Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, United States.
Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States.
Obes Res Clin Pract. 2020 Sep-Oct;14(5):456-461. doi: 10.1016/j.orcp.2020.08.007. Epub 2020 Sep 12.
While depression generally improves after bariatric surgery, less is known regarding heterogeneity in long-term symptom change. Given that depressive symptoms have been associated with weight change following bariatric surgery, identifying and characterizing subgroups with more severe depressive symptoms may have prognostic utility for understanding post-surgical weight loss. This study sought to characterize patterns of change in depressive symptoms and evaluate associations with weight loss in the seven years following bariatric surgery.
Participants were 2308 patients who underwent bariatric surgery as part of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Depressive symptoms (measured by the Beck Depression Inventory) and weight were assessed annually following surgery.
A group-based trajectory model identified six subgroups that evidenced distinct patterns of change in depressive symptoms, with the majority (87.0%) exhibiting stable low to average levels. Generalized linear mixed models indicated trajectory groups differed in percent total weight loss (%TWL), with trajectories characterized by initial decreases in depressive symptoms over the first two years (5.2% of participants) experiencing the highest %TWL (20.7% vs. 14.9-18.4% in the other trajectories at 7 years).
Findings demonstrate meaningful heterogeneity in the pattern of changes in depressive symptoms after surgery. While most patients experience relatively low stable levels of depressive symptoms, those who have initial symptom improvement demonstrate the greatest magnitude of weight loss. Further research is necessary to explore the directionality of this association and the time-varying mechanisms by which depression and weight may mutually influence each other.
虽然减重手术后抑郁症状通常会改善，但对长期症状变化的异质性知之甚少。鉴于抑郁症状与减重手术后的体重变化有关，识别和描述具有更严重抑郁症状的亚组可能对理解手术后体重减轻具有预后意义。本研究旨在描述减重手术后 7 年内抑郁症状变化的模式，并评估其与体重减轻的相关性。
共有 2308 名患者作为 LABS-2 研究的一部分接受了减重手术。术后每年评估抑郁症状（贝克抑郁量表）和体重。
基于群组的轨迹模型确定了六个具有不同抑郁症状变化模式的亚组，其中大多数（87.0%）表现出稳定的低至中等水平。广义线性混合模型表明，轨迹组在总体重减轻百分比（%TWL）方面存在差异，具有前两年抑郁症状下降轨迹的患者（5.2%的参与者）经历了最高的%TWL（20.7%，而其他轨迹组在 7 年时为 14.9%-18.4%）。
研究结果表明，手术后抑郁症状变化模式存在显著的异质性。虽然大多数患者经历了相对较低且稳定的抑郁症状水平，但那些最初症状改善的患者体重减轻幅度最大。需要进一步研究探索这种关联的方向性以及抑郁和体重可能相互影响的时变机制。
