Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California3Veterans Affairs/Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, Cali.
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California5Southern California Evidence-Based Practice Center, RAND Corporation, Santa Monica.
JAMA. 2016 Jan 12;315(2):150-63. doi: 10.1001/jama.2015.18118.
Bariatric surgery is associated with sustained weight loss and improved physical health status for severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery; however, the prevalence of these conditions and whether they are associated with postoperative outcomes remains unknown.
To determine the prevalence of mental health conditions among bariatric surgery candidates and recipients, to evaluate the association between preoperative mental health conditions and health outcomes following bariatric surgery, and to evaluate the association between surgery and the clinical course of mental health conditions.
We searched PubMed, MEDLINE on OVID, and PsycINFO for studies published between January 1988 and November 2015. Study quality was assessed using an adapted tool for risk of bias; quality of evidence was rated based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.
We identified 68 publications meeting inclusion criteria: 59 reporting the prevalence of preoperative mental health conditions (65,363 patients) and 27 reporting associations between preoperative mental health conditions and postoperative outcomes (50,182 patients). Among patients seeking and undergoing bariatric surgery, the most common mental health conditions, based on random-effects estimates of prevalence, were depression (19% [95% CI, 14%-25%]) and binge eating disorder (17% [95% CI, 13%-21%]). There was conflicting evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Neither depression nor binge eating disorder was consistently associated with differences in weight outcomes. Bariatric surgery was, however, consistently associated with postoperative decreases in the prevalence of depression (7 studies; 8%-74% decrease) and the severity of depressive symptoms (6 studies; 40%-70% decrease).
Mental health conditions are common among bariatric surgery patients-in particular, depression and binge eating disorder. There is inconsistent evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Moderate-quality evidence supports an association between bariatric surgery and lower rates of depression postoperatively.
减重手术可使严重肥胖患者持续减轻体重并改善身体健康状况。寻求减重手术的患者可能存在多种心理健康状况；然而，这些状况的普遍程度及其与术后结果的关系尚不清楚。
确定减重手术候选者和接受者中心理健康状况的流行程度，评估术前心理健康状况与减重手术后健康结果之间的关系，以及评估手术与心理健康状况临床病程之间的关系。
我们检索了 1988 年 1 月至 2015 年 11 月期间发表在 PubMed、OVID MEDLINE 和 PsycINFO 上的研究。使用改良的偏倚风险工具评估研究质量；根据 GRADE（推荐评估、制定与评价）标准对证据质量进行评级。
我们确定了 68 篇符合纳入标准的文献：59 篇报告了术前心理健康状况的流行程度（65363 例患者），27 篇报告了术前心理健康状况与术后结果之间的关系（50182 例患者）。在寻求并接受减重手术的患者中，基于患病率的随机效应估计，最常见的心理健康状况是抑郁症（19%[95%CI，14%-25%]）和暴食障碍（17%[95%CI，13%-21%]）。术前心理健康状况与术后体重减轻之间的关系存在相互矛盾的证据。抑郁症或暴食障碍与体重结果的差异均无一致关联。然而，减重手术与术后抑郁症患病率降低（7 项研究；降低 8%-74%）和抑郁症状严重程度降低（6 项研究；降低 40%-70%）一致相关。
心理健康状况在减重手术患者中很常见，尤其是抑郁症和暴食障碍。术前心理健康状况与术后体重减轻之间的关系证据不一致。中等质量证据支持减重手术与术后抑郁症发生率降低相关。
