The Effect of Bariatric Surgery on Long-term Depression Treatment in Patients With Obesity

Abstract

Objective: In a large multisite cohort of Veterans who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG), initiation of (ie, incident) and persistence of (ie, continuation of preoperative) depression treatment are compared with matched nonsurgical controls.

Background: Bariatric surgery has been associated with short-term improvements in depression but less is known about longer term outcomes.

Methods: In a retrospective cohort study, we matched 1713 Veterans with depression treatment who underwent bariatric surgery in Veterans Administration bariatric centers from fiscal year 2001 to 2016 to 15,056 nonsurgical controls using sequential stratification and examined the persistence of depression treatment via generalized estimating equations. Incidence of depression treatment was compared using Cox regression models between 2227 surgical patients and 20,939 matched nonsurgical controls without depression treatment at baseline.

Results: In surgical patients with depression treatment at baseline, the use of postsurgical depression treatment declined over time for both surgical procedures, but postsurgical patients had greater use of depression treatment at 5 years [RYGB: odds ratio=1.24, 95% confidence interval (CI): 1.04-1.49; LSG: odds ratio=1.27, 95% CI: 1.04-1.56] compared with controls. Among those without depression treatment at baseline, bariatric surgery was associated with a higher incidence of depression treatment compared with matched controls (RYGB: hazard ratio=1.34, 95% CI: 1.17-1.53; LSG: hazard ratio at 1-5 years=1.27, 95% CI: 1.10-1.47).

Conclusions: Bariatric surgery was associated with a greater risk of postoperative incident depression treatment and greater persistence of postoperative depression treatment. Depression may worsen for some patients after bariatric surgery, so clinicians should carefully monitor their patients for depression postoperatively.

Figure 1.

Odds Ratios and 95% Confidence Intervals Comparing the Odds of Persisting with Depression Treatment up to 5 Years in Bariatric Patients and Matched Non-Surgical Patients among those with Depression Treatment at Baseline, by Bariatric Procedure

Figure 2.

Unadjusted Depression Treatment Incidence: Kaplan-Meier Estimated Cumulative Incidence of Post-operative Depression Treatment up to 5 Years in Bariatric Surgical Patients and Matched Non-Surgical Patients without Baseline Depression Treatment, by Bariatric Procedure

Figure 3.

Adjusted Depression Treatment Incidence: Association and 95% Confidence Intervals of Bariatric Surgery and Depression Treatment Incidence up to 5 Years after Surgery in Patients without Baseline Depression Treatment Note: The proportional hazards assumption was not met for patients receiving LSG, so hazard ratios were estimated separately for the first year of follow-up and the remaining years 1–5. Proportional hazards assumption was met for patients undergoing RYGB procedures, so hazard ratios were estimated for the entire 5-year period for these cohorts. Hazard ratios and 95% confidence intervals are from Cox models in matched surgical patients and non-surgical controls without depression treatment at baseline. HR=hazard ratio; RYGB=Roux-en-Y gastric bypass; Sleeve=laparoscopic sleeve gastrectomy.