Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery.

BACKGROUND: Many bariatric surgery programs require that candidates undergo a preoperative mental health evaluation. Candidates may be motivated to suppress or exaggerate psychiatric symptoms (i.e., engage in impression management), if they believe doing so will enhance their chances of receiving a recommendation to proceed with surgery. METHOD: 237 candidates for bariatric surgery completed the Beck Depression Inventory-II (BDI-ll) as part of their preoperative psychological evaluation (Time 1). They also completed the BDI-II approximately 2-4 weeks later, for research purposes, after they had received the mental health professional's unconditional recommendation to proceed with surgery (Time 2). RESULTS: There was a small but statistically significant increase in mean BDI-II scores from Time 1 to Time 2 (11.4 vs 12.7, P<.001). Clinically significant changes, defined as a change from one range of symptom severity to another, were observed in 31.2% of participants, with significant increases in symptoms occurring nearly twice as often as reductions (20.7% vs 10.5%, P<.008). Demographic variables were largely unrelated to changes in BDI-II scores from Time 1 to Time 2. CONCLUSION: Approximately one-third of bariatric surgery candidates reported a clinically significant change in depressive symptoms after receiving psychological "clearance" for surgery. Possible explanations for these findings include measurement error, impression management, and true changes in psychiatric status.

How do mental health professionals evaluate candidates for bariatric surgery? Survey results.

BACKGROUND: The prevalence of extreme obesity and the popularity of bariatric surgery have increased dramatically in recent years. Many surgery programs require that candidates undergo a preoperative psychological evaluation, but no consensus exists for guiding mental health professionals in the conduct of these evaluations. METHOD: A survey was sent to bariatric surgeons, who were asked to distribute the surveys to the mental health professionals to whom they refer surgery candidates for preoperative evaluations. 194 respondents provided information on the assessment methods they use, which psychosocial domains are the focus of their evaluations, and what they consider to be contraindications to surgery. Responses to open-ended questions were coded for content. RESULTS: Most respondents reported using clinical interviews (98.5%), symptom inventories (68.6%), and objective personality/psychopathology tests (63.4%). A minority used tests of cognitive function (38.1%) and projective personality tests (3.6%). Over 90% of respondents listed mental health issues among the most important areas to assess. Similarly, 92.3% listed psychiatric issues as "clear contraindications" to surgery, but no specific disorder was listed by a majority of respondents. Issues related to informed consent and treatment adherence were the non-psychiatric domains most frequently listed as important areas to assess and as contraindications to surgery. CONCLUSION: The assessment practices of mental health professionals who evaluate bariatric surgery candidates vary widely. No consensus is likely to emerge until large long-term studies identify consistent psychosocial predictors of poor postoperative outcomes.