Presurgical Psychiatric Evaluations of Candidates for Bariatric Surgery, Part 1: Reliability and Reasons for and Frequency of Exclusion
J Clin Psychiatry 2007;68(10):1557-1562
© Copyright 2017 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Objective: Many bariatric surgery programs include psychiatric evaluations as part of the preoperative screening procedure. Surveys of surgeons and mental health professionals have found variability in opinion regarding what psychosocial problems warrant denial of clearance for surgery. Few studies have reported the number of patients who are not cleared for surgery due to psychiatric reasons, and no study has reported the reliability of decision making. The goals of the present study were to examine the reliability of decisions to clear candidates for surgery, determine the percentage of candidates who were not cleared for surgery, and detail the reasons candidates were not cleared for surgery.
Method: Five hundred candidates for bariatric surgery were evaluated from July 2004 until July 2006 with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders supplemented by a module specific to this population. Reliability for determining clearance was evaluated in 73 patients. Reasons for not clearing patients were recorded on the Surgery Clearance Form.
Results: Eighteen percent (N = 92) of the patients were not cleared for surgery. The kappa coefficient of reliability of determining surgical clearance was 0.83. The most common reasons for the negative recommendation were overeating to cope with stress or emotional distress, current eating disorder, uncontrolled psychopathology, and the presence of significant life stressors. Only 1 patient was excluded for a lack of understanding of the potential risks of surgery.
Conclusions: The decision whether to clear candidates for bariatric surgery can be made reliably. Approximately 1 in 5 surgical candidates did not pass the initial psychiatric screening, usually because of current eating pathology, other forms of uncontrolled psychopathology, or difficulty coping with current life stressors.