Abstract
Background: Many bariatric surgery programs require that candidates undergo a preoperative mental health evaluation. Candidates may be motivated to suppress or exaggerate psychiatric symptoms (i.e., engage in impression management), if they believe doing so will enhance their chances of receiving a recommendation to proceed with surgery.
Method: 237 candidates for bariatric surgery completed the Beck Depression Inventory-II (BDI-II) as part of their preoperative psychological evaluation (Time 1). They also completed the BDI-II approximately 2–4 weeks later, for research purposes, after they had received the mental health professional’s unconditional recommendation to proceed with surgery (Time 2).
Results: There was a small but statistically significant increase in mean BDI-II scores from Time 1 to Time 2 (11.4 vs 12.7,P<.001). Clinically significant changes, defined as a change from one range of symptom severity to another, were observed in 31.2% of participants, with significant increases in symptoms occurring nearly twice as often as reductions (20.7% vs 10.5%,P<.008). Demographic variables were largely unrelated to changes in BDI-II scores from Time 1 to Time 2.
Conclusion: Approximately one-third of bariatric surgery candidates reported a clinically significant change in depressive symptoms after receiving psychological “clearance” for surgery. Possible explanations for these findings include measurement error, impression management, and true changes in psychiatric status.
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Preparation of this manuscript was supported in part by the following grants from the National Institutes of Health: K23-DK070777 to Dr. Fabricatore, K24-DK065018 to Dr. Wadden, and K23-DK60023 and R03-DK067885 to Dr. Sarwer.
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Fabricatore, A.N., Sarwer, D.B., Wadden, T.A. et al. Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery. OBES SURG 17, 1213–1219 (2007). https://doi.org/10.1007/s11695-007-9204-1
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DOI: https://doi.org/10.1007/s11695-007-9204-1