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Axis I and II Disorders and Quality of Life in Bariatric Surgery Candidates

J Clin Psychiatry 2008;69(2):295-301

Objective: This study examined the prevalence of Axis I and II psychopathology and its relationship with quality of life in candidates for bariatric surgery.

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 March 2006.

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 = .035).

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 complications.