Depression, anxiety, and suicidal ideation in young adults 5 years after undergoing bariatric surgery as adolescents

Abstract

Purpose: Metabolic and bariatric surgery (MBS) is increasingly used in adolescents. The aim was to explore symptoms of depression and anxiety in young adults over 5 years' follow-up after undergoing MBS.

Methods: Beck Depression Inventory-2 and the Beck Anxiety Inventory were used to assess symptoms of depression and anxiety in 62 patients 1, 2, and 5 years after having Roux-en-Y gastric bypass at 13-18 years of age. Mental health, eating-related problems, and weight outcomes were tested for association with suicidal ideation at the 5-year follow-up.

Results: At the 5-year follow-up, the mean score for depression was 11.4 (± 12.4), indicating minimal symptoms of depression. The mean score for anxiety was 12.82 (± 11.50), indicating mild anxiety symptoms. Still, several participants reported moderate or severe symptoms of depression (26%) and anxiety (32%). Women reported more symptoms than men (P = 0.03 and 0.04). No significant changes were found in self-reported symptoms of depression and anxiety between the 1-year and the 5-year follow-up (P = 0.367 and 0.934). Suicidal ideation was reported by 16% at the 5-year follow-up. Participants reporting suicidal ideation had lost significantly less excess weight than participants without suicidal ideation (P = 0.009).

Conclusion: Five years after adolescent MBS, a substantial minority still struggles with mental health issues, and women are more burdened than men. Our results indicate an association between less optimal weight loss and suicidal ideation 5 years after MBS. The findings emphasize the importance of offering long-term follow-up and mental health treatment several years after MBS.

Level of evidence: Level III, cohort study.

Clinical trial registration: The study is registered with ClinicalTrials.gov (NCT00289705). First posted February 10, 2006.

Keywords: Adolescent; Anxiety; Bariatric surgery; Depression; Obesity; Suicidal ideation.

Conflict of interest statement

KJ has received speaker honorariums unrelated to the submitted article from Merck and Novo Nordisk. KJ has been on an advisory board unrelated to the submitted article for Novo Nordisk (reimbursement directed to her institution). TO has received reimbursement unrelated to the submitted article from Johnson & Johnson, NovoNordisk, Merck, and Mölnlycke (reimbursement directed to his institution). CM has received personal fees unrelated to the submitted article from Sigrid AB, Itrim AB, and Weight Watchers Int. CM reports shareholding in Health Support Sweden AB. All remaining authors have nothing to disclose.

Figures

Fig. 1

Individual change or stability in symptoms of depression and anxiety between 2 and 5 years after gastric bypass. BDI-2 Beck Depression Inventory 2, BAI Beck Anxiety Inventory. a Always non-symptomatic: BDI-2 < 20 (i.e., minimal or mild) at both follow-ups (n = 30); always symptomatic: BDI-2 ≥ 20 (i.e., moderate to severe) at both follow-ups (n = 6); deteriorating: BDI-2 < 20 at 2-year follow-up and ≥ 20 at 5-year follow-up (n = 3); improving: BDI-2 ≥ 20 at 2-year follow-up and < 20 at 5-year follow-up (n = 4). b Always non-symptomatic: BAI < 16 (i.e., minimal or mild) at both follow-ups (n = 25); always symptomatic: BAI ≥ 16 (i.e., moderate to severe) at both follow-ups (n = 6); deteriorating: BAI < 16 at 2-year follow-up and ≥ 16 at 5-year follow-up (n = 7); improving: BAI ≥ 16 at 2-year follow-up and < 16 at 5-year follow-up (n = 5)