Department of Behavioral Health, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA.
Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA.
Mil Med. 2022 Aug 25;187(9-10):e1169-e1175. doi: 10.1093/milmed/usab078.
Research on effectiveness of preoperative psychological measures as predictors of weight loss success and weight regain following bariatric surgery has been inconsistent. Despite mixed findings, preoperative psychological assessment instruments are used routinely, including in military medical facilities. Health concerns associated with obesity potentially impact military family readiness, with accompanying utilization of medical resources. Examining psychological factors associated with successful bariatric surgery outcomes may help to optimize care.
This retrospective, observational study sought to identify characteristic elevations on two recommended preoperative psychological assessment instruments for bariatric surgery candidates: the Personality Assessment Inventory (PAI) and the Millon Behavioral Medicine Diagnostic (MBMD). Additionally, profile analysis was performed on assessment scales based on groupings of whether or not patients (N = 194) met their ideal BMI over a 60-month period. The Institutional Review Board at Madigan Army Medical Center approved this study protocol.
Means and standard deviations for PAI and the MBMD are presented for this sample of benefits-eligible patients in the military health system. Measures between bariatric outcome groups were not significantly different, but characteristic elevations for bariatric surgery candidates overall were identified.
The average elevations of scales were not above clinical cutoff, but still indicate characteristic trends in patients undergoing surgery at an MTF. These scales may be important to attend to with bariatric surgery candidates, especially scales which are related to psychopathology, treatment prognosis, and treatment management. Study results about scale elevations on preoperative psychological assessment instruments may help patients better manage bariatric surgery and can lead to enhanced warfighter readiness and decreased utilization of healthcare resources. Future work should examine postoperative behavioral and psychological factors, as the adjustment to lifestyle limitations of bariatric surgery is substantial.
术前心理措施对减重手术成功和减重后体重反弹的预测效果的研究结果一直不一致。尽管研究结果喜忧参半，但术前心理评估工具仍被常规使用，包括在军事医疗设施中。肥胖相关的健康问题可能会影响军人家庭的准备情况，并伴随医疗资源的利用。研究与成功减重手术结果相关的心理因素可能有助于优化护理。
本回顾性观察研究旨在确定两种推荐的减重手术候选者术前心理评估工具（人格评估量表和米伦行为医学诊断量表）上的特征性升高。此外，还根据患者（N=194）是否在 60 个月内达到理想 BMI 对评估量表进行了分组分析。麦迪根陆军医疗中心的机构审查委员会批准了这项研究方案。
本研究对符合军事医疗系统福利条件的患者样本进行了 PAI 和 MBMD 的均值和标准差分析。减重结果组之间的测量值没有显著差异，但确定了所有减重手术候选者的特征性升高。
各量表的平均升高值未超过临床临界值，但仍表明手术患者存在特征性趋势。这些量表对于接受减重手术的患者可能很重要，特别是与精神病理学、治疗预后和治疗管理相关的量表。关于术前心理评估工具的量表升高的研究结果可能有助于患者更好地管理减重手术，并能提高战士的准备情况，减少医疗资源的利用。未来的研究应检查术后行为和心理因素，因为减重手术对生活方式限制的调整是巨大的。
