King׳s College London, Department of Primary Care and Public Health Sciences, Capital House, 42 Weston Street, London SE1 3QD, UK; NIHR Biomedical Research Centre at Guy׳s and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
Department of Surgery, Whittington Hospital, Magdala Avenue, London N19 5NF, UK.
J Affect Disord. 2015 Mar 15;174:644-9. doi: 10.1016/j.jad.2014.12.050. Epub 2014 Dec 29.
Obesity is associated with depression. This study aimed to evaluate whether clinical depression is reduced after bariatric surgery (BS).
Obese adults who received BS procedures from 2002 to 2014 were sampled from the UK Clinical Practice Research Datalink. An interrupted time series design, with matched controls, was conducted from three years before, to a maximum of seven years after surgery. Controls were matched for body mass index (BMI), age, gender and year of procedure. Clinical depression was defined as a medical diagnosis recorded in year, or an antidepressant prescribed in year to a participant ever diagnosed with depression. Adjusted odds ratios (AOR) were estimated.
There were 3045 participants (mean age 45.9; mean BMI 44.0kg/m(2)) who received BS, including laparoscopic gastric banding in 1297 (43%), gastric bypass in 1265 (42%), sleeve gastrectomy in 477 (16%) and six undefined. Before surgery, 36% of BS participants, and 21% of controls, had clinical depression; between-group AOR, 2.02, 95%CI 1.75-2.33, P<0.001. In the second post-operative year 32% had depression; AOR, compared to time without surgery, 0.83 (0.76-0.90, P<0.001). By the seventh year, the prevalence of depression increased to 37%; AOR 0.99 (0.76-1.29, P=0.959).
Despite matching there were differences in depression between BS and control patients, representing the highly selective nature of BS.
Depression is frequent among individuals selected to undergo bariatric surgery. Bariatric surgery may be associated with a modest reduction in clinical depression over the initial post-operative years but this is not maintained.
肥胖与抑郁有关。本研究旨在评估减重手术（BS）后临床抑郁症是否减少。
从英国临床实践研究数据链接中抽取了 2002 年至 2014 年间接受 BS 手术的肥胖成年人。采用从术前三年到术后最多七年的时间进行中断时间序列设计，并与匹配对照进行比较。对照组按体重指数（BMI）、年龄、性别和手术年份进行匹配。临床抑郁症的定义是在当年记录的医学诊断或曾诊断为抑郁症的参与者当年开出处方的抗抑郁药。估计调整后的优势比（AOR）。
共有 3045 名参与者（平均年龄 45.9；平均 BMI 44.0kg/m2）接受了 BS，包括腹腔镜胃带术 1297 例（43%）、胃旁路术 1265 例（42%）、袖状胃切除术 477 例（16%）和 6 例未定义。手术前，BS 组有 36%的患者和对照组有 21%的患者患有临床抑郁症；组间 AOR 为 2.02，95%CI 为 1.75-2.33，P<0.001。术后第二年有 32%的人患有抑郁症；与无手术相比，AOR 为 0.83（0.76-0.90，P<0.001）。到第七年，抑郁症的患病率上升到 37%；AOR 为 0.99（0.76-1.29，P=0.959）。
尽管进行了匹配，但 BS 和对照组患者之间的抑郁情况仍存在差异，这代表了 BS 的高度选择性。
在选择接受减重手术的人群中，抑郁症很常见。减重手术可能与术后最初几年临床抑郁症的适度减少有关，但这种减少并不能持续。
