Bariatric surgery is helpful in enabling sustained weight loss, but effects on depression are unclear. Reductions in depression-related symptoms and increases in suicide rate have both been observed after bariatric surgery, but these observations are confounded by the presence of pre-existing depression. The goal of this study is to evaluate the effect of bariatric surgery on subsequent depression diagnosis.
In this observational study, a prospective cohort study was simulated by evaluating depression risk based on diagnostic codes. An administrative database was utilized for this study, containing records and observations between 1 January 2008 through 29 February 2016 of enrolled patients in the United States. Individuals considered in this analysis were enrolled in a commercial health insurance program, observed for at least 6 months prior to surgery, and met the eligibility criteria for bariatric surgery. In all, 777,140 individuals were considered in total.
Bariatric surgery was found to be significantly associated with subsequent depression relative to both non-surgery controls (HR = 1.31, 95% CI, 1.27–1.34, P < 2e–32) and non-bariatric abdominal surgery controls (HR = 2.15, 95% CI, 2.09–2.22, P < 2e–32). Patients with pre-surgical psychiatric screening had a reduced depression hazard ratio with respect to patients without (HR = 0.85, 95% CI, 0.81–0.89, P = 3.208e–12). Men were found to be more susceptible to post-bariatric surgery depression compared with women. Pre-surgical psychiatric evaluations reduced the magnitude of this effect. Relative to bariatric surgeries as a whole, vertical sleeve gastrectomy had a lower incidence of depression, while Roux-en Y Gastric Bypass and revision/removal surgeries had higher rates.
In individuals without a history of depression, bariatric surgery is associated with subsequent diagnosis of depression. This study provides guidance for patients considering bariatric surgery and their clinicians in terms of evaluating potential risks and benefits of surgery.
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The data that support the findings of this study are available from Aetna Inc. but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of Aetna Inc.
Nguyen NT, Esteban Varela J. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Publ Gr. 2016. https://doi.org/10.1038/nrgastro.2016.170.
Sheets CS, Peat CM, Berg KC, White EK, Bocchieri-Ricciardi L, Chen EY, et al. Post-operative psychosocial predictors of outcome in bariatric surgery. Obes Surg. 2015;25:330–45.
Luppino FS, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67:220–9.
Burgmer R, et al. Psychological outcome 4 years after restrictive bariatric surgery. Obes Surg. 2014;24:1670–8.
Mitchell JE, et al. Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS-2) study. Obesity. 2014;22:1799–806.
Ivezaj V, Grilo CM. When mood worsens after gastric bypass surgery: characterization of bariatric patients with increases in depressive symptoms following surgery. Obes Surg. 2015;25:423–9.
Rydén A, Torgerson JS. The Swedish Obese Subjects Study-what has been accomplished to date? Surg Obes Relat Dis. 2006;2:549–60.
Adams TD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.
L.R. J-C, T.A. W. Risk of depression and suicide in patients with extreme obesity who seek bariatric surgery. Obes Manage. 2007;3:255–60.
Tindle HA, et al. Risk of suicide after long-term follow-up from bariatric surgery. Am J Med. 2010;123:1036–42.
Hedley AA, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291:2847–50.
Denny JC, et al. PheWAS: demonstrating the feasibility of a phenome-wide scan to discover gene-disease associations. Bioinformatics. 2010;26:1205–10.
R Development Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2013. http://www.R-project.org/.
UnitedHealthcare. Bariatric Surgery, Policy Number 2018T0362AA.
Roberts RE, Kaplan Ga, Shema SJ, Strawbridge WJ. Are the obese at greater risk for depression? Am J Epidemiol. 2000;152:163–70.
Panel CDC. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115:956.
Mechanick JI, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update. Surg Obes Relat Dis. 2013;9:159–91.
Ford DE, Erlinger TP. Depression and C-reactive protein in US adults: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2004;164:1010–4.
Bjerkeset O, Romundstad P, Evans J, Gunnell D. Association of adult body mass index and height with anxiety, depression, and suicide in the general population: the HUNT study. Am J Epidemiol. 2008;167:193–202.
De Wit LM, Van Straten A, Van Herten M, Penninx BW, Cuijpers P. Depression and body mass index, a u-shaped association. BMC Public Health. 2009 Jan 13,9:14.
Bauchowitz AU, et al. Psychosocial evaluation of bariatric surgery candidates: a survey of present practices. Psychosomatic Med. 2005;67:825–32.
McGuire MT, Wing RR, Klem ML, Lang W, Hill JO. What predicts weight regain in a group of successful weight losers? J Consult Clin Psychol. 1999;67:177–85.
English WJ, et al. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018. https://doi.org/10.1016/j.soard.2017.12.013.
Griggs CL, et al. National trends in the use of metabolic and bariatric surgery among pediatric patients with severe obesity. JAMA Pediatr. 2018;172:1191.
We thank Aetna Inc. for the data used in this study and Dr. Gabriel Brat for his suggestions on this work. K-HY is a Harvard Data Science Fellow, and WY is supported by NIH Ruth L. Kirschstein National Research Service Award #4TL1TR001101-04 and 5TL1TR001101-05.
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Yuan, W., Yu, KH., Palmer, N. et al. Evaluation of the association of bariatric surgery with subsequent depression. Int J Obes 43, 2528–2535 (2019). https://doi.org/10.1038/s41366-019-0364-6
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