"If you're offered help, take it": A qualitative study examining bariatric patients' experience of telephone-based cognitive behavioural therapy.

The increased recognition of patients' mental health needs after bariatric surgery has resulted in the emergence of accessible psychosocial interventions; however, there is a dearth of literature on patient experience and satisfaction with these interventions. We explored patients' perceptions and experiences of telephone-based cognitive behavioural therapy (Tele-CBT) in this qualitative study. Ten participants from the Toronto Western Hospital Bariatric Surgery Program in Toronto, Canada who completed the Tele-CBT (ClinicalTrials.gov Identifier: NCT02920112) were individually interviewed from November 2014 to June 2016 until thematic saturation occurred (ie, no more new coding groups emerged). Interviews were transcribed, independently coded, checked for discrepancies, and analysed using grounded theory. Four themes emerged: (1) participants were generally satisfied with Tele-CBT (eg, therapeutic alliance, resources provided, relevance of therapy to their own bariatric journey), (2) participants noticed emotional, cognitive, and behavioural changes following therapy, (3) the optimal time to deliver the Tele-CBT was when weight loss plateaued, generally at one-year post-surgery, and (4) participants found the telephone modality convenient. CBT was generally found to be helpful and the telephone format increased convenience and accessibility. Patients reported learning skills and receiving resources that could help them improve their well-being following bariatric surgery.

Associations Between Social Anxiety, Depression, and Use of Mobile Dating Applications.

This study explores associations between symptoms of social anxiety (SA) and depression with participants' extent of dating app use, self-reported motivations for dating app use, and likelihood of initiating interaction with dating app matches. Three-hundred seventy-four participants completed an online battery of surveys that examined psychopathology and dating app use. SA and depression symptoms were positively associated with participants' extent of dating app use, and symptoms of psychopathology and gender interacted to predict various dating app use motivations. Symptoms of SA and depression predicted lower likelihood of initiating contact with a dating app match among men but not women. This study provides an initial step toward understanding the relationship between SA, depression, and use of dating apps.

Evaluation of a Patient-Care Planning Intervention to Improve Appointment Attendance by Adults After Bariatric Surgery.

OBJECTIVES: Bariatric surgery is recognized as a durable treatment for severe obesity; however, high rates of nonattendance and patient engagement during the postoperative period remain challenges. This pre/post study evaluates a quality-improvement initiative to improve attendance at bariatric surgery program appointments and to heighten program efficiency, as measured by appointment attendance, cancellations and new assessments. METHODS: Patients and staff were consulted in order to identify causes for patient attrition after surgery. The ideas for change that were implemented were advance care-planning calls and e-mails in order to tailor appointments to patients' needs and an online application of follow-up care information. Online surveys were used to assess patient satisfaction. After several plan-do-study-act cycles, appointment attendance rates for 5,676 appointments between April 1, 2014, and May 29, 2015, were compared pre- and post-quality improvement intervention. For the intervention, 1,294 patients were called, representing 4,124 appointments. Both preoperative and postoperative attendance rates and costs were examined. RESULTS: Although postoperative attendance and no-show rates changed by only 1.8% postintervention, advance cancellations increased by 6%; indications of special-cause variation were attributable to the intervention. With advance cancellations increasing, time was available for preoperative and nonroutine postoperative appointments, refilling 6.6 appointments per week. As a result, cost savings were $21,251 based on unused clinician time. The contact rate of patients was 45%, and patient satisfaction was high. CONCLUSIONS: In summary, this quality-improvement intervention was able to improve patient-centred care and clinic efficiency through the use of advance-care planning as evaluated by appointment attendance data and patient satisfaction surveys.

Psychosocial predictors of quality of life and weight loss two years after bariatric surgery: Results from the Toronto Bari-PSYCH study.

