Frequency of mental disorders among obese patients seeking bariatric surgery through the Structured Clinical Interview for DSM Disorders (SCID-I/P)

Author(s)

Leorides Severo Duarte Guerra

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2014-09-01

Examining board members

Wang Yuan Pang; Arthur Kaufman; Maria Ines Soares Quintana; Beatriz Helena Carvalho Tess

• Advisor: Wang Yuan Pang

Abstract

Background: According to the World Health Organization\'s projections for the 21st. century, non-communicable diseases (NCD) will account for the largest burden of diseases in the world. Cardiovascular diseases and neuropsychiatric disorders stand out as the two main groups of health problems among the NCD. Overweight and obesity are considered precursors and aggravating factors of cardiovascular disease, whose prevalence has grown around the world, claiming for public efforts to stop its growth and minimize its harmful effects. Mental disorders, in turn, account for nearly one-third of the burden of disability resulting from all NCD. The aim of the present investigation is to estimate the frequency of mental disorders in a sample of obese individuals who sought a university hospital in order to undergo bariatric surgery to control or reduce the excess of body weight. Objective: To estimate, through a standardized interview, the frequency of mental disorders and correlated factors among obese patients seeking bariatric surgery. Methods: The sample was composed of 393 treatment-seeking obese patients (79.1% women; mean age 43.0 years, mean BMI: 47.8 kg/m2), who were recruited from a university-based bariatric center. Trained clinicians assessed the participants through the Structured Clinical Interview for DSM-IV Axis I Diagnosis (SCID-I/P). HCL (Manic Symptoms Cheklist), MDQ (Mood Disorders Questionnarie), MADRS (Montgomery-Åsberg Depression Rating Scale), M-A QoLII (Moorehead-Ardelt Quality of Life Questionnaire II). Results: The lifetime rate of any mental disorders was 80.9% (81.7% men vs. 80.7% women). Lifetime affective disorders were the most frequent diagnosis (total 64.9%, bipolar disorders 35.6%, and depressive disorders 29.3%). Among those respondents presenting any lifetime mental disorders, about half of the sample presented 3 or more concurrent disorders. The rate of current frequency of any mental disorders was 57.8% (57.6% men vs. 58.5% women). Anxiety disorders were the most frequent diagnosis (46.3%) among those participants with a current disorder. Age and educational level were associated with the likelihood of presenting current mental disorders. The scales showed good internal consistency: the HCL - 32, Cronbach\'s alpha 0.9; MDQ 0.8, MADRS 0.9 and M-A QoL II 0.7. The HCL -32 and MDQ demonstrated good capacity discriminant to correctly classify cases of bipolar disorder. HCL -32 the area under the curve (AUC) was 0.7 (95 % CI 0.7-0.80, when compared to the diagnosis of SCID-I/P, with a sensitivity of 0.7 and specificity 0.7 . The best cutoff point was 16/17 to detect bipolar disorder II. In the factorial structure of the HCL -32, data variability was best explained by two important factors: elation of mood and irritation / activation. MDQ sensitivity was 0.80 and specificity 0.60. The best cutoff value of 4/ 5 for detecting bipolar disorder I, with AUC of 0.8 (95 % CI 0.7 to 0.9).The MADRS of 5 items had a sensitivity of 0.8 and specificity 0.9. The best cutoff point was 10/11 to detect depressive symptoms and AUC of 0.9. According to the MA QoL II, about 50% of the sample reported being satisfied with their quality of life. There is a significant correlation among the scales used, ranging from 0.6 to -0.6. Conclusions: Mental disorders are frequent conditions among obese patients before bariatric surgery. High rates of mental disorders suggest that both disorders might exert mutual causal relationships or share common etiological factors. This study may help to understand the relationship between mental disorders and obesity. Systematic evaluation of obese patients with standardized psychometric instruments in the pre-surgery period may clarify the existence of psychiatric disorders before the bariatric surgery. Often, some psychiatric disorders are detected only after the surgery, interfering with the recovery and stabilization of quality of life of patients in the post-operative period. Future follow-up studies are needed to verify the possible predictors of prognosis in this population (AU)

• FAPESP's process: 12/17498-9 - Bipolar spetrun disorders in severely obese patients candidates for bariatric surgery
• Grantee: Leorides Severo Duarte Guerra
• Support Opportunities: Scholarships in Brazil - Master