Considerations for the use of the Beck Depression Inventory in the Assessment of Weight-Loss Surgery Seeking Patients

Background The Beck Depression Inventory (BDI) is an assessment frequently used in pre-surgical evaluation for patients seeking bariatric surgery. Items on the BDI reflect both cognitive and somatic symptoms associated with depression. However, many patients seeking bariatric surgery have medical symptomatology and health concerns independent of the syndrome of depression, and thus scores on the BDI may inflate their actual level of depression.With depression viewed by some clinicians as contraindicated for bariatric surgery, clarification of the BDI items is necessary. Methods Pre-surgical BDIs of 259 bariatric patients were reviewed. An exploratory factor analysis was conducted to examine the factor structure of the BDI in this population. Independent sample t-tests compared the means of the cognitive and somatic items. Results A clear two-factor solution emerged on the BDI, indicating items mapped on to either a cognitive or a somatic domain. The patients in the present sample also were more likely to endorse somatic and health-related symptoms on the BDI. Conclusions The factor structure of the BDI in this population is similar to that in other non weight-loss surgery populations. However, this population is more likely to endorse somatic complaints that may not be indicative of depression, rather an acknowledgement of actual medical complaints. Thus, assessors should be mindful of specific symptom endorsement, rather than a total depression score when utilizing the BDI to help determine surgery suitability.     

Validity and Clinical Utility of Subtyping by the Beck Depression Inventory in Women Seeking Gastric Bypass Surgery

Background

The Beck Depression Inventory (BDI) is commonly used in the screening and evaluation process with bariatric surgery candidates despite relatively limited psychometric evidence in this patient group. We examined the validity of the BDI and its clinical utility for subtyping women seeking gastric bypass surgery.

Methods

One hundred twenty-four women evaluated for gastric bypass surgery were administered the Structured Clinical Interview for DSM-IV (SCID-I/P) and completed a self-report battery of psychosocial measures including the BDI.

Results

Based on the SCID-I/P, 12.9 % (n?=?16) met criteria for current mood disorder. Receiver operating characteristic (ROC) curve analysis revealed the BDI had a good area under the curve (0.788) for predicting SCID-I/P mood disorder diagnosis; BDI score of >15 optimized both sensitivity and specificity. Patients diagnosed with SCID-I/P mood disorders had significantly higher levels of eating disorder psychopathology, self-esteem, and shame, than those without mood disorders. Based on a BDI cut-off score of >15, 41.9 % (n?=?52) were categorized as high-BDI and 58.1 % (n?=?72) as low-BDI. Patients characterized as high-BDI also had significantly higher levels of all associated measures than those with low-BDI; effect sizes for the differences by BDI subtyping were generally 2–3 times greater than those observed when comparing SCID-I/P-based mood versus no mood disorder subgroups.

Conclusions

In women seeking gastric bypass surgery, the BDI demonstrated limited acceptability efficiency for identifying mood disorders with a cut-point score of >15. When identifying clinical severity, however, subtyping women by BDI scores of >15 may identify a significantly more disturbed subgroup than relying on a SCID-I/P-generated mood disorder diagnosis.

     

The Utility of the Beck Depression Inventory in a Bariatric Surgery Population

Background  

The Beck Depression Inventory (BDI) is commonly used in bariatric surgery psychological assessments. However, several items may be measuring physical consequences of obesity (e.g., sleep disturbance, chronic pain, or sexual dysfunction) rather than depressive symptoms.     

Depression Before and After Bariatric Surgery in Low-Income Patients: the Utility of the Beck Depression Inventory

Background

The prevalence of psychological disorders in bariatric surgery candidates is well established, where anxiety and depression are commonly observed. Depression prevalence and evolution after gastric bypass, and its impact on weight loss, have been less explored, especially among low-income patients.

Methods

A retrospective study with low-income patients undergoing bariatric surgery from 2015 to 2016. A comparative analysis of preoperative depression (the Beck Depression Inventory II) was performed and compared at 6 and 12 months. A demographic and weight loss analysis was also performed.

