University of Michigan Medical School, Ann Arbor, MI, USA.
Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Surg Endosc. 2018 Aug;32(8):3683-3690. doi: 10.1007/s00464-018-6101-8. Epub 2018 Feb 12.
Bariatric surgery patients with mental illness may experience worse surgical outcomes compared to those without. Depression is the most prevalent mental health diagnosis amongst Americans with obesity. Accurate diagnosis and treatment is of paramount importance to mitigate perioperative risk. Unfortunately, there is no standard method to screen patients for depression prior to surgery. Our goal was to understand the relationship between traditional clinical screening tools and a novel patient-reported depression screening survey, Patient Health Questionnaire 8 (PHQ-8), in the setting of the bariatric surgery preoperative assessment.
The study included all adult bariatric surgery patients from January 2014 through June 2016. Patients who were not assessed using both the PHQ-8 and a traditional clinical depression screening were excluded from the study. There were a total of 4486 patients who met the eligibility criteria and were included in analysis. We used comparative statistics to examine the association between these screening tools and to test for contributing demographic, surgical, and socioeconomic factors.
The overall rate of clinically diagnosed depression in the study cohort was 45.6%. In comparison, 14.8% of all patients screened positive for depression using the PHQ-8. Of the patients without a traditional clinical diagnosis of depression, 10.2% screened positive for depression using the PHQ-8. This subset of undiagnosed patients was more likely to be non-white, employed, and had a higher BMI than their clinically diagnosed counterparts.
We found a higher rate of clinically diagnosed depression in our cohort compared to the general population. However, when using the validated PHQ-8 survey, the rate of depression more closely approximated the national incidence. Further, a significant proportion of patients were undiagnosed and/or misdiagnosed by current clinical assessments. Standardizing preoperative depression screening using validated patient-centered tools may prevent the consequences of untreated depression.
与没有精神疾病的肥胖症患者相比，患有精神疾病的肥胖症患者在接受减重手术后可能会出现更差的手术结果。抑郁症是美国肥胖人群中最常见的心理健康诊断。准确的诊断和治疗对于减轻围手术期风险至关重要。不幸的是，目前没有标准的方法可以在手术前对患者进行抑郁症筛查。我们的目标是了解传统临床筛查工具与新型患者报告的抑郁症筛查工具（PHQ-8）在肥胖症患者术前评估中的关系。
本研究纳入了 2014 年 1 月至 2016 年 6 月期间所有接受减重手术的成年患者。排除未使用 PHQ-8 和传统临床抑郁症筛查工具进行评估的患者。共有 4486 名符合纳入标准的患者纳入分析。我们使用比较统计学方法来研究这些筛查工具之间的关系，并检验是否存在与人口统计学、手术和社会经济因素相关的因素。
在研究队列中，有临床诊断的抑郁症总体发生率为 45.6%。相比之下，有 14.8%的患者使用 PHQ-8 筛查出患有抑郁症。在没有临床诊断为抑郁症的患者中，有 10.2%的患者使用 PHQ-8 筛查出患有抑郁症。这部分未被诊断的患者更有可能是非白人、就业和 BMI 更高，与他们有临床诊断的对照组相比。
我们发现，与一般人群相比，我们的队列中患有临床诊断的抑郁症的比例更高。然而，使用经过验证的 PHQ-8 调查，抑郁症的发生率更接近全国发病率。此外，相当一部分患者被当前的临床评估漏诊和/或误诊。使用经过验证的以患者为中心的工具进行标准化术前抑郁症筛查，可能有助于预防未治疗的抑郁症带来的后果。
