Presurgical Psychological Evaluations Research Articles

Sleep and aberrant eating behaviors in metabolic/bariatric presurgical candidates

BackgroundMetabolic/bariatric surgery (MBS) is the most effective treatment for obesity, yet many factors influence successful individual weight loss. Among those are a variety of health behaviors that are assessed in the process of presurgical psychological evaluations, including eating pathology and sleep disturbance (both of which are relatively common among surgical candidates). ObjectivesThis study aims to examine the relationship between sleep, binge eating, and night eating behaviors among individuals seeking MBS. SettingMedical center and private psychological practice in Mississippi. MethodsPatients (N = 311) seeking presurgical psychological evaluations for bariatric surgery completed self-report measures. Of these, 83.0% were females and 70.7% of those with ethnicity data identified as White. Average body mass index (BMI) in the sample was 46.5 (standard deviation [SD] = 8.02). Correlations between variables were calculated and examination of the indirect effect of sleep disturbance on night eating as mediated by binge eating was conducted. ResultsSleep disturbance, binge eating, and night eating were significantly associated (b = .22–.45). Mediation analysis yielded a significant indirect effect, indicating that binge eating propensity explains the relationship between impaired sleep and night eating symptoms (b = .09, standard error [SE] = .03, confidence interval [CI]: .04–.18). ConclusionsThe observed relationship between sleep disturbance, night eating, and binge eating among bariatric candidates provides implications for future research and treatment approaches. Specifically, additional attention to sleep disturbance in the presurgical assessment process and consideration of sleep hygiene as a potential target for intervention may facilitate improvements in overall health, adjustment, and sustained weight loss.

Differences in presurgical MMPI-3 scores across trajectories of recovery from spine surgery.

Approximately 30% of patients who undergo spinal surgery for chronic back pain continue to experience significant pain and disability up to 2 months following surgery. Prior studies have identified mental health variables including depression and anxiety as predictors of poorer postsurgical outcomes using screening instruments, but no studies have examined long-term outcomes using the Minnesota Multiphasic Personality Inventory-3 (MMPI-3), a commonly used tool used in presurgical psychological evaluations (PPE). Using group-based trajectory modeling and a sample of 404 spine surgery evaluees, the present study examined the trajectories of changes in disability scores from presurgery through 3, 12, and 24 months postsurgery. We then compared scores on MMPI-3 scales between trajectory groups. We identified three trajectory groups of change in disability over time: a rapid-remitting group (8%), characterized by moderate presurgical disability that rapidly and substantially remitted by 12 and 24 months; a steady-recovering group (68%), characterized by moderate presurgical disability, slower change over time, and mild levels of disability at the 2-year time point; and a persisting disability group (24%), characterized by severe presurgical disability that continued into long-term follow-ups. Participants in the persisting pain group produced higher presurgical scores on somatic/cognitive and internalizing MMPI-3 scales than participants in the rapid-remitting and steady-recovering groups. Our results support the clinical utility of the MMPI-3 in PPEs and highlight the importance of evaluating somatic/cognitive concerns and internalizing dysfunction to identify patients who are likely to have poorer postsurgical outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A semi-structured interview is associated with bariatric surgery outcomes.

Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (𝛽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (𝛽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (𝛽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.

Further evidence regarding the convergent and discriminant validity of Minnesota Multiphasic Personality Inventory-3 (MMPI-3) scores in the preoperative psychological evaluation of patients seeking metabolic and bariatric surgery

BackgroundPsychological testing is used in some preoperative psychological evaluations of patients seeking metabolic and bariatric surgery. The Minnesota Multiphasic Personality Inventory-3 (MMPI-3) contains new norms, updated item content, and new scales such as Eating Concerns and Impulsivity, which are relevant to the assessment of patients seeking metabolic and bariatric surgery. ObjectiveThe goal of this investigation was to establish convergent and discriminant properties of the MMPI-3 scales with relevant clinical interview and medical record data from electronic medical records. SettingAcademic medical center in the Midwest. MethodsA sample of 790 consecutive patients who completed a preoperative psychological evaluation and took the MMPI-3 were included. Data from medical records and the assessment report were coded by a trained research assistant. ResultsMMPI-3 scale scores demonstrated good convergent and discriminant validity. For instance, the Emotional/Internalizing Dysfunction scales correlated with depression and anxiety disorder, suicide history, sexual abuse history, psychotropic medication use, and eating behaviors. Behavioral/Externalizing Dysfunction scales correlated with alcohol, nicotine, and substance use and eating behaviors such as loss-of-control overeating. The Eating Concerns scale demonstrated the highest correlational patterns with various eating behaviors such as loss-of-control overeating, binge eating, and stress eating. ConclusionsMMPI-3 scale scores perform as well as their Minnesota Multiphasic Personality Inventory-2 Restructured Form counterparts. Newer scales, such as Eating Concerns and Impulsivity, perform particularly well in the assessment of various eating behaviors.

