Mental health evaluations for adolescents prior to bariatric surgery: a review of existing practices and a specific example of assessment procedures

Authors

  • R. Sysko,

    Corresponding author
    1. Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
    2. The Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
    • Address for correspondence: Dr R Sysko, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA. E-mail: syskor@nyspi.columbia.edu

    Search for more papers by this author
  • L. J. Zandberg,

    1. Graduate School of Applied and Professional Psychology, Piscataway, NJ, USA
    Search for more papers by this author
  • M. J. Devlin,

    1. Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
    2. The Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
    Search for more papers by this author
  • R. A. Annunziato,

    1. Department of Psychology, Fordham University, Bronx, NY, USA
    Search for more papers by this author
  • J. L. Zitsman,

    1. Department of Surgery, Division of Pediatric Surgery, Center for Adolescent Bariatric Surgery, Columbia University Medical Center, New York, NY, USA
    Search for more papers by this author
  • B. T. Walsh

    1. Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
    2. The Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
    Search for more papers by this author

  • Dr. Sysko is supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant DK088532-01A1 and holds stock in Pfizer Pharmaceuticals. Dr. Walsh has received research support from Astra Zeneca. None of the other authors report a conflict.

Summary

Best practice guidelines for adolescents considering bariatric surgery recommend a preoperative mental health evaluation. However, only general information about these assessments appears in the literature, which makes consistency of administration challenging. This review proposes a specific empirically derived format for pre-surgical mental health evaluations and summarizes currently available data on the psychiatric functioning of adolescents seeking bariatric surgery. Studies of mental health evaluations for adults preparing for bariatric surgery are reviewed, as is the limited literature relevant to adolescent evaluations. A specific and detailed example of an evaluation (clinical interview, self-report questionnaires, cognitive assessment) used for younger patients at a major metropolitan hospital centre is presented, followed by data from an initial group of adolescents completing this evaluation. A total of 200 adolescents (n = 139 female; age: 14–18 years; body mass index: 35.4–83.3 kg m−2) are presented for bariatric surgery. A notable subset of adolescents reported current Axis I conditions (31.5%) and current mental health treatment (29.5%), but reports of current illicit drug use (1.5%) and regular alcohol use (0.5%) were relatively rare. Procedures for using the completed evaluation and post-surgery monitoring of psychosocial issues are discussed. Adolescents considering weight loss surgery should receive comprehensive pre-surgical mental health evaluations, but additional data are needed to develop specific recommendations for the use of these evaluations in post-operative care.

Ancillary