Results

Seventy-three patients were included. Female sex comprised 76.7% of cases, and baseline depression was present in 45.2%, being severe in 2.7%. The analysis at 6 months showed Beck’s score improvement (12.3 baseline vs. 4.2 points at 6 months, p?=?0.006), as well as for individual items (excepting irritability). At 12 months, the mean score was 5 points, without difference vs. 6 months. At 6 and 12 months, depression (any degree) was present in 9.6 and 8.6%, corresponding to percentage change rates of ??65.8 and ??59.3%. Only one patient (2.7%) presented severe depression. Depression status before surgery had no influence in weight loss amount at 12 months.

Conclusion

Almost half of bariatric surgery candidates have some degree of depression that improves dramatically soon after bariatric surgery. Such change continues stable during the first year. Improvement was independent of gender, and depression has no influence on weight loss. In low-income bariatric patients, depression is lower than reports from developed countries, but similar improvement has been observed.

     

Health-Related Quality of Life and Symptoms of Depression in Extremely Obese Persons Seeking Bariatric Surgery

Background: Extreme obesity, defined by a body mass index (BMI) ≥40 kg/m², is associated with increased risk of depression and with impairments in healthrelated quality of life (HRQoL). This study examined the relationships among BMI, HRQoL, and symptoms of depression in persons with extreme obesity. Method: Participants were 306 patients who sought bariatric surgery (mean ± SD age 43.8±9.4 years, BMI 52.8±9.3 kg/m²) and who completed questionnaires to assess symptoms of depression and HRQoL prior to surgery. We defined HRQoL impairment as a score ≥1 SD below national means. Results: Impairments in HRQoL were common: >40% of participants scored in the impaired ranges of physical functioning, physical role limitations, and bodily pain. Results of analyses of variance (ANOVAs) indicated that impairments in HRQoL were significantly related to symptoms of depression. Patients with impaired HRQoL scored above the cut-off point for clinically significant depression, while those without such impairment scored below that cut-off, regardless of BMI. The contribution of BMI to depression was not significant in any ANOVA. Conclusion: HRQoL is more strongly and more directly related to symptoms of depression than is BMI. These findings highlight the need to assess HRQoL in patients with extreme obesity and suggest that interdisciplinary strategies to address HRQoL impairments may be beneficial in this population.     

Validity of the Beck Depression Inventory as a Screening Tool for a Clinical Mood Disorder in Bariatric Surgery Candidates

Background

The Beck Depression Inventory (BDI) is one of the most commonly used instruments to assess depression in persons with obesity. While it has been validated in normal and psychiatric populations, in obese populations, its validity remains uncertain. This study aimed to investigate the validity and reliability of the BDI-IA and BDI-II in severely obese bariatric surgery candidates.

Methods

Consecutive new candidates at a bariatric surgery clinic were invited to participate in the study by their consulting surgeon. All candidates were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I); 118 completed the BDI-IA and 83 completed the BDI-II. Two hundred one patients (response rate, 88?%) participated in the study. The current sample (82?% female) had an average body mass index of 42.83?±?6.34 and an average age of 45?±?12?years.

Results

Based on the SCID-I, 54 candidates (26.9?%) met the criteria for a mood disorder, with 37 meeting the criteria for current major depressive disorder. Individuals diagnosed with a clinical mood disorder had significantly higher scores on the BDI (BDI-IA, 23.59?±?9.69 vs. 12.76?±?8.29; BDI-II, 22.93?±?5.22 vs. 11.25?±?8.44). Our results indicated that, as a screening tool for a clinical mood disorder, the BDI-II had an optimal cutoff of 13, with a sensitivity of 100 and specificity of 67.75.

Conclusions

Results indicated that the BDI-IA should not be used as a tool to measure depressive symptomatology in obese bariatric surgery candidates. No cutoff was identified with adequate sensitivity and specificity, and over 20?% of patients were misclassified. As a screening tool for a clinical mood disorder, the BDI-II was adequate; however, prevalence rates were significantly overestimated.     

The clinical utility of the Beck Depression Inventory after traumatic brain injury.