Psychometric Properties of the Brief Coping Orientation to Problems Experienced Inventory Among Patients Pursuing Bariatric Surgery.

The Brief COPE Inventory is a widely used scale that measures how a person copes with a specific situation. Despite its widespread use, the factor structure of this scale is somewhat unclear and has not been tested among patients pursuing bariatric surgery. We tested competing factor analytic models of the Brief COPE Inventory among patients pursuing bariatric surgery to identify the best fitting factor model for use in pre-surgical psychological evaluations. We also examined reliability and validity of the subscales from the best fitting model of coping. Participants included 1984 patients pursuing bariatric surgery (Mage = 42.58years, SD = 10.89, 81.39% female). The best fitting model of the Brief COPE Inventory among patients pursuing bariatric surgery was a three-factor model including interpersonal, intrapersonal, and maladaptive coping strategies. These results were replicated in a subset of the original sample and demonstrated appropriate convergent and discriminant validity with several key outcomes. The Brief COPE Inventory can be conceptualized as a multidimensional scale assessing interpersonal coping, intrapersonal coping, and maladaptive coping among patients pursuing bariatric surgery. Future work should examine how these subscales are related to surgical outcomes among people receiving treatment for excess weight.

Anxiety predicts reduced weight loss 30 months after bariatric surgery.

Though psychosocial factors are routinely examined in presurgical psychological evaluations, the predictive value of some psychosocial factors on postsurgical weight loss is still relatively unknown. Additional research examining the predictive value of psychological constructs preoperatively and long-term weight outcomes is needed to enhance the clinical utility of the presurgical psychological evaluations. This study aimed to examine psychosocial factors as predictors of weight outcomes 30 months after bariatric surgery. University hospital in the Appalachian region of United States. Participants included 196 adults who underwent bariatric surgery. Psychosocial data were collected as part of a routine psychological evaluation prior to bariatric surgery. Objective weight was obtained through patients' medical records at 12, 24, and 30 months after surgery. Linear mixed models was used to examine presurgical psychosocial factors predicting postsurgical weight loss (n at 12 months = 153, n at 24 months = 130, n at 30 months = 92). Anxiety had a significant interaction effect with time (estimate = -.01, P = .013), indicating that higher anxiety was associated with less weight loss over time. Those with severe anxiety before surgery lost the most weight 12 months after surgery but also regained the most weight 30 months after surgery. Other predictors were not statistically significant. Anxiety assessed prior to surgery predicted reduced weight loss 30 months after bariatric surgery, after controlling for surgery type, baseline weight, sex, and age. Results highlight the importance of evaluation and treatment of anxiety in presurgical bariatric candidates.

Use of the Stanford Integrative Psychosocial Assessment for Transplant as a Pre-surgical Psychological Evaluation Tool for Bariatric Surgery.

How clinicians perform pre-surgical psychological evaluations (PSPE) for bariatric surgery remains variable across institutions. Bariatric PSPE guidelines state that self-report measures should be incorporated in the PSPE procedure, yet only 50-60% of PSPEs utilize patient self-report measures. Previous studies describing the presurgical psychological evaluation report a range of measures, however a gold standard in PSPE has yet to be agreed upon. Given this gap in how a presurgical psychological evaluation for bariatric patients is defined, incorporating more objective measures into this process may help clinicians identify specific areas in which a patient is struggling and benefit from additional psychosocial support. The present study proposes the use of the SIPAT, a semi-structured interview initially developed to assess organ transplant candidates, as part of this evaluation. A total of 292 adult patients underwent a pre-surgical psychological evaluation for bariatric surgery between November 2017 and February 2020 at a Midwest medical center. Patient average age was 45.2 (11.3) years and 83.3% were female. At time of analysis, 160 patients received bariatric surgery. Logistic regression and analyses of bivariate associations were conducted in R. The SIPAT exhibited good convergent validity via correlations with analogous scales on the PROMIS 43, and it yielded a small effect size predicting patients who ultimately received surgery. Accordingly, this semi-structured interview may be a useful tool to help differentiate patients for surgical candidacy.