OBJECTIVES: Studies exploring the impact of pre-surgery psychiatric status as a predictor of health related quality of life (QOL) after bariatric surgery have been limited to short-term follow-up and variable use of psychosocial measures. We examined the effect of pre-operative psychiatric factors on QOL and weight loss 2-years after surgery. METHODS: 156 patients participated in this prospective cohort study, the Toronto Bariatric Psychosocial Cohort Study, between 2010 and 2014. Patients were assessed pre-surgery for demographic factors, weight, psychiatric diagnosis using the MINI International Neuropsychiatric Interview and symptom measures for QOL, depression and anxiety at pre-surgery and at 1 and 2years post-surgery. RESULTS: At 2-years post-bariatric surgery, patients experienced a significant decrease in mean weight (-48.43kg, 95% [-51.1, -45.76]) and an increase only in physical QOL (+18.91, 95% [17.01, 20.82]) scores as compared to pre-surgery. Multivariate regression analysis identified pre-surgery physical QOL score (p<0.001), younger age (p=0.005), and a history of a mood disorder as significant predictors of physical QOL. Only a history of a mood disorder (p=0.032) significantly predicted mental QOL (p=0.006). Pre-surgery weight (p<0.001) and a history of a mood disorder (p=0.047) were significant predictors of weight loss 2-years post-surgery. CONCLUSIONS: Bariatric surgery had a sustained impact on physical QOL but not mental QOL at 2-years post-surgery. A history of mood disorder unexpectedly increased physical QOL scores and weight loss following surgery. Further research is needed to determine if these results are due to bariatric surgery candidate selection within this program.

The relationship between eating psychopathology and obstructive sleep apnea in bariatric surgery candidates: A retrospective study.

OBJECTIVE: Obstructive sleep apnea (OSA), eating psychopathology, and major depressive disorder (MDD) are highly prevalent in patients with severe obesity. Our study aimed to identify differences in binge-eating disorder (BED) prevalence in bariatric surgery candidates with and without OSA. METHODS: In this retrospective study, demographic data, psychiatric diagnoses, OSA diagnosis, binge eating, depressive and quality of life (QOL) symptoms were collected from 1,099 bariatric surgery candidates from a Canadian setting. Analysis of variance was used to identify differences in psychopathology and QOL between groups with OSA and BED, BED alone, OSA alone or neither BED or OSA. RESULTS: Study participants' mean body mass index was 49.3 kg/m2 and 52.6% had a diagnosis of OSA. Patients with OSA were significantly more likely to have a diagnosis of past BED (χ2 = 6.848, p = .009) and current MDD (χ2 = 5.165, p = .023). Binge-eating (p < .001) and depressive symptoms (p < .001) were significantly higher in patients with co-morbid BED and OSA compared to patients with OSA alone or patients with no diagnosis of BED or OSA. Patients with co-morbid BED and OSA only had significantly lower physical (p < .001) and mental QOL (p = .007) compared to patients with no diagnosis of BED or OSA. DISCUSSION: Our findings suggest that patients with a history of BED should be reassessed for OSA. Research is needed to examine whether BED may predispose individuals to developing obesity and OSA.

Predictors of Vitamin Adherence After Bariatric Surgery.

BACKGROUND: Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. METHODS: A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. RESULTS: Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). CONCLUSIONS: Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

Toronto Bariatric Interprofessional Psychosocial Assessment Suitability Scale: Evaluating A New Clinical Assessment Tool for Bariatric Surgery Candidates.

BACKGROUND: Patients who are referred for possible bariatric surgery (BS) intervention undergo a series of assessments conducted by an interdisciplinary health care team to determine suitability for surgery. Herein, we report the initial validation and reliability studies of the Bariatric Interprofessional Psychosocial Assessment Suitability Scale (BIPASS) and its relationship to interdisciplinary psychosocial assessment practices for BS. METHODS: This study was conducted at the Toronto Western Hospital, a Level 1A BS center of excellence accredited by the American College of Surgeons. Phase I: a total of 4 blinded raters applied the BIPASS to 31 randomly selected BS cases referred to our program to establish interrater reliability. Phase II: in all, 3 raters with clinical experience in bariatric psychosocial care applied the BIPASS to 54 randomly selected BS cases. RESULTS: In total, 46 of 54 (85.1%) patients were women. The median age of all patient cases was 49 years (range: 21-74). Raters׳ BIPASS scores ranged from 4-52 (median = 19.24, standard deviation =10.38). BIPASS scores were highly predictive of the BS psychosocial outcome (area under curve = 0.915; 95% CI: 0.844-0.985; p < 0.001). A BIPASS score of ≥16 was chosen as the cutoff score for further clinical assessment before proceeding with surgical evaluation based on a receiver operating characteristic curve analysis (sensitivity = 0.839; specificity = 0.783). The instrument has very good interrater reliability (Pearson correlation coefficient = 0.847) even among novice raters. CONCLUSION: The findings show that the BIPASS is a comprehensive screening tool in the psychosocial assessment of BS candidates, which standardizes the evaluation process and systematically identify at-risk patients for negative outcomes after BS.