Department of Psychiatry, University of Toronto, Toronto, Canada.
Obes Surg. 2013 Feb;23(2):205-11. doi: 10.1007/s11695-012-0762-5.
Bariatric surgery is recognized as a treatment for severe obesity; however, little is known about factors influencing patient surgery non-completion. This study explored the relationship between psychiatric factors and patient non-completion during the pre-bariatric surgery suitability assessment.
A total of 367 individuals underwent a structured psychiatric interview and were classified as either surgery completers (SC) or surgery non-completers (SNC) if they attended at least one pre-surgery assessment appointment but did not receive surgery.
The results showed that in comparison to the SC group, the SNC group had significantly higher rates of overall past Axis I psychiatric disorders (58.1 vs. 46.6 %, p = 0.035), past anxiety disorders (17.4 vs. 9.4 %, p = 0.03), and past substance use disorders (8.7 vs. 3.7 %, p = 0.03). For specific past psychiatric disorders, the SNC group exhibited significantly higher rates of a past post-traumatic stress disorder (PTSD) (5 vs. 1 %, p = 0.029) and past substance dependence disorder (7 vs. 1 %, p = 0.005). Although overall current psychiatric disorders did not significantly differ between groups, the SNC group had significantly higher rates of current PTSD (2 vs. 0 %, p = 0.049) and current generalized anxiety disorder (4 vs. 0 %, p = 0.005).
A past history of an anxiety or substance use disorder may play a role in patients not completing the assessment component of the bariatric surgery process. Additional psychosocial support, such as cognitive behavioral therapy or targeted psychoeducation, may help improve patient completion of the pre-surgery assessment phase.
减重手术被认为是治疗重度肥胖的一种方法；然而，人们对影响患者手术完成的因素知之甚少。本研究探讨了在减重手术适宜性评估前，精神因素与患者手术未完成之间的关系。
共有 367 名个体接受了结构化的精神科访谈，如果他们至少参加了一次术前评估预约但未接受手术，则将其归类为手术完成者（SC）或手术未完成者（SNC）。
结果显示，与 SC 组相比，SNC 组总体过去的轴 I 精神障碍发生率显著更高（58.1%比 46.6%，p=0.035），过去的焦虑障碍发生率更高（17.4%比 9.4%，p=0.03），过去的物质使用障碍发生率更高（8.7%比 3.7%，p=0.03）。对于特定的过去精神障碍，SNC 组过去创伤后应激障碍（PTSD）（5%比 1%，p=0.029）和过去物质依赖障碍的发生率显著更高（7%比 1%，p=0.005）。尽管两组之间总体当前精神障碍无显著差异，但 SNC 组当前 PTSD（2%比 0%，p=0.049）和当前广泛性焦虑障碍（4%比 0%，p=0.005）的发生率更高。
过去患有焦虑或物质使用障碍可能会导致患者无法完成减重手术评估过程的评估部分。额外的社会心理支持，如认知行为疗法或有针对性的心理教育，可能有助于提高患者完成术前评估阶段的完成率。