Sleep disturbance and insomnia in individuals seeking bariatric surgery.

Sleep disturbance is well established in individuals with obesity, and the relationship between poor sleep and obesity is supported by population, longitudinal, experimental, and intervention studies. However, the prevalence and characteristics of poor sleep in individuals seeking bariatric surgery have thus far been poorly examined. We sought to characterize self-reported sleep parameters in individuals seeking bariatric surgery and to compare these data with controls. Two Academic Medical Centers, United States, and an online survey of healthy controls. Individuals seeking bariatric surgery (n = 427) completed presurgical psychological evaluations at 2 comprehensive bariatric surgery programs. Data on medical co-morbidities and from self-report questionnaires on sleep quality, insomnia, anxiety, and depression were abstracted from charts. Data from controls (n = 180) were collected using an online survey tool and compared with bariatric cases. Across study sites, 40.4% of bariatric cases took at least 30 minutes to fall asleep, 46.7% had insufficient total sleep time (<6.5 hr), 65.1% reported general poor sleep quality, and 30.8% reported clinically significant insomnia symptoms. Approximately 20% of the variance in poor sleep quality and insomnia was explained by body mass index, obstructive sleep apnea, anxiety, and depression. Cases and controls were similar, although bariatric cases reported significantly poorer sleep efficiency. Our results suggest that similar to a control population, the majority of patients seeking bariatric surgery are experiencing sleep difficulties. Presurgical assessment and treatment of sleep problems may be beneficial to patients and may help improve weight loss treatment outcomes. Optimally, assessment would include 1 of the 2 self-report questionnaires used herein, and treatment would involve Cognitive Behavioral Therapy for Insomnia. Future research assessing sleep patterns with objective measurement tools and evaluating the impact of sleep on postsurgical outcomes is warranted.

Psychological Assessment Instruments for Use in Liver and Kidney Transplant Evaluations: Scarcity of Evidence and Recommendations

Psychopathology among liver and kidney transplant patients is prevalent. Although pre-surgical psychological evaluations are routinely conducted, understanding which specific psychological test to use is under-developed. The purpose of this review is to examine the psychometric properties of broadband and narrowband psychological measures in pre-surgical liver and kidney transplant evaluations. Overall, there is a paucity of research in this domain that hamper abilities to make clear recommendations on what to use alongside a clinical interview. This review highlights the need for additional research examining instruments that may predict patients’ successful recovery from transplant surgery. Despite the scarcity of research, instruments that appear to be useful in this population include the Minnesota Multiphasic Personality Inventory–2 (MMPI-2), the Personality Assessment Inventory (PAI), the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), and the Transplant Evaluation and Rating Scale (TERS).

Presurgical Psychological Evaluation: Risk Factor Identification and Mitigation.

Presurgical psychological evaluations (PPEs) are becoming an established component of the surgical process, though methods of conducting PPEs are variable. There is a lack of clarity about the goals of PPEs, the types of information that should be included, and the process for integrating information and making recommendations to the referring physicians/surgeons. This review proposes an empirically supported model for PPEs that is systematic, but flexible enough to be utilized across the broad range of surgical evaluations. This five-step method is termed the Risk Identification and Mitigation (RIM) model and is discussed in detail. The RIM model presented in this review can both serve as a structure to be utilized in under-researched PPE areas and as a stimulus for future empirical investigations.

Associations Between Approach and Avoidance Coping, Psychological Distress, and Disordered Eating Among Candidates for Bariatric Surgery

