zeller MH, Modi AC, Noll JG, et al. Psychosocial functioning improves following adolescent bariatric surgery. Obesity. 2009;17:985–90.PubMedCrossRefGoogle Scholar
  63. 63.
    Stangier U, Heidenreich T, Peitz M, et al. Cognitive therapy for social phobia: individual versus group treatment. Behav Res Ther. 2003;41:991–1007.PubMedCrossRefGoogle Scholar
  64. 64.
    Allison DB, Newcomer JW, Dunn AL, et al. Obesity among those with mental disorders: a National Institute of Mental Health meeting report. Am J Prev Med. 2009;36:341–50.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Haldis Ø. Lier
    • 1
  • Eva Biringer
    • 1
  • Bjarte Stubhaug
    • 1
    • 3
  • Hege R. Eriksen
    • 2
  • Tone Tangen
    • 3
  1. 1.Section of Mental Health ResearchHaugesund Hospital, Helse Fonna HFHaugesundNorway
  2. 2.HEMIL Research Centre for Health Promotion, Unifob HealthUniversity of BergenBergenNorway
  3. 3.Section of Psychiatry, Institute of Clinical MedicineUniversity of BergenBergenNorway

Personalised recommendations