Umberto Albert1,2, Tommaso Bonavigo2, Oriana Moro3, Elide Francesca De Caro3, Silvia Palmisano1, Elisabetta Pascolo-Fabrici1,2, Federico Sandri4, Nicolò de Manzini1, Lisa Di Blas5. 1. Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy. 2. Department of Mental Health, Azienda Sanitaria Giuliano-Isontina-ASUGI, Trieste, Italy. 3. Department of Life Sciences, University of Trieste, Via Weiss 2, 34100, Trieste, Italy. 4. IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy. 5. Department of Life Sciences, University of Trieste, Via Weiss 2, 34100, Trieste, Italy. diblali@units.it.
Abstract
PURPOSE: This longitudinal study examined how pre-intervention psychological health helps predict bariatric surgery (BS) success as percentage of expected body mass index loss (%EBMIL) over shorter to longer periods. METHODS: Adult candidates for BS (N = 334, 67.4% females) completed the Symptoms Checklist 90 (SCL-90) questionnaire; on average, 11 months occurred between the pre-surgery psychological evaluations and the bariatric intervention. We explored the factor structure of the SCL-90 items and inspected how SCL-90 empirical factors compared with SCL-90 scales and general indices predicted %EBMIL at 3-6-month, 1-year, and 2-year follow-up occasions, adjusting for gender, pre-intervention use of antidepressants and actual and ideal BMIs. RESULTS: Factor analysis combined the 90 items into 8 factors, which partially replicated the expected item structure. The SCL-90 empirical factors (but not the SCL-90 scales and indices) contributed to predict BS success. In fact, the Relational Distress factor directly protected from weight regain at 1-year follow-up, indirectly via 1-year %EBMIL at the 2-year follow-up, when it further strengthened the impact of the empirical factor of Generalized Anxiety on the 2-year BS outcome. The results also evidenced a cascade effect of the pre-surgery actual BMI across time as well as unique and direct effects of pre-surgery use of antidepressants and perceived ideal BMI on the 2-year outcome. CONCLUSIONS: SCL-90 empirical factor scores for obese patients are more efficient in anticipating BS success compared with original scale scores. They reveal that relational distress and anxiety are risk factors for postoperative weight loss, in addition to pre-intervention actual BMI, antidepressant therapy, and perceived ideal BMI. LEVEL OF EVIDENCE: III, well-designed cohort.
PURPOSE: This longitudinal study examined how pre-intervention psychological health helps predict bariatric surgery (BS) success as percentage of expected body mass index loss (%EBMIL) over shorter to longer periods. METHODS: Adult candidates for BS (N = 334, 67.4% females) completed the Symptoms Checklist 90 (SCL-90) questionnaire; on average, 11 months occurred between the pre-surgery psychological evaluations and the bariatric intervention. We explored the factor structure of the SCL-90 items and inspected how SCL-90 empirical factors compared with SCL-90 scales and general indices predicted %EBMIL at 3-6-month, 1-year, and 2-year follow-up occasions, adjusting for gender, pre-intervention use of antidepressants and actual and ideal BMIs. RESULTS: Factor analysis combined the 90 items into 8 factors, which partially replicated the expected item structure. The SCL-90 empirical factors (but not the SCL-90 scales and indices) contributed to predict BS success. In fact, the Relational Distress factor directly protected from weight regain at 1-year follow-up, indirectly via 1-year %EBMIL at the 2-year follow-up, when it further strengthened the impact of the empirical factor of Generalized Anxiety on the 2-year BS outcome. The results also evidenced a cascade effect of the pre-surgery actual BMI across time as well as unique and direct effects of pre-surgery use of antidepressants and perceived ideal BMI on the 2-year outcome. CONCLUSIONS: SCL-90 empirical factor scores for obese patients are more efficient in anticipating BS success compared with original scale scores. They reveal that relational distress and anxiety are risk factors for postoperative weight loss, in addition to pre-intervention actual BMI, antidepressant therapy, and perceived ideal BMI. LEVEL OF EVIDENCE: III, well-designed cohort.
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Authors: Nicola Di Lorenzo; Stavros A Antoniou; Rachel L Batterham; Luca Busetto; Daniela Godoroja; Angelo Iossa; Francesco M Carrano; Ferdinando Agresta; Isaias Alarçon; Carmil Azran; Nicole Bouvy; Carmen Balaguè Ponz; Maura Buza; Catalin Copaescu; Maurizio De Luca; Dror Dicker; Angelo Di Vincenzo; Daniel M Felsenreich; Nader K Francis; Martin Fried; Berta Gonzalo Prats; David Goitein; Jason C G Halford; Jitka Herlesova; Marina Kalogridaki; Hans Ket; Salvador Morales-Conde; Giacomo Piatto; Gerhard Prager; Suzanne Pruijssers; Andrea Pucci; Shlomi Rayman; Eugenia Romano; Sergi Sanchez-Cordero; Ramon Vilallonga; Gianfranco Silecchia Journal: Surg Endosc Date: 2020-04-23 Impact factor: 4.584