Individuals seeking bariatric surgery evidence risk for binge and disordered eating behaviors, which can lead to poorer post-surgical weight loss outcomes. Use of avoidant coping strategies to manage stress, along with symptoms of depression, are associated with disordered eating in the general population. However, the role of coping has not been examined among candidates for bariatric surgery, and coping and depression have rarely been considered in combination. Given the emerging standard that psychologists are involved in evaluations and treatment before and after surgery, consideration of these variables is clinically relevant. Participants were 399 patients undergoing pre-surgical bariatric psychological assessment. Hierarchical linear regression analyses tested whether gender, age, and BMI; approach and avoidance coping; and depression and anxiety were associated with disordered eating (binge eating, restraint, eating concerns, shape concerns, weight concerns) in a cross-sectional study design. In initial steps of the model controlling demographic variables, approach coping predicted less and avoidance coping predicted more disordered eating across most outcomes examined. In models including depression and anxiety, avoidance (but not approach) coping remained a relevant predictor. The effects of depression were also quite robust, such that participants who were more depressed reported more disordered eating. More anxious participants reported more restrained eating. Avoidance coping and depressive symptoms emerged as key variables in understanding recent disordered eating among patients considering bariatric surgery. Pre-surgical psychological evaluations and treatment approaches could be enhanced with consideration of patient coping strategies, particularly avoidant coping responses to stress, independent of psychological distress.

Flexible and Conditional Administration of the Minnesota Multiphasic Personality Inventory–2–Restructured Form in Presurgical Psychological Evaluations of Spine Surgery Candidates

The purpose of this study was to evaluate a flexible and conditional administration (FCA) for the MMPI–2–RF in archival samples of spine surgery and spinal cord simulator candidates presenting for presurgical psychological evaluations. The sample included 1,477 spine surgery candidates (709 male, 276 female) and 476 spinal cord stimulator candidates (178 male, 298 female). Using a simulation design, the results of this study indicated that an FCA of the MMPI–2–RF closely approximates the amount of information gained from a standard MMPI–2–RF administration. In addition, time savings were substantial in both samples, particularly the spine surgery sample, as item savings varied from 40% to 80%, depending on the number of substantive domains flexibly administered. Overall, the results of the study lend support for the feasibility of the FCA approach in presurgical evaluations of spine surgery candidates, in particular for those situations where the length of the test would otherwise preclude its use.

Time savings and accuracy of a simulated flexible and conditional administration of the MMPI-2-RF in presurgical psychological evaluations of bariatric surgery candidates

BackgroundThe Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has empirically validated utility in presurgical psychological evaluations of bariatric surgery patients. However, clinicians may prefer shorter, symptom-focused measures. ObjectivesThe purpose of the present study is to evaluate the feasibility and potential administration time savings of a proposed flexible and conditional (FCA) administration of the MMPI-2-RF in presurgical evaluations of bariatric surgery candidates. SettingBariatric surgery candidates evaluated at a large hospital as well as a private practice in the Midwest. MethodsMMPI-2-RF scores were available for a total of 4099 adult bariatric surgery candidates from 2 separate samples. The hospital sample included 911 males and 2430 females. The average BMI was 49.3 kg/m2 (SD = 11.0). The private practice sample included 105 males, 640 females, and 13 individuals who did not report gender. The average BMI was 48.8 kg/m2 (SD = 8.4). The authors used a simulation design in which existing MMPI-2-RF responses were used to simulate an FCA administration. ResultsThe findings indicated that an FCA of the MMPI-2-RF closely approximates the amount of information typically gained from a full administration of the test in the 2 samples of bariatric surgery candidates. Items savings and estimated time savings ranged from 44% to 88% in both samples, depending on the number of conditionally administered scales. ConclusionsThe present study supports the feasibility of an FCA of the MMPI-2-RF, potentially shortening administration time and reducing patient burden. However, the findings are limited because the accuracy and time savings are based on a simulation, not actual FCA administrations.

A418 - The Integration of Medical, Psychological, and Quality of Life Measures in the Prediction and Maintenance of Excess Weight Loss after Bariatric Surgery

Background: The National Institute of Health, the American Association of Clinical Endocrinologists, the American Society for Metabolic and Bariatric Surgery, and the Obesity Society Guidelines for the Clinical Management of Bariatric Surgery patients have long recommended that assessment of bariatric surgery candidates include presurgical psychological evaluations as a national standard practice amongst bariatric centers.

Reliability and Validity of the Minnesota Multiphasic Personality Inventory – 2 – Restructured Form (MMPI-2-RF) in Spine Surgery and Spinal Cord Stimulator Samples

It is not uncommon for patients to report diminished outcomes as a result of spine surgery or a spinal cord stimulator implant. Presurgical psychological evaluations are increasingly used to identify patients at increased risk for such outcomes and use of personality assessment instruments in these evaluations provides incremental information beyond a clinical interview and medical chart review. This investigation explores the psychometric properties of the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI–2–RF) in a sample of spine surgery patients (n = 810) and in a sample of spinal cord stimulator patients (n = 533). Results indicated that MMPI–2–RF substantive scale scores are reliable, with evidence of good convergent and discriminant validity in both samples. Incorporating the MMPI–2–RF as part of the presurgical evaluation of spine surgery and spinal cord stimulator patients can provide meaningful insight into patients’ functioning and help guide pre- and postsurgical treatment in these settings.

