title: Anxiety and depression in association with morbid obesity: changes with improved physical health after duodenal switch.
abstract: BACKGROUND
  Patients with morbid obesity have an increased risk for anxiety and depression. The "duodenal switch" is perhaps the most effective obesity surgery procedure for inducing weight loss. However, to our knowledge, data on symptoms of anxiety and depression after the duodenal switch are lacking. Furthermore, it has been hypothesized that self-reported physical health is the major predictor of symptoms of depression in patients with morbid obesity. We therefore investigated the symptoms of anxiety and depression before and after the duodenal switch procedure and whether post-operative changes in self-reported physical health were predictive of changes in these symptoms.
  
  
  METHODS
  Data were assessed before surgery (n = 50), and one (n = 47) and two (n = 44) years afterwards. Symptoms of anxiety and depression were assessed by the "Hospital Anxiety and Depression Scale", and self-reported physical health was assessed by the "Short-Form 36" questionnaire. Linear mixed effect models were used to investigate changes in the symptoms of anxiety and depression. Correlation and linear multiple regression analyses were used to study whether changes in self-reported physical health were predictive of post-operative changes in the symptoms of anxiety and depression.
  
  
  RESULTS
  The symptom burden of anxiety and depression were high before surgery but were normalized one and two years afterwards (P < 0.001). The degree of improvement in self-reported physical health was associated with statistically significant reductions in the symptoms of anxiety (P = 0.003) and depression (P = 0.004).
  
  
  CONCLUSIONS
  The novelty of this study is the large and sustained reductions in the symptoms of anxiety and depression after the duodenal switch procedure, and that these changes were closely associated with improvements in self-reported physical health.
authors.affiliation: Faculty of Health Studies, Sogn og Fjordane University College, Box 523, 6803 Førde, Norway. john.andersen@isf.uib.no
authors.forename: John Roger
authors.initials: JR
authors.lastname: Andersen
authors.forename: Anny
authors.initials: A
authors.lastname: Aasprang
authors.forename: Per
authors.initials: P
authors.lastname: Bergsholm
authors.forename: Nils
authors.initials: N
authors.lastname: Sletteskog
authors.forename: Villy
authors.initials: V
authors.lastname: Våge
authors.forename: Gerd Karin
authors.initials: GK
authors.lastname: Natvig
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000209:etiology*; D001294:Attitude to Health; D050110:Bariatric Surgery / Q000379:methods; D017281:Cost of Illness; D003866:Depressive Disorder / Q000209:etiology*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011795:Surveys and Questionnaires; D055815:Young Adult