PRIMARY OBJECTIVE: To examine the psychometric properties of the Beck Depression Inventory (BDI) in traumatic brain injury (TBI) and to determine the relative endorsement of somatic-performance and cognitive-affective items in this group. Research design: Prospective 2 year follow up assessment. METHODS: 117 patients discharged from an inpatient TBI rehabilitation service completed the BDI as part of a 24 month follow up assessment. Demographic and injury related data were obtained from patient files and significant others. Main outcomes: A principal components analysis revealed three factors describing affective and performance items, negative attitudes towards oneself and somatic disturbance. The reliability estimate was high (coefficient alpha = 0.92). A dependent sample t-test revealed higher endorsement of the cognitive-affective subscale with more clients classified as at least moderately depressed using the cognitive-affective rather than the total BDI score. CONCLUSION: This study provides preliminary evidence suggesting that the BDI may be an effective screening tool for self reported depression in TBI.     

Functioning of Obese Individuals in Pre- and Postoperative Periods of Bariatric Surgery

Background

Obesity is a pathologic condition that causes functional incapacity, with reduction of quality of life and life expectancy and an increase in mortality. Bariatric surgery is indicated to alleviate associated comorbidities and increase physical capacity. The objective of this work was to evaluate the functional capacity of patients with morbid obesity before and after (3 months) bariatric surgery.

Methods

This was a cross-sectional study involving 67 patients, where 61 were women and six men, with a mean age of 38?±?10 years and mean BMI of 50.45?±?8.5 kg/m². All patients were assessed before surgery and 3 months afterwards. The following assessments were performed: 6-min walk test (6MWT), functional independence measure (FIM), and test for risk of falling and transfer capacity, called the timed up-and-go test.

Results

The study demonstrated a reduction in parameters evaluated in 6MWT with a statistically significant difference at two times (rest and final) when evaluated before and after bariatric surgery (p?<?0.001). In relation to the FIM and timed up-and-go test, the patients showed a statistically significant improvement (p?<?0.001) for both when comparing the tasks evaluated at the pre- and postoperative moments.

Conclusions

Obesity has an impact on the functioning and quality of life of patients. We observed an improvement in all instruments used for assessment before and after bariatric surgery, where a linear component was demonstrated in relation to diminution of body mass index and functioning.     

Selenium Is Significantly Depleted Among Morbidly Obese Female Patients Seeking Bariatric Surgery

Background  

The aim of this study was to compare serum levels of trace elements in morbidly obese female patients seeking bariatric surgery with those of age-matched females with body mass index (BMI) less than or equal to 30.     

The Impact of Weight Loss on Depression Status in Obese Individuals Subjected to Intragastric Balloon Treatment

Background

Although depression is considered to be significantly related to morbid obesity disorder, no information exists on the evolution of depression status after weight loss, in particular when an intragastric balloon is used. This prospective 6-month study examines both the effect on depression status and the relation of weight loss to depression in morbidly obese patients treated by intragastric balloon.

Methods

One hundred consecutive females fulfilling criteria for balloon treatment were assessed for depression and divided into two groups (65 depressed, 35 non-depressed). Obesity-related parameters were comparable.

Results

During the treatment period, the depression status of the mildly, moderately, and severely depressed patients improved from 40, 32.3, and 27.7 % to 20, 7.7, and 1.5 %, respectively, with 70.8 % finally exhibiting no depression at all. During the same period, body weight, BMI, body fat, and excess weight loss (EWL) were comparable between all groups, the range of BMI affecting neither the depression score nor the reduction of obesity parameters. However, there was a significant [percentage of EWL >30] weight loss difference in favor of those who were less severely depressed initially.

Conclusion

The degree of weight loss observed in obese depressed females—being comparable to that achieved by non-depressed females—after intragastric balloon insertion was found to positively affect their depression status.     

护士心理契约结构维度的探索性与验证性因素分析

目的 验证护士心理契约量表的结构维度,探讨其作为护理人力资源管理测评工作的有效性.方法 采用自编的护士心理契约量表对我国华中、华东、华南等地区14所不同等级和性质医院的402名在编护士进行横断面调查,并进行探索性因素分析、验证性因素分析及信度、效度分析.结果 护士心理契约医院责任和护士责任2个分量表分别由现实责任、发展责任和团队责任3个因子构成,其累积方差贡献率分别达59.612%和63.486%;三因素模型拟舍X2/dr分别为2.48和3.05,RMSEA分别为0.07和0.09;总体及各维度Cronbach's α为0.808～0.943;各维度与总量表的相关系数为0.772～0.931.结论 护士心理契约问卷具有良好的心理测量学特征,且三维结构是最理想的结构模型,可以作为护理人力资源管理的有效测评工具.     

Importance of Musculoskeletal Pain in Work Activities in Obese Individuals

Background

The consequences of obesity include musculoskeletal pain and its influence on a person's social, personal, and professional life, which is a great challenge for the multidisciplinary team in the treatment of obesity. The objective of this work was to evaluate musculoskeletal pain in the work activities of obese individuals.

Methods

An uncontrolled cross-sectional study was conducted. During 8 months, all obese individuals seen in the preoperative period at a tertiary care referral center for the treatment of obesity and metabolic syndrome were invited to participate in the study. Ninety-five persons filled out the Nordic questionnaire for the analysis of musculoskeletal symptoms (Nordic musculoskeletal questionnaire (NMQ)) after having signed an informed consent form and having met the inclusion criteria of the study.

Results

Of the 95 patients assessed, 71 were females, the mean age was 39.3?±?10.1 years, and mean body mass index was 47.25?±?8.72 kg/m². Sixty-three (66.31 %) individuals felt musculoskeletal pain in some region of the body in the last 12 months, and 42 (44.21 %) sometimes gave up working in the same period because of musculoskeletal pain. There was a statistical association between BMI and the three aspects evaluated by the NMQ.

Conclusions

Musculoskeletal pain was very related to obese individuals who participated in this study, and in the majority cases, execution of the work activities of these persons was impeded. This indicates a need for further studies that address this subject to better attend to and intervene in the health of this population.     

The Effect of Weight Loss on the Cardiac Structure and Function After Laparoscopic Adjustable Gastric Banding Surgery in Morbidly Obese Individuals

Background

Herein, we investigate the anthropometric, biochemical and left ventricle (LV) geometry changes following the laparoscopic adjustable gastric banding (LAGB) operation in morbidly obese individuals.

Methods

Eighty-three morbidly obese participants (mean age, 46.1?±?11.5 years; 30.1 % men), scheduled for elective LAGB were examined before and 12 months after the surgery. LV geometry and diastolic function were investigated by 2-dimensional echocardiography, whereas laboratory tests assessed the glycaemic, serum lipid and inflammatory marker profiles.

Results

Twelve months after the operation, body mass index (BMI) decreased from 46.9?±?7.2 kg/m² to 40.1?±?8.2 kg/m² (p?p?p?2.7 vs. 52.0?±?12.3 g/m^2.7, p?p?=?0.0001) and BMI (ß?=?0.26, p?=?0.015) were both associated with diminished LV mass. Additionally, a statistically significant correlation between LV mass and changes in BMI (R?=?0.29, p?=?0.007), waist circumference (R?=?0.32, p?=?0.004), LV end-diastolic diameter (R?=?0.63, p?=?0.0001) and E-wave deceleration time (R?=??0.24, p?=?0.03) were observed within our study population.

Conclusions

LV mass decreases 12 months after LAGB surgery, but no improvements in LV geometry and function occur. The regression of LV mass is better predicted by weight loss than by reduction in blood pressure or changes in metabolic parameters.     

