a Department of Family Medicine , National Taiwan University Hospital , Taipei , Taiwan.
b Department of Family Medicine, College of Medicine , National Taiwan University , Taipei , Taiwan.
Ann Med. 2018 Nov;50(7):605-612. doi: 10.1080/07853890.2018.1511917. Epub 2018 Sep 7.
Bariatric surgery is associated with a significant improvement in depressive mood in the initial postoperative years, but the maintenance of the improvement is under debate.
To explore the association between bariatric surgery and major depressive disorder (MDD) in a 12-year nationwide cohort study.
Using the National Health Insurance Research Database of Taiwan, we identified 2302 patients who underwent bariatric surgery in 2001-2009. These patients were matched by propensity score to 6493 obese patients who did not receive bariatric surgery. We followed the surgical and control cohorts until death, any diagnosis of MDD or 31 December 2012. We used Cox proportional hazard regression models to calculate the relative risk of MDD in those who received bariatric surgery.
Overall, there was a 1.70-fold (95% CI: 1.27-2.27) higher risk of MDD in the surgical group. Subjects receiving malabsorptive procedures showed a higher risk of MDD (3.01, 95% CI: 1.78-5.09) than those receiving restrictive procedures (1.51, 95% CI: 1.10-2.07). Stratified by follow-up period, there was a higher risk of MDD in the surgical group (2.92, 95% CI: 1.75-4.88) than in the restrictive group four years after bariatric surgery.
Bariatric surgery was significantly associated with an elevated risk of MDD. KEY MESSAGES Bariatric surgery is associated with a significant improvement in depressive mood in the initial postoperative years, but the improvement is not maintained. Less is known about the relationship between bariatric surgery and risk of major depressive disorder. This was the first nationwide cohort study which found that bariatric surgery was significantly associated with an elevated risk of MDD (aHR: 1.70; CI: 1.27-2.27), mainly with malabsorptive procedures (aHR: 3.01; CI: 1.78-5.09) and at time points more than four years after surgery (aHR: 2.92; CI: 1.75-4.88) compared with the risk in matched controls. These findings imply an association between long-term malabsorption and the postoperative incidence of MDD. Long-term malabsorption might be related to the incidence of major depressive disorder after bariatric surgery. The possible causal relationship between nutritional deficiency after bariatric surgery and major depressive disorder warrants further investigation.
减重手术可显著改善术后初期的抑郁情绪，但改善效果的维持仍存在争议。
在一项为期 12 年的全国队列研究中，探讨减重手术与重度抑郁症（MDD）之间的关系。
利用台湾全民健康保险研究数据库，我们确定了 2001 年至 2009 年间 2302 例接受减重手术的患者。通过倾向评分，将这些患者与 6493 例未接受减重手术的肥胖患者进行匹配。我们对手术组和对照组进行随访，直至死亡、任何 MDD 诊断或 2012 年 12 月 31 日。我们使用 Cox 比例风险回归模型计算接受减重手术者 MDD 的相对风险。
总体而言，手术组 MDD 的风险增加了 1.70 倍（95%CI：1.27-2.27）。与接受限制型手术者相比，接受吸收不良型手术者 MDD 的风险更高（3.01，95%CI：1.78-5.09）。按随访时间分层，术后 4 年，手术组 MDD 的风险高于限制型组（2.92，95%CI：1.75-4.88）。
减重手术与 MDD 风险升高显著相关。
减重手术可显著改善术后初期的抑郁情绪，但改善效果无法维持。减重手术与重度抑郁症之间的关系知之甚少。这是第一项全国性队列研究，结果表明减重手术与 MDD 风险升高显著相关（aHR：1.70；95%CI：1.27-2.27），主要与吸收不良型手术（aHR：3.01；95%CI：1.78-5.09）和术后 4 年以上（aHR：2.92；95%CI：1.75-4.88）相关。这些发现提示长期吸收不良与术后 MDD 发生率之间存在关联。长期吸收不良可能与减重手术后重度抑郁症的发生有关。减重手术后营养不良与重度抑郁症之间的因果关系值得进一步研究。
