RESUMO
BACKGROUND: Psychiatric disorders tend to distribute unevenly in women and men with severe obesity. The current research aimed to identify homogeneous clusters of concurrent psychiatric disorders among patients seeking bariatric surgery, by gender. METHODS: We recruited a consecutive sample of 393 candidates with obesity (311 women and 82 men) in a university-based bariatric center. Trained clinicians assessed psychiatric disorders through the Structured Clinical Interview for DSM-IV (SCID). Latent class analysis categorized pre-surgical patients into uniform clusters of co-occurring psychiatric disorders. RESULTS: For both genders, the 3-class psychopathological clustering was the best-fitting solution. Among women, the latent classes were: (1) "oligosymptomatic", wherein 42% of patients showed low probability of psychiatric disorders; (2) "bipolar with comorbidities", in 33%; and (3) "anxiety/depression", in 25%. Among men, (1) "bipolar with comorbidities" was found in 47% of patients; (2) "oligosymptomatic", in 40%; and (3) "anxiety/depression", in 13%. For both genders, the probability of presenting eating disorders was higher in both "bipolar" and "anxiety/depression" classes. Substance use disorders was prominent among "bipolar" men. In comparison with "oligosymptomatic" class, the likelihood of higher BMI was observed among "bipolar" men and poorer work attainment among men with "anxiety/depression". LIMITATION: Participants was cross-sectionally drawn from a single bariatric center. CONCLUSIONS: Pre-surgical men and women with severe obesity were distributed in three comorbidity profiles and revealed analogous psychopathological patterns. The class of "bipolar disorders" most likely presented comorbidity with eating and substance use disorder. This natural clustering of psychiatric disorders among bariatric patients suggests gender-related therapeutic approaches and surgical outcomes.
Assuntos
Cirurgia Bariátrica/psicologia , Obesidade Mórbida/psicologia , Fatores Sexuais , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/etiologia , Transtorno Bipolar/psicologia , Análise por Conglomerados , Comorbidade , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
The current study investigates the patterns of disease persistence and comorbidity of psychiatric disorders among patients with class III obesity in pre-operative period. For 393 treatment-seeking patients with severe obesity recruited from a bariatric center, we ascertained their psychiatric diagnosis through Structured Clinical Interview for DSM-IV (SCID-I). Following, the frequency, persistence and comorbidity pattern of psychiatric disorders in this sample were determined. Current psychiatric disorders were observed in over half of patients during preoperative period, being anxiety disorders the most frequent diagnosis. For lifetime disorders, mood disorders were the most frequent diagnosis. Most of the sample presented 2 or more concurrent lifetime psychiatric disorders. While mood and eating disorders were frequent conditions, anxiety disorders were the most persistent conditions (the highest one month-to-lifetime prevalence ratio) and were significantly correlated with bipolar, depressive and eating disorders. Psychiatric disorders are frequent and enduring conditions among patients looking for bariatric surgery. Comorbid anxiety, mood, and eating disorders are remarkable features in treatment-seeking patients with obesity. Prognostic implications of preoperative psychiatric disorders on surgery outcome should be demonstrated prospectively in intervention studies.
Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos do Humor/epidemiologia , Obesidade Mórbida/psicologia , Adulto , Cirurgia Bariátrica/psicologia , Brasil/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Período Pré-Operatório , PrevalênciaRESUMO
BACKGROUND: Clinical assessment of depression is an important part of pre-surgical assessment among individuals with morbid obesity. However, there is no agreed-upon instrument to identify mood psychopathology in this population. We examined the reliability and criterion validity of the clinician-administered Montgomery-Åsberg Depression Rating Scale (MADRS) and the utility of a short version for bariatric surgery candidates. METHODS: The sample was 374 patients with obesity, consecutively recruited from the waiting list of a bariatric surgery clinic of University Hospital, Brazil: women 80%, mean BMI 47 kg/m(2), mean age 43.0 years. The 10-item MADRS was analyzed against the SCID-I. Items that showed small relevance to sample's characteristics and contribution to data variability were removed to develop the short 5-item version of scale. We calculated the sensitivity and specificity of cutoff points of both versions MADRS, and values were plotted as a receiver operating characteristic curve. RESULTS: For the 10-item MADRS, the Cronbach's alpha coefficient was 0.93. When compared against SCID-I, the best cut-off threshold was 13/14, yielding sensitivity of 0.81 and specificity 0.85. Following items were removed: reduced appetite, reduced sleep, concentration difficulties, suicide thought and lassitude. The 5-item version showed an alpha coefficient of 0.94 and a best cut-off threshold of 10/11, yielding sensitivity of 0.81 and specificity 0.87. Similar overall ability to discriminate depression of almost 90% was found for both 10-item and 5-item MADRS. CONCLUSION: The MADRS is a reliable and valid instrument to assess depressive symptoms among treatment-seeking bariatric patients. Systematic application of the abbreviated version of the MADRS can be recommended for enhancing the clinical detection of depression during perioperative period.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Depressão/diagnóstico , Saúde Mental/estatística & dados numéricos , Adulto , Brasil , Depressão/etiologia , Transtorno Depressivo/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Obesity and psychiatric disorders are burdensome health problems commonly observed in general population and clinical samples. However, non-standardized assessment and small size of the sample might hamper conclusions of the investigations. The objective of this study is to replicate previous findings on frequency of psychiatric disorders and associated factors among obese patients seeking bariatric surgery, assessed through standardized interview. MATERIAL AND METHOD: The sample was comprised of 393 treatment-seeking obese patients (79.1% women; mean age 43.0 years, mean BMI 47.8 kg/m(2)) recruited from a university-based bariatric center. Trained clinicians ascertained the psychiatric diagnosis of the participants through structured clinical interview for DSM-IV Axis I diagnosis (SCID-I). RESULTS: The current rate of any psychiatric disorders was 57.8% (58.5% men vs. 57.6% women). The current anxiety disorders were the most frequent diagnosis (46.3%) among those participants with current disorder. Age and educational level were associated with the likelihood of presenting current psychiatric disorders. The lifetime rate of any psychiatric disorders was 80.9% (81.7 men vs. 80.7% women). Lifetime affective disorders were the most frequent diagnosis (total 64.9%; bipolar disorders 35.6% and depressive disorders 29.3%). About half of the sample presented 3 or more concurrent disorders among those respondents presenting any lifetime psychiatric disorders. CONCLUSIONS: Psychiatric disorders are frequent conditions among obese patients before bariatric surgery. Systematic assessment of patients in the pre-surgical phase is recommended. Prognostic implications of psychiatric disorders on surgery outcome should be demonstrated in follow-up study.