Sleep disturbance and insomnia in individuals seeking bariatric surgery.

BACKGROUND: Sleep disturbance is well established in individuals with obesity, and the relationship between poor sleep and obesity is supported by population, longitudinal, experimental, and intervention studies. However, the prevalence and characteristics of poor sleep in individuals seeking bariatric surgery have thus far been poorly examined. OBJECTIVES: We sought to characterize self-reported sleep parameters in individuals seeking bariatric surgery and to compare these data with controls. SETTING: Two Academic Medical Centers, United States, and an online survey of healthy controls. METHOD: Individuals seeking bariatric surgery (n = 427) completed presurgical psychological evaluations at 2 comprehensive bariatric surgery programs. Data on medical co-morbidities and from self-report questionnaires on sleep quality, insomnia, anxiety, and depression were abstracted from charts. Data from controls (n = 180) were collected using an online survey tool and compared with bariatric cases. RESULTS: Across study sites, 40.4% of bariatric cases took at least 30 minutes to fall asleep, 46.7% had insufficient total sleep time (<6.5 hr), 65.1% reported general poor sleep quality, and 30.8% reported clinically significant insomnia symptoms. Approximately 20% of the variance in poor sleep quality and insomnia was explained by body mass index, obstructive sleep apnea, anxiety, and depression. Cases and controls were similar, although bariatric cases reported significantly poorer sleep efficiency. CONCLUSIONS: Our results suggest that similar to a control population, the majority of patients seeking bariatric surgery are experiencing sleep difficulties. Presurgical assessment and treatment of sleep problems may be beneficial to patients and may help improve weight loss treatment outcomes. Optimally, assessment would include 1 of the 2 self-report questionnaires used herein, and treatment would involve Cognitive Behavioral Therapy for Insomnia. Future research assessing sleep patterns with objective measurement tools and evaluating the impact of sleep on postsurgical outcomes is warranted.

Predictors of suicidality in bariatric surgery candidates.

Risk for suicidality (current or past suicidal ideation or attempt) increases after bariatric surgery; however, there is a paucity of research investigating suicidality predictors in this population. This study involved a retrospective chart review of individuals seeking psychological clearance for bariatric surgery. In total, 32 participants (15.8%) were classified as reporting suicidality. These participants endorsed greater depressive symptomatology and hopelessness, and hopelessness and mood disorder diagnosis each uniquely predicted whether or not a patient was classified as reporting suicidality. The findings within suggest that increased attention to the relationship among these variables may improve methods for identification of high-risk patients. Implications for clinical practiced are discussed.

The Weight-Related Abuse Questionnaire (WRAQ): Reliability, validity, and clinical utility.

Weight-related teasing (WRT)/stigmatization may be distinct from teasing and general abuse and may differentially impact adult outcomes. As WRT increases in severity so do depression and disordered eating. Currently, there are no validated measures designed to assess abuse specific to weight. Thus, we developed the Weight-Related Abuse Questionnaire (WRAQ) and validated it in young adult and clinically obese populations. The WRAQ was administered to 3 samples of participants: 292 undergraduate students, 382 undergraduate students, and 59 individuals seeking bariatric surgery. Concurrent validity was assessed via measures of WRT and general childhood abuse. Convergent validity was assessed with measures of depression and disordered eating. Study 1 data were used to further develop the structure of the WRAQ. Study 2 indicated that the WRAQ had excellent psychometric properties (based on factor analyses and reliability/scale consistency analysis) and strong concurrent and convergent validity, supporting the validity of the questionnaire. 6-month test-retest reliability was also good. In Study 3 responses on the WRAQ converged well with interview responses, showed good psychometric properties, and showed moderate correlations with measures of childhood abuse and psychopathology. The WRAQ has strong psychometric properties and is strongly associated with measures of current psychopathology. Additionally, it fills a gap in the assessment literature and may be a beneficial tool for determining which individuals are at increased risk for psychopathology.

Weight-related abuse: Perceived emotional impact and the effect on disordered eating.

The purpose of this article was to evaluate theories that (1) weight-related abuse (WRA) plays a unique role in the development of disordered eating, above and beyond general childhood verbal abuse and weight-related teasing, and (2) the perceived emotional impact of WRA mediates the relationship between WRA and current disordered eating. Self-report questionnaires on childhood trauma, weight-related teasing, WRA, and current eating behaviors were administered to a total of 383 undergraduate students. In initial regressions, WRA significantly predicted binge eating, emotional eating, night eating, and unhealthy weight control. WRA continued to significantly predict all 4 forms of disordered eating following the introduction of measures of weight-related teasing and childhood verbal abuse into the regression. Latent variable analysis confirmed that perceived emotional impact of WRA mediated the relationship between WRA and disordered eating, and tests for indirect effects yielded a significant indirect effect of WRA on disordered eating through perceived emotional impact. In sum, WRA is a unique construct and the content of childhood or adolescent maltreatment is important in determining eventual psychopathology outcomes. These findings support the necessity of incorporating information on developmental history and cognitive factors into assessment and treatment of individuals with disordered eating.

Childhood verbal abuse: a risk factor for depression in pre-bariatric surgery psychological evaluations.

The present study evaluated the importance of multimodal assessment of childhood verbal abuse (CVA) in pre-bariatric surgery psychological evaluations, and the role of CVA as a predictor of depression. Data from the psychological evaluations of 184 pre-bariatric surgery patients were retrospectively examined. Using two self-report measures and an interview-based screen, 52.2 % of participants reported experiencing some form of CVA; conversely, assessments of CVA based on only one measure yielded significantly lower prevalence rates. Endorsement of CVA on multiple measures was associated with more severe depressive symptomatology and greater likelihood of mood disorder diagnosis. Based on these data, a self-report measure and interview-based screen for CVA should be included in pre-bariatric psychological evaluations; either of these assessments may be conducted via a single-item screen. Lastly, patients who endorse CVA on multiple measures should be monitored closely for symptoms of depression post-surgery.

Childhood abuse, adult interpersonal abuse, and depression in individuals with extreme obesity.

This study sought to examine (a) a mediational model of childhood abuse, adult interpersonal abuse, and depressive symptoms and (b) the impact of weight-related teasing on rates and correlates of childhood abuse. Charts of 187 extremely obese individuals seeking psychological clearance for bariatric (weight-loss) surgery were retrospectively examined. Among the participants, 61% reported a history of childhood abuse, 30.5% reported adult interpersonal abuse, and 15% reported clinically significant depressive symptoms. Initially, the relationship between childhood abuse and current depressive symptoms was significant (p<.001). However, the introduction of adult interpersonal abuse as a mediator in the model reduced the magnitude of its significance (Sobel's test p=.01). The associations between childhood abuse and adult interpersonal abuse and between adult interpersonal abuse and depressive symptoms were significant (p<.001 and p=.002, respectively), and the model showed a good fit across multiple indices. Finally, weight-related teasing was a significant moderator in the relationship between childhood and adult interpersonal abuse. Bariatric surgery patients report elevated rates of childhood abuse that are comparable to rates in psychiatric populations (e.g., eating disorders, depression), and higher than those in community samples and other medical populations. The relationship between child abuse and depressive symptomatology may be partially explained by the presence of adult interpersonal abuse; additionally, the relationship between childhood and adult interpersonal abuse was stronger for those who did not endure weight-related teasing than for those who did.