Depression and anxiety before and after bariatric surgery: a longitudinal cohort study at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

BACKGROUND

Bariatric surgery is an effective long-term treatment for severe obesity. Psychological outcomes after surgery are clinically important.

METHODS

This prospective, non-interventional, longitudinal cohort enrolled adults scheduled for bariatric surgery at King Abdulaziz University Hospital (Jeddah, Saudi Arabia). The participants completed two online questionnaires: one pre-and one post-surgery (planned at approximately 6 months). Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Positive screening was defined as PHQ-9 ≥10 and GAD-7 ≥10. Weight was self-reported using the questionnaires. Post-surgical complications were self-reported in the post-surgery questionnaire as 'yes/no' items. Pre- and post-surgery scores were compared using the paired t-test. Sensitivity analysis was assessed using the Wilcoxon signed-rank test. Proportions that screened positive were compared using the Z-test. Univariate linear regression was used to assess the association between symptom changes and demographic, clinical, and surgical factors. Analyses were conducted using Stata/AC v18.

RESULTS

Twenty-seven participants completed the pre-surgery questionnaire, and 23 completed the post-surgery questionnaire. The matched analyses included 23 participants. The mean (SD) age was 33.6 (10.4) years, and 11 (47.8%) were female. Although follow-up was planned at approximately 6 months, the completion time varied (mean 359.5 [273.5] days; median 224; range 84-906). The mean (SD) GAD-7 decreased from 6.0 (5.9) to 5.2 (5.5) (p=0.565), while the mean (SD) PHQ-9 decreased from 7.5 (7.3) to 5.9 (6.4) (p=0.430). The proportion screening positive decreased from 26.1% to 17.4% for GAD-7 (p=0.475), and from 26.1% to 13.0% for PHQ-9 (p=0.265). In the univariate models, post-surgical complications were associated with worse anxiety and depression trajectories, while prior anxiety diagnosis was associated with greater improvement in anxiety symptoms.

CONCLUSION

In this cohort, the average depression and anxiety scores declined after bariatric surgery, although the overall changes were not statistically significant. Self-reported post-surgical complications were consistently associated with worse psychological outcomes. Our findings support the need for integrated psychiatric follow-ups during the bariatric surgical evaluations, before surgery and after surgery, particularly in patients with reported complications.