Mental health in adolescents undergoing bariatric surgery : Psychological outcomes four months and two years after gastric bypass

Sammanfattning: Bariatric surgery is tried out as a new treatment option for adolescents with severe obesity. Little is known about outcomes in mental health in adolescents who undergo weight loss surgery.The 3 studies in this thesis assess mental health in adolescents before, and after 4 months, 1 year and 2 years after undergoing gastric bypass. The studies are part of the Swedish national AMOS study and all adolescents in the studies are from the AMOS cohort. AMOS included adolescents 13–18 years with a BMI ≥ 40 or ≥ 35 with comorbidity who had been under regular childhood obesity treatment for at least one year before undergoing surgery. Exclusion criteria were few but included psychotic disease and alcohol/drug dependence. Two out of 3 adolescents in AMOS are girls; mean age at surgery was 16.8 years and mean BMI 45.6.In study I, mental health was evaluated in 37 adolescents from baseline to 4 months after surgery. Compared to age and gender-matched population norms, the adolescents presenting for bariatric surgery reported impaired mental health. Four months after surgery significant improvements were seen for anxiety, depressive symptoms and self-concept. No significant change was seen for anger or disruptive behavior. The adolescents reported on average a mental health comparable to norms 4 months after surgery. However, not all adolescents had a positive mental health outcome and 16 % reported clinically significant impaired mental health on two or more variables. No baseline differences could be seen between the impaired adolescents and the improved or unchanged adolescents. In study II mental health was assessed in 88 adolescents at baseline and 1 and 2 years after surgery. Two years after surgery significant reduction was seen in symptoms of anxiety, depression, anger, and disruptive behavior. Also obesity-related problems were reduced. Improvements were seen for self-concept, self-esteem and mood. Improvements took place mainly during the first year after surgery and the second year was characterized by stabilization. Two years after surgery, the adolescents reported on average symptoms of anxiety, depression, anger, and disruptive behavior comparable to norms. Also self-concept was at a normative level. However, the adolescents reported mood lower than age-matched peers and mood was also low when it was compared to middle-aged adults undergoing surgery. A marked group, 19 %, reported depressive symptoms in the clinical range and 13 % reported severe depressive symptoms.In study III adolescents (20 %) who reported poor mental health (PMH) 2 years after surgery were compared to adolescents who reported average/good mental health 2 years after surgery. Anxiety, depression and mental health at baseline could significantly predict PMH 2 years after surgery. However, several aspects of mental health were assessed at baseline and no other variable could predict mental health after surgery. Significant differences were seen between the groups at the follow-up 1 year after surgery; however few mental health variables had a significantly different trend between the groups over the first year. Suicidal ideation was reported by 14 % of the adolescents 2 years after surgery. Weight outcome was comparable between the two groups at all assessment points and physical health was equally improved in both groups 2 year after surgery. The studies in the present thesis show a general improvement in several aspects of mental health in adolescents, such as reduced symptoms of anxiety and depression, reduced externalizing symptoms, improved self-concept and reduced problems related to weight and body shape over 2 years after gastric bypass. However, not all adolescents have a positive psychosocial outcome and 4 months after surgery 16 % report impaired mental health. Depressive symptoms in the clinical range are reported by 1 out of 5, 2 years after surgery and 14 % report suicidal ideation. These figures are much higher than expected from the adult surgery literature. The studies in the present thesis indicate that adolescent bariatric surgery candidates are a vulnerable group and that repeated monitoring and psychological interventions are important before and after bariatric surgery.