Clinical versus patient-reported measures of depression in bariatric surgery
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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.
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.
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.
KeywordsBariatric surgery Depression Mental health
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.
Compliance with ethical standards
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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