Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cinncinnati, Ohio 45229, USA.
Surg Obes Relat Dis. 2011 Jan-Feb;7(1):50-4. doi: 10.1016/j.soard.2010.05.016. Epub 2010 Jun 4.
The preoperative psychological evaluation (including the assessment of depressive symptoms) is an important component in determining adolescent bariatric candidacy. The adult bariatric data have suggested that candidates can engage in "impression management" and underreport depressive symptoms during their preoperative evaluation. The present study examined whether adolescent depressive symptoms among bariatric candidates change during preoperative preparation compared with adolescents with extreme obesity who were not seeking surgery.
Adolescent candidates for bariatric surgery (n = 30; 60% female; mean age 16.5 ± 1.4 years) completed the Beck Depression Inventory-II (BDI-II) at initial consultation (time 1, mean body mass index [BMI] 64.5 ± 11.5 kg/m(2)) and again immediately preoperatively (time 2, mean interval 4.7 ± 2.9 months; mean BMI 64.4 ± 10.4 kg/m(2)). Comparators (n = 25; 64% female; mean age 16.2 ± 1.2 years; mean BMI 46.5 ± 4.8 kg/m(2)) were studied at enrollment in a research protocol and again 6 months later (mean interval 6.2 ± 0.4 months; mean BMI 46.8 ± 5.0 kg/m(2)). The height and weight were also taken.
We found a small, but statistically significant, difference in the BDI-II scores at time 1, with bariatric candidates reporting greater depressive symptoms (mean 16.6 ± 12.9) than the comparators (mean 10.6 ± 9.0; P < .05). No difference was seen in the BDI-II scores between the bariatric candidates (mean 14.4 ± 12.1) and the comparators (mean 10.4 ± 8.2) at time 2 (P = .17). The change in BDI-II scores for the bariatric candidates showed a trend toward significance (P = .09).
These results reinforce the position that the adult bariatric literature does not necessarily generalize to the adolescent bariatric population. They further suggest that impression management might not be a significant concern in the assessment of adolescent bariatric candidates. Future research should examine whether preoperative changes in psychological functioning predict the postoperative outcomes.
术前心理评估（包括抑郁症状评估）是确定青少年接受减重手术资格的重要组成部分。成人减重手术的数据表明，候选者可能会在术前评估中进行“印象管理”，从而少报抑郁症状。本研究旨在检查与不寻求手术的极度肥胖青少年相比，减重手术候选者的术前准备过程中，抑郁症状是否会发生变化。
30 名接受减重手术的青少年候选者（60%为女性；平均年龄 16.5 ± 1.4 岁）分别在初次就诊（时间 1，平均体重指数[BMI]64.5 ± 11.5 kg/m2）和术前即刻（时间 2，平均间隔 4.7 ± 2.9 个月；平均 BMI 64.4 ± 10.4 kg/m2）时完成贝克抑郁自评量表第二版（BDI-II）。在研究方案中，25 名对照组（64%为女性；平均年龄 16.2 ± 1.2 岁；平均 BMI 46.5 ± 4.8 kg/m2）在入组时进行了研究，并在 6 个月后再次进行了研究（平均间隔 6.2 ± 0.4 个月；平均 BMI 46.8 ± 5.0 kg/m2）。同时记录了身高和体重。
我们发现，在时间 1 时 BDI-II 评分存在较小但具有统计学意义的差异，减重手术候选者的抑郁症状报告（平均 16.6 ± 12.9）比对照组（平均 10.6 ± 9.0；P <.05）更严重。但在时间 2 时，两组的 BDI-II 评分无差异（减重手术候选者平均 14.4 ± 12.1；对照组平均 10.4 ± 8.2；P =.17）。减重手术候选者的 BDI-II 评分变化有显著趋势（P =.09）。
这些结果强化了这样一种观点，即成人减重手术文献不一定适用于青少年减重手术人群。此外，这些结果进一步表明，在评估青少年减重手术候选者时，印象管理可能不是一个显著的关注点。未来的研究应检查术前心理功能的变化是否能预测术后结果。
