Axis I and II Disorders and Quality of Life in Bariatric Surgery Candidates
J Clin Psychiatry 2008;69(2):295-301
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: This study examined the prevalence of Axis I and II
psychopathology and its relationship with quality of life in candidates for
Method: Consecutive obese subjects (N = 282) with a body mass
index (BMI) of 30 kg/m2 or more received a thorough psychiatric
assessment including the Structured Clinical Interviews for DSM-IV Axis I and
II Disorders; the Hamilton Rating Scale for Depression; the Bulimic
Investigatory Test, Edinburgh; and the short-form Quality of Life Enjoyment and
Satisfaction Questionnaire. Subjects were recruited between November 2001 and
Results: The overall prevalence of lifetime Axis I disorders
in the sample was 37.6%. Mood disorders were the most common diagnoses (22.0%).
Anxiety disorders and eating disorders were found in 18.1% and 12.8% of the
sample, respectively. Alcohol or substance use disorders were uncommon. The
percentage of subjects meeting criteria for at least 1 lifetime Axis I disorder
did not vary by BMI class or gender. The prevalence of current Axis I disorders
was 20.9% (N = 59). Fifty-five subjects (19.5%) met criteria for at least 1
Axis II disorder. Cluster C disorders, including avoidant, dependent, and
obsessive-compulsive personality disorders, comprised virtually all the
disorders in the sample (N = 53, 18.8%). Quality of life was poor, unrelated
with gender or BMI, and significantly more impaired in individuals with
comorbid Axis I and II disorders compared with those without disorders (p =
Conclusion: About one fifth of the sample presented with a
current Axis I disorder, and the same percentage had a personality disorder.
Although obesity surgery is not contraindicated based on psychiatric disorders,
adequate preoperative treatment should be provided to individuals in need of
psychiatric support to improve the postoperative outcome and reduce the risk of