title: Body mass index, depression, and suicidality: The role of self-esteem in bariatric surgery candidates.
abstract: Previous research suggests a relationship between weight and depression/suicidality, although few studies have examined the mechanisms underlying this association. This study examined the mediating role of self-esteem in the relationship between BMI and depression/suicidality, as well as the moderating role of gender in the mediated pathways.
  
  
  
  As part of a screening process in consideration for bariatric surgery, 3,101 adults (81.4% female, 18.6% male) were assessed one time. Five univariate mediation and five univariate moderated-mediation models were hypothesized and analyzed. For the mediation models, we entered five outcome variables separately: 1) severity of depressed mood, 2) diagnosis of Major Depressive Disorder, 3) lifetime history of suicide attempts, 4) suicidal ideation at the time of evaluation, and 5) severity of suicidality, BMI as the independent variable, and self-esteem as the mediator. For the moderated-mediated models, gender was examined as a moderator to examine whether self-esteem was a stronger mediator for one gender, compared to the other.
  
  
  
  Findings supported the mediating role of self-esteem across all five outcomes. Further, the mediated effect was moderated by gender, such that the mediation effect was stronger for males, compared to females.
  
  
  
  The majority of the sample consisted of White females, limiting broad applicability of findings. All variables were assessed simultaneously, at baseline, limiting the ability to make causal attributions.
  
  
  
  Study findings suggest that self-esteem may help explain the relationship between BMI and depression/suicidality, particularly for men. Thus, interventions targeting self-esteem may be useful for improving psychological outcomes among those presenting for bariatric surgery.
authors: Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA. Electronic address: myusufov@mclean.harvard.edu.
authors: Miryam
authors: M
authors: Yusufov
authors: Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors: Kristy
authors: K
authors: Dalrymple
authors: Department of Psychology, University of Rhode Island, Kingston, RI 02881, USA.
authors: Michael H
authors: MH
authors: Bernstein
authors: Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA.
authors: Emily
authors: E
authors: Walsh
authors: Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA.
authors: Lia
authors: L
authors: Rosenstein
authors: Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors: Iwona
authors: I
authors: Chelminski
authors: Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors: Mark
authors: M
authors: Zimmerman
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015992:Body Mass Index; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology*; D012649:Self Concept; D012737:Sex Factors; D013406:Suicide, Attempted
keywords: Bariatric surgery; Body mass index; Depression; Mediation; Moderation; Self-esteem; Suicidal ideation; Weight