title: Employment outcomes one year after bariatric surgery: the role of patient and psychosocial factors.
abstract: BACKGROUND
  Patients undergoing bariatric surgery generally report improved work performance after this procedure; however, previous research has been limited by a lack of standardized employment measures and a failure to account for the impact of psychiatric illness on employment outcomes. To address these limitations, this study aims to assess changes in patients' employment impairment and productivity 12 months post-surgery and to identify psychosocial predictors of change in employment outcomes.
  
  
  METHODS
  A total of 164 patients underwent bariatric surgery between February 2010 and November 2012 in this prospective cohort study. The primary outcome was a change in employment impairment (EI) as measured by total Lam Employment Absence and Productivity Scale (LEAPS) scores and changes in participants' job status category. Multiple linear regression models assessed whether baseline demographic or clinical factors, including a history of psychiatric illness and changes in depressive, anxiety and quality of life (QOL) symptoms, were associated with a change in LEAPS scores.
  
  
  RESULTS
  Participants reported a significant reduction in EI post-surgery (p < 0.0001) and improvement in work productivity (p < 0.0001) 12 months after surgery. Only changes in depression (confidence interval (CI) 0.46, 0.76, p < 0.0001), anxiety (CI 0.49, 0.85, p < 0.0001) and mental QOL (CI -0.30, -0.17, p < 0.0001) were significant predictors of change in EI total scores. Logistic regression analysis did not identify significant predictors of change in participant job status.
  
  
  CONCLUSIONS
  Patients with pre-bariatric surgery psychiatric distress are more likely to report greater employment impairment and worse employment productivity pre-surgery. These patients also experience the greatest improvements in post-surgery employment functioning.
authors.affiliation: Bariatric Surgery Program, Toronto Western Hospital, Toronto, Canada, sanjeev.sockalingam@uhn.ca.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.forename: Susan
authors.initials: S
authors.lastname: Wnuk
authors.forename: Karin
authors.initials: K
authors.lastname: Kantarovich
authors.forename: Christopher
authors.initials: C
authors.lastname: Meaney
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.forename: Raed
authors.initials: R
authors.lastname: Hawa
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cassin
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D050110:Bariatric Surgery / Q000523:psychology / Q000534:rehabilitation* / Q000706:statistics & numerical data; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery*; D011184:Postoperative Period; D011584:Psychology; D011788:Quality of Life; D016896:Treatment Outcome