Laparoscopic Colorectal Surgery in Obese Patients

Background: The aim of the study was to the evaluate results of laparoscopic colorectal surgery in obese patients. Methods: All patients who underwent elective laparoscopic colorectal surgery from January 1993 to December 2003 were included in the study. BMI >30 was used as an objective obesity criterion. The evaluated parameters included BMI, age, sex, diagnosis and associated diseases, American Society of Anesthesiologists classification score (ASA), type and duration of procedure, peroperative and postoperative complications, postoperative course, reoperation, length of hospitalization, morbidity and early mortality. Results: 435 patients were evaluated. There were 80 patients (18%) in the obese group, and 355 patients (82%) were non-obese. The samples were comparable in terms of age, gender, ASA, diagnosis and procedure. Peroperative complications occurred more frequently in the obese group of patients (4% vs 2.5%, P>0.05) and the operating time was longer as well (151 min vs 141 min, P>0.05), both statistically not significant. There was no difference in postoperative course in both groups with regard to intravenous administration of analgesics (2 days), start of solid diet (day 3) and first bowel movement (day 4). Morbidity was higher in the obese group of patients (33% vs 24%, P>0.05), and reoperations were also more frequent here (13% vs 7%, P>0.05), which was reflected in prolonged hospital stay (14 days vs 12 days, P>0.05). On the other hand, early mortality was surprisingly lower in the obese group of patients (2.5% vs 6%, P>0.05). However, none of these differences achieved statistical significance on the set significance level of P=0.05. Conclusion: With sufficient experience, laparoscopic colorectal surgery in obese patients is feasible and safe. It is associated with no increased risk of complications and preserves all benefits of the mini-invasive approach.     

Prevalence of Loss-of-Function FTO Mutations in Lean and Obese Individuals

OBJECTIVE

Single nucleotide polymorphisms (SNPs) in intron 1 of fat mass– and obesity-associated gene (FTO) are strongly associated with human adiposity, whereas Fto^−/− mice are lean and Fto^+/− mice are resistant to diet-induced obesity. We aimed to determine whether FTO mutations are disproportionately represented in lean or obese humans and to use these mutations to understand structure-function relationships within FTO.

RESEARCH DESIGN AND METHODS

We sequenced all coding exons of FTO in 1,433 severely obese and 1,433 lean individuals. We studied the enzymatic activity of selected nonsynonymous variants.

RESULTS

We identified 33 heterozygous nonsynonymous variants in lean (2.3%) and 35 in obese (2.4%) individuals, with 8 mutations unique to the obese and 11 unique to the lean. Two novel mutations replace absolutely conserved residues: R322Q in the catalytic domain and R96H in the predicted substrate recognition lid. R322Q was unable to catalyze the conversion of 2-oxoglutarate to succinate in the presence or absence of 3-methylthymidine. R96H retained some basal activity, which was not enhanced by 3-methylthymidine. However, both were found in lean and obese individuals.

CONCLUSIONS

Heterozygous, loss-of-function mutations in FTO exist but are found in both lean and obese subjects. Although intron 1 SNPs are unequivocally associated with obesity in multiple populations and murine studies strongly suggest that FTO has a role in energy balance, it appears that loss of one functional copy of FTO in humans is compatible with being either lean or obese. Functional analyses of FTO mutations have given novel insights into structure-function relationships in this enzyme.Genome-wide association studies have revealed that single nucleotide polymorphisms (SNPs) within the first intron of fat mass– and obesity-associated gene (FTO) are strongly associated with adiposity (1–4). These associations have been largely consistent across multiple different ethnicities including Europeans (5–8), Asians (9–11), Hispanics (12,13), and Africans (13,14). At present, it remains unclear whether these SNPs influence the expression or splicing of the FTO gene and/or whether the unequivocal association with obesity is causally related to alterations in expression or function of FTO. If the effect of the intron 1 SNPs is through FTO, it also remains unclear whether the obesity risk SNPs result in a loss or a gain of FTO function. It remains possible that the SNPs influence the expression and/or function of neighboring genes and that such an effect might underlie the association with adiposity. There are several examples in metabolic disease where common variants close to a particular gene are associated with alterations in risk of common phenotypes such as fat mass or risk of obesity, whereas rare loss- or gain-of-function mutations in the same gene are associated with a more severe version of the same metabolic phenotype (e.g., MCR4 [5,15–19], POMC [20,21], BDNF [22–24], and PCSK1 [25,26]). When information is available from both types of variants, clarity of mechanistic understanding is greatly enhanced. To establish whether nonsynonymous variants of FTO might be enriched in either lean or obese subjects, we sequenced the FTO coding region and intron-exon boundaries in a large group of subjects with severe obesity and a similarly sized group of individuals with lifelong leanness. We have recently established that FTO encodes a 2-oxoglutarate (2-OG) Fe²⁺-dependent dioxygenase (27). In this study, we have examined the functional enzymatic properties of naturally occurring variants to gain further insights into structure-function relationships in the human enzyme.     

急性阑尾炎肥胖患者腹腔镜与开腹手术的对比研究

目的：探讨肥胖的急性阑尾炎患者行腹腔镜手术的效果及优缺点。方法回顾性分析2010年1月～2013年12月80例手术治疗肥胖的急性阑尾炎患者的临床资料,体重指数28～40。开腹组38例,腹腔镜组42例。比较2组手术时间、术中出血量、止痛药物及抗生素应用、术后发热、术后并发症、住院时间及费用的差异。结果腹腔镜组2例中转开腹。2组手术时间差异无显著性（P＞0．05）。与开腹组比较,腹腔镜组术中出血少[（14．98±12．77） ml vs．（31．58±19．00） ml, t＝-4．550, P＝0．000],术后抗生素使用时间短[（2．7±1．0） d vs．（4．1±1．2） d, t＝-5．470, P＝0．000],术后需要止痛少[5．0％（2／40） vs．26．3％（10／38）,χ2＝6．802,P＝0．009],留置引流少[2．5％（1／40） vs．18．4％（7／38）,χ2＝5．367, P＝0．021],术后发热少[5．0％（2／40） vs．23．7％（9／38）,χ2＝5．616, P＝0．018],术后切口愈合不良少[5．0％（2／40） vs．21．1％（8／38）,χ2＝4．493, P＝0．034],住院时间短[（5．9±3．2） d vs．（8．7±4．1） d, t＝-3．345, P＝0．001],但住院费用高[（7800±396）元vs．（4914±434）元, t＝30．716, P＝0．000]。结论对于肥胖的阑尾炎患者,腹腔镜阑尾切除术具有手术创伤小、术后恢复快、疼痛轻、并发症少、住院时间短等优点,住院费用可以接受,是首选治疗方法。     

Use of the Beck Depression Inventory for assessing depression in patients hospitalized with severe burn. Disentangling symptoms of depression from injury and treatment factors

The objective of this study was to assess whether scores on the Beck Depression Inventory (BDI) are biased by injury severity among hospitalized survivors of burn (N=262). A confirmatory factor analysis (CFA) model was developed with a general depression factor that loaded on all items and somatic and cognitive factors that were orthogonal to the general factor and to each other. The model fit the data well and substantially better than an alternative three-factor model with correlated factors. Percent total body surface area burned (TBSA) was significantly associated with the general depression factor (p=.04), but also with the orthogonal somatic factor (p<.001), suggesting biased measurement due to overlap between somatic symptoms of depression and the severity of the burn injury. Analysis of item communalities, however, suggested that only approximately 2% of total predicted item variance was associated with bias related to injury severity. It was concluded that, despite a small amount of bias, the BDI is a reasonably accurate clinical tool even in the context of severe burn. Appropriate adjustments for bias, however, should be made in research with the BDI among patients with acute burn.     

Inherent Abnormalities of Fat Cells from Massively Obese Individuals

In vitro investigations into adipose cell dynamics have revealed intrinsic characteristics of massively obese individuals' cells that could contribute to a relatively intractable expanded fat mass. Morbidly corpulent peoples' preadipocytes replicate to a greater degree than those from lean individuals. Coupled with exaggerated differentiation this enhanced growth would result in a greater number of fat cells which would increase adipose tissue mass. The relative resistance to de-differentiation that adipocytes from the massively obese demonstrate would contribute to stability of an increased number of adipocytes further exacerbating the problem. The increased message of an energy sensing protein, the obese gene product, suggests that the morbidly obese are insensitive to its action. Together these attributes provide a strong argument for a significant genetic role in the pathogenesis of obesity.