Depression is associated with increased severity of co-morbidities in bariatric surgical candidates

Background: Depression is prevalent among bariatric surgical patients, and previous studies have suggested a link between depression and quality of life. Our objective was to examine the relationship between depression and other co-morbidities of obesity at a university hospital in the United States. Methods: Data were collected from 1368 consecutive patients evaluated for bariatric surgery. The demographic and co-morbidity profiles of these patients were compared between the depressed and nondepressed individuals. Depression was defined as an Assessment of Obesity-Related Co-morbidities score of >= 3, signifying that the patient required medical treatment for (score of 3) or had complications of (score of 4-5) depression. Results: The prevalence of depression among these patients was 36%. The mean age of the patients with depression was older (44.3 +/- 9.4 versus 42.2 +/- 9.6, P < .05), but the mean body mass index was similar. Depression was more prevalent among the female patients (37.4% versus 29.6%, P < .05). Diabetes mellitus, hypertension, polycystic ovarian syndrome, idiopathic intracranial hypertension, and obesity hypoventilation syndrome occurred with similar frequency and severity in persons with and without depression. The analysis revealed a significantly greater prevalence and severity of dyslipidemia (P < .05), gastroesophageal reflux disease (P < .05), back pain (P < .0001), joint pain (P < .05), sleep apnea (P < .01), stress incontinence (P < .01), and hernia (P < .05) among patients with depression. Overall, patients with depression had more co-morbidities per patient (5.46 versus 4.55) and a greater likelihood of severe or complicated co-morbidifies (2.67 versus 1.89 per patient). Conclusion: This report has characterized a link between depression and other co-morbidities in bariatric surgical patients. This association was independent of the body mass index. Although a causal relationship could not yet be identified, our findings indicate that depression, in this patient population, is associated with a greater prevalence and increased severity of medical co-morbidities that express distinct physical symptoms. (Surg Obes Relat Dis 2009;5:559-564.) (C) 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved.