Psychological and emotional outcomes after bariatric surgery: a cross-sectional comparison of sleeve gastrectomy and gastric bypass patients .

OBJECTIVE

This study aimed to assess depressive and anxiety symptoms after bariatric surgery and to identify clinical, socioeconomic and psychosocial factors associated with postoperative psychological outcomes.

METHODS

This cross-sectional study included 300 adults who had undergone bariatric surgery at least 12 months previously (172 sleeve gastrectomy and 128 gastric bypass). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7). Psychosocial factors were assessed using the Rosenberg Self-Esteem Scale (RSES), Body Shape Questionnaire (BSQ), Emotional Eating Scale (EES) and Multidimensional Scale of Perceived Social Support (MSPSS). Socioeconomic status, psychotropic medication use and percentage of total weight loss (%TWL) were recorded. Group comparisons, correlation analyses and multivariable linear regression were performed.

RESULTS

Patients who underwent gastric bypass reported significantly higher depressive and anxiety symptoms compared with sleeve gastrectomy patients (PHQ-9: 9.7±4.2 vs 7.3±3.7; GAD-7: 8.5±4.0 vs 6.5±3.9; both p<0.01). Greater %TWL was inversely associated with depressive (r = -0.29, p<0.001) and anxiety symptoms (r = -0.24, p<0.001). Participants with struggling socioeconomic status had higher PHQ-9 scores than those with comfortable status (10.4±4.5 vs 7.1±3.4; Cohen's d=0.73), and psychotropic medication users reported greater symptom severity than non-users (PHQ-9: 10.8±4.3 vs 7.3±3.6; p<0.001). Depressive and anxiety symptoms were moderately correlated with lower self-esteem (RSES), greater body image dissatisfaction (BSQ), higher emotional eating (EES) and lower perceived social support (MSPSS) (all |r|=0.30-0.55). In multivariable regression, surgery type, %TWL, socioeconomic status and psychotropic medication use independently predicted depressive symptoms, with the model explaining approximately 33% of the variance.

CONCLUSIONS

Bariatric surgery affects physical and mental health. Gastric bypass patients report more depression and anxiety, sleeve gastrectomy boosts self-esteem, and weight loss improves well-being, though social and medication factors raise psychological risk.