Thursday, September 27, 2018 1:05 PM–2:05 PM Understanding Anxiety and Depression when Performing Spine Surgery: 121. Patient activation buffers the adverse impact of psychosocial risk factors on spine surgery and spinal cord stimulation

BACKGROUND CONTEXT A growing body of research demonstrates that psychosocial factors can have adverse impacts on the outcome of spine surgery (SS) and spinal cord stimulation (SCS). Research using the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has found that problems such as demoralization, elevated somatic focus, malaise, family conflicts are associated with poorer SS and SCS results. More recently, another characteristic, “patient activation” – the extent to which patients are engaged and active in their own health care – has been found to be associated with improved spine surgery results. PURPOSE The purpose of this study is to assess whether patient activation can mitigate the adverse impacts of established psychosocial risk factors on the outcomes of SS and SCS. STUDY DESIGN/SETTING Prospective mediation design in which candidates for SS and SCS underwent a presurgical psychological evaluation including baseline psychometrics, and completed baseline outcome measures. Patients completed follow-up measures at an average of 5 months postop PATIENT SAMPLE A total of 581 patients who underwent either SS (70.7%) or SCS 29.3%. Mean age 50.2, Mean education level 13.53. 40.6% men, 50.4% women. OUTCOME MEASURES Oswestry Disability Index, Likert-Scale ratings of Pain, Negative Emotions, Satisfaction with surgery results. METHODS At baseline all patients underwent presurgical psychological evaluation, which included a diagnostic interview, review of medical records and psychometric testing including the MMPI-2-RF. Patients also completed the Patient Activation Measure (PAM). Correlations between baseline psychometric testing results and outcomes were obtained. RESULTS Results confirmed previous research demonstrating that multiple MMPI-2-RF, especially those that assess demoralization, malaise and somatic complaints, are significantly associated with poorer postop improvement in function (Oswestry score), higher levels of pain and reduced satisfaction with results. On the other hand, higher levels of patient activation (as assessed by PAM) were correlated with greater postop functional ability and greater outcome satisfaction (but did not impact reported pain level). Mediation analyses indicated that PAM scores significantly attenuated the negative impact of MMPI-2-RF factors on both functional improvement and outcome satisfaction. CONCLUSIONS Extensive research indicates that certain psychosocial factors are associated with negative outcomes of spine surgery and spinal cord stimulation. The current results indicate that patient activation—patient's involvement in obtaining information, decision making and resilience during times of stress—can mitigate such adverse effects. Presurgical psychological evaluations should include examination of patient strengths in additional to psychosocial risk factors, so that treatments can be appropriately individualized and the most effective surgical results obtained. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Patient Activation Mediates the Association Between Psychosocial Risk Factors and Spine Surgery Results.

Although spine surgery (SS) and spinal cord stimulators (SCSs) can provide significant relief for patients with intractable pain, their effectiveness is variable. Previously, a number of pre-operative psychosocial risk factors have predicted suboptimal outcomes of these procedures. However, recent research has found that "patient activation"-the extent to which patients are engaged and active in their own health care-can predict positive surgical results. The purpose of the current investigation was to determine whether patient activation helps explain associations between established psychosocial risk factors and suboptimal outcomes. Candidates for SS and SCS (n = 1254; 56.3% women, mean age 50.4years) consented to participate in an outcome study prior to their pre-surgical psychological evaluation. Of those, 46.3% returned self-report measures an average of 180days (SD = 79.1) post-surgery. Bootstrapped mediation analyses indicated that patient activation mediates numerous associations between psychosocial risk factors and suboptimal outcomes. That is, patients' involvement in obtaining information, decision making, and their resilience can explain why some patients do not experience adverse surgical results when pre-surgical psychosocial risk factors are present. Pre-surgical psychological evaluations should include examination of patient strengths in addition to psychosocial risk factors, so that treatments can be appropriately individualized and the most effective surgical results obtained.

