Dataset Information

The Complex Association Between Bariatric Surgery and Depression: a National Nested-Control Study.

ABSTRACT:

Background

Although bariatric surgery has been shown to reduce weight loss and obesity-related conditions, an improvement in depression remains unclear. The aim of this study was to determine whether bariatric surgery is associated with a resolution of depression, and the prevention of its onset.

Method

Patients with a BMI ≥ 30 kg/m² who had undergone bariatric surgery were identified from the Clinical Practice Research Datalink (CPRD), matched 5:1 to controls. Cox regression analysis was used to determine the risk of developing de novo depression. Kaplan-Meier analysis compared the proportion of patients with no further consultations related to depression between the two groups.

Results

In total, 3534 patients who underwent surgery, of which 2018 (57%) had pre-existing depression, were matched to 15,480 controls. Cox proportional hazard modelling demonstrated surgery was associated with a HR of 1.50 (95% CI 1.32-1.71, p < 0.005) for developing de novo depression. For those with pre-existing depression, by 5 years, just over 20% of post-surgical patients had no further depression episodes compared with 17% of controls.

Conclusion

In individuals with a history of depression, bariatric surgery is associated with an improvement in mental health. On the contrary, the finding of increased de novo diagnoses of depression following surgery indicates the need for further study of the mechanisms by which bariatric surgery is associated with depression in this subset of patients.

SUBMITTER: Arhi CS

PROVIDER: S-EPMC8041688 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description: To investigate whether bariatric surgery increases the risk of fracture. Retrospective nested case-control study. Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases. 12?676 patients who underwent bariatric surgery, age and sex matched with 38?028 obese and 126?760 non-obese controls. Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence. Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for biliopancreatic diversion. Patients undergoing bariatric surgery were more likely to have fractures than were obese or non-obese controls, and this risk remained higher after surgery. Fracture risk was site specific, changing from a pattern associated with obesity to a pattern typical of osteoporosis after surgery. Only biliopancreatic diversion was clearly associated with fracture risk; however, results for Roux-en-Y gastric bypass and sleeve gastrectomy remain inconclusive. Fracture risk assessment and management should be part of bariatric care.

Project description:Background/objectivesBariatric 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.Subjects/methodsIn 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.ResultsBariatric 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.ConclusionsIn 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.