title: Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis.
abstract: OBJECTIVE
  Bariatric surgery is associated with sustained weight loss and improved physical health status for severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery; however, the prevalence of these conditions and whether they are associated with postoperative outcomes remains unknown.
  
  
  OBJECTIVE
  To determine the prevalence of mental health conditions among bariatric surgery candidates and recipients, to evaluate the association between preoperative mental health conditions and health outcomes following bariatric surgery, and to evaluate the association between surgery and the clinical course of mental health conditions.
  
  
  METHODS
  We searched PubMed, MEDLINE on OVID, and PsycINFO for studies published between January 1988 and November 2015. Study quality was assessed using an adapted tool for risk of bias; quality of evidence was rated based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.
  
  
  RESULTS
  We identified 68 publications meeting inclusion criteria: 59 reporting the prevalence of preoperative mental health conditions (65,363 patients) and 27 reporting associations between preoperative mental health conditions and postoperative outcomes (50,182 patients). Among patients seeking and undergoing bariatric surgery, the most common mental health conditions, based on random-effects estimates of prevalence, were depression (19% [95% CI, 14%-25%]) and binge eating disorder (17% [95% CI, 13%-21%]). There was conflicting evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Neither depression nor binge eating disorder was consistently associated with differences in weight outcomes. Bariatric surgery was, however, consistently associated with postoperative decreases in the prevalence of depression (7 studies; 8%-74% decrease) and the severity of depressive symptoms (6 studies; 40%-70% decrease).
  
  
  CONCLUSIONS
  Mental health conditions are common among bariatric surgery patients-in particular, depression and binge eating disorder. There is inconsistent evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Moderate-quality evidence supports an association between bariatric surgery and lower rates of depression postoperatively.
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California3Veterans Affairs/Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, Cali.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Dawes
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California5Southern California Evidence-Based Practice Center, RAND Corporation, Santa Monica.
authors.forename: Melinda
authors.initials: M
authors.lastname: Maggard-Gibbons
authors.affiliation: Southern California Evidence-Based Practice Center, RAND Corporation, Santa Monica6Akasha Center for Integrative Medicine, Santa Monica, California.
authors.forename: Alicia R
authors.initials: AR
authors.lastname: Maher
authors.affiliation: Southern California Evidence-Based Practice Center, RAND Corporation, Santa Monica.
authors.forename: Marika J
authors.initials: MJ
authors.lastname: Booth
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California4Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
authors.forename: Isomi
authors.initials: I
authors.lastname: Miake-Lye
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Beroes
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California5Southern California Evidence-Based Practice Center, RAND Corporation, Santa Monica.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
mesh_terms: D050110:Bariatric Surgery / Q000523:psychology*; D056912:Binge-Eating Disorder / Q000150:complications*; D003866:Depressive Disorder / Q000150:complications*; D006801:Humans; D008603:Mental Health; D009767:Obesity, Morbid / Q000523:psychology*; D016896:Treatment Outcome; D015431:Weight Loss