Emotion Regulation Difficulties and Psychopathology in Bariatric Surgery Candidates

Abstract

Evidence suggests high rates of psychiatric disorders in bariatric surgery candidates (e.g., Kalarchian et al., 2007; Mitchell et al., in press), although no rigorous studies have examined the prevalence in a Canadian sample. As such, the first purpose of this study was to assess the prevalence of Axis I disorders, and associations with quality of life, in a sample of consecutively referred bariatric surgery candidates at the Toronto Western Hospital Bariatric Surgery Program. In light of emerging evidence linking emotion regulation difficulties with diverse psychiatric symptoms, the second purpose of this study was to examine whether emotion regulation difficulties were common or specific determinants of mood, anxiety, and eating psychodiagnostic categories, as such information would help inform interventions. Three hundred and twenty-one bariatric surgery candidates (80.1% female; M age = 44.37 years) were assessed using a structured psychodiagnostic interview and completed questionnaires of health-related quality of life and emotion regulation difficulties. Results indicated that 54.5% of patients met DSM-IV-TR criteria for a lifetime psychiatric diagnosis and 18.4% met criteria for a current psychiatric disorder. Major depressive disorder was the most common lifetime psychiatric disorder and binge eating disorder was the most prevalent current psychiatric disorder. Compared to patients without a current Axis I disorder, participants diagnosed with a current Axis I disorder reported significantly worse functioning on most mental and physical health domains (p’s < .01). Overall, a series of regression analyses revealed that difficulties regulating emotions accounted for unique variance in current mood and anxiety disorder status (p’s < .001). Difficulties in emotion regulation were not significantly associated with current eating disorder status after Bonferroni correction. Taken together, these results confirm the high rates of psychiatric disorders in a Canadian sample of bariatric surgery candidates and provide evidence for associated functional health impairment. The data also add to the growing body of literature demonstrating emotion regulation difficulties across psychodiagnostic categories and are consistent with suggestions that psychosocial interventions for bariatric patients might benefit from directly targeting difficulties in emotion regulation. Further study of these associations is needed to replicate these findings and elucidate how difficulties in emotion regulation interact with psychopathology to affect patients’ post-operative outcomes.