Bariatric Surgery is Linked to Lowering Anxiety, Depression Symptoms

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Bariatric surgery is linked to a significant reduction in anxiety and depression, according to a new study.¹

In a cohort of participants who previously partook in the By-Band-Sleeve study, a randomized trial to evaluate the surgical management of severe obesity, there was a high prevalence of anxiety and depression pre-randomization but reduced anxiety and depressive symptoms post-randomization.

Previous studies have demonstrated surgeries have a short-term impact on mental health, including anxiety and depression. For instance, a 2022 study found bariatric surgery improved mental health by 9.5%.² Research also suggests people who undergo bariatric surgery have higher rates of preoperative depression. A 2016 meta-analysis found 23% of patients had a mood disorder at the time of the surgery with 19% having depression.¹

A prospective, observational cohort study conducted on behalf of The By-Band-Sleeve Collaborating Group, the current study was led by investigators with the intent of evaluating the prevalence and short-term course of anxiety and depression following bariatric surgery.

“To our knowledge, it is the largest prospective study to assess the short-term effects of bariatric surgery on both anxiety and depressive symptoms in the UK,” the team wrote. “Participants were screened with a validated case-finding scale, which is reliable in detecting both disorders.”

All participants, recruited between January 2013 to September 2019 from 12 National Health Service surgical centers in England, had either undergone gastric bypass, gastric band, or sleeve gastrectomy surgery within 6 months of randomization. At baseline, the mean age was 47.8 years old, the BMI was 46.3 and 75.2% of the participants were female.

The team assessed anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) at baseline at 12 months post-randomization in 758 participants. They also collected sociodemographic variables pre-randomization, such as BMI, age, sex, ethnicity, marital status, tobacco use, employment status, and income band.

Of the participants who completed the baseline anxiety and depression subscales, 46.1% (95% CI, 42.4% to 49.7%) of the participants met the criteria for anxiety and 48.2% met the criteria for depression at baseline (95% CI, 44.5 to 51.8) After surgery, the investigators observed a significant reduction in clinical cases of anxiety (-9.5%, 95% CI, -14.3% to -4.8% P <.001) and depression (-22.3%, 95% CI -27.0% to -17.6% P <.001).

The median HADS score had reduced from 7 at baseline to 5. Before randomization, the HADS score for depression and anxiety had both been 7, but after randomization, the HADS score for anxiety reduced to 5 and for depression it reduced to 3.

One limitation of the study was the significant non-return rate of 30% for the questionnaires at post-randomization. Due to the incompletion of the questionnaires, it is possible some people who did not fill it out post-randomization could have developed anxiety or depressive disorders.

Additionally, participants did not have a formal structured interview to diagnosis anxiety or depression—they just had the questionnaires. The team did not assess the change in BMI and include a control group who did not undergone surgery which could have impacted results. Nevertheless, despite the limitations, the study demonstrated bariatric surgery improves anxiety and depression symptoms.

“Future work must be undertaken to understand the mechanisms underpinning these associations and whether these improvements were sustained in the long term,” investigators concluded.

References

1. By-Band-Sleeve Collaborating Group. Prevalence and short-term change in symptoms of anxiety and depression following bariatric surgery: a prospective cohort study. BMJ Open. 2024;14(1):e071231. Published 2024 Jan 3. doi:10.1136/bmjopen-2022-071231
2. Goldenshluger A, Maor T, Via-Kagan R, Zelekha O, Gepner Y. Short-Term Changes in Mental, Physical, and Social Factors After Metabolic Bariatric Surgery in Adolescents: A Nationwide Prospective Cohort Study. Front Nutr. 2022;9:878202. Published 2022 May 12. doi:10.3389/fnut.2022.878202