Confirmatory factor analysis of the Beck Depression Inventory-II in bariatric surgery candidates.

Screening for depression is an integral part of psychological evaluations conducted prior to bariatric surgery. The Beck Depression Inventory-II (BDI-II) is the most commonly used measure of depression in these treatment evaluations. The reliability and validity of the BDI-II has not yet been evaluated within bariatric surgery-seeking samples, evidencing a significant gap in the present literature. The purpose of the present study is to evaluate the structural validity of the BDI-II and to examine the reliability and convergent and criterion validity of this instrument within a bariatric surgery-seeking sample. The study population consisted of 505 ethnically diverse bariatric surgery candidates presenting for presurgical psychological evaluations in a midwestern urban academic medical center. Confirmatory factor analytic results indicated that a 3-factor model consisting of affective, cognitive, and somatic factors was the best fitting model of depression within this sample. Internal consistency reliability was satisfactory for each subscale, ranging from .72 to .82. Moderate to large correlations were observed between each BDI-II subscale and a measure of depression previously validated with bariatric surgery candidates indicating adequate convergent validity. On the basis of clinical interview, 14% of the sample was diagnosed with current major depression. Significant mean differences were observed between depressed and nondepressed patients with respect to each BDI-II subscale score, demonstrating criterion-related validity. The BDI-II is a reliable and valid measure of depression for bariatric surgery candidates. Understanding the factor structure of the BDI-II can be useful for planning potential presurgical psychological interventions.

Psychiatric factors and weight loss patterns following gastric bypass surgery in a veteran population.

BackgroundAlthough pre-surgical psychological evaluations are commonly administered to patients considered for weight loss surgeries, the value of these evaluations for predicting weight loss success has been questioned. In this study, we addressed this issue by examining patient’s total number of psychiatric indicators rather than individual psychological factors as predictors of weight loss/weight regain.MethodsSixty adult veterans completed gastric bypass surgery or laparoscopic gastric banding after completing a multidisciplinary evaluation for surgical clearance, including a psychological assessment. Patients were subsequently followed for 24 month to examine changes in weight, body mass index, and risk of weight regain.ResultsNearly three fourths of the sample carried either a single (40.0%) or multiple psychiatric diagnoses (33.4%). Nearly half (47.5%) of the sample ceased losing weight after 1 year, with 29.5% regaining weight after this point. Neither psychiatric nor biomedical factors effectively predicted 1-year weight loss totals; however, we observed a significant linear relationship between the number of psychiatric factors and post-1-year weight changes (r = 0.33, p = 0.01). After adjusting for demographic and biomedical factors, patients with two or more psychiatric diagnoses were found to be significantly more likely to experience weight loss cessation or weight regain after 1-year (OR = 6.4, 95% CI = 1.3–12.4) relative to those with zero or one psychiatric diagnosis.ConclusionsAssessing mental health factors in terms of the total number of psychiatric conditions improved the prediction of weight loss surgery outcomes in this veteran sample. An expanded model for understanding how psychological factors may affect weight loss surgery may improve the utility of pre-bariatric psychological assessments.

Psychological Evaluation of Bariatric Surgery Applicants: Procedures and Reasons for Delay or Denial of Surgery

Psychologists play an important role as members of the bariatric surgery team. The current investigation examined the frequency with which psychologists recommend delay or denial of surgery for psychological reasons, the procedures they use in making their clinical decisions, and the reasons for such conclusions. A sample of 103 psychologists with experience in conducting pre-surgical psychological evaluations responded to a brief survey. There was significant variability in the number of evaluations psychologists complete and the instruments they use to make their clinical decisions. For most candidates, the evaluation results in psychological clearance for surgery. However, approximately 15%, on average, are delayed or denied for psychological reasons. The most common reasons for delaying or denying surgery were significant psychopathology (including psychosis or bipolar disorder), untreated or undertreated depression, and lack of understanding about the risks and postoperative requirements of surgery, which were reported by 51, 39, and 30% of respondents, respectively. Several other reasons were reported less frequently and many appeared to be idiosyncratic. Psychologists differ in their preoperative evaluation practices. Further research is needed to determine the reasons for the variability in clinical decision making and the long-term medical and psychosocial outcomes associated with the recommendation to delay or deny surgery for psychosocial reasons. When patients receive such a recommendation, they can be encouraged to seek a second opinion from a mental health professional with bariatric expertise.