Long-term Mental Health Outcomes of Bariatric Surgery

减肥手术的长期心理健康结果

基本信息

批准号：
9922248
负责人：
MATTHEW L MACIEJEWSKI
金额：
$ 42.07万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-15 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9922248
关键词：
Address Adverse effects Affect Aftercare Bariatrics Body Weight Changes Body Weight decreased Chronic Data Epidemiology Female Gastrectomy Gastric Bypass Health Benefit Health Expenditures Incidence Intervention Longitudinal trends Longterm Follow-up Medicare Mental Depression Mental Health Monitor Non obese Obesity Observational Study Operative Surgical Procedures Opioid Outcome Overweight Patients Postoperative Period Prevalence Public Health Recording of previous events Reporting Resolution Risk Veterans Weight Woman alcohol misuse bariatric surgery base beneficiary cohort drinking experience follow-up high risk men improved men novel older patient opioid misuse opioid use opioid use disorder opioid user physical conditioning prescription opioid prescription opioid misuse public health relevance randomized trial screening

项目摘要

DESCRIPTION (provided by applicant): Numerous randomized trials and observational studies have found that Roux-en-Y gastric bypass, adjustable gastric banding, and vertical sleeve gastrectomy cause dramatic weight loss and improved control of many chronic conditions. As a result, rates of bariatric surgery have increased over the past two decades. Bariatric surgery has short term benefits but less is known about long-term outcomes, particularly mental health outcomes. Emerging evidence suggests that bariatric surgery may induce new onset opioid use disorder (OUD) or alcohol misuse (AM) and exacerbate existing AM or OUD. Obese people have greater rates of AM than overweight and normal weight people and AM appears to worsen two years after surgery. Obese people also have greater rates of depression, which appears to decrease 1-2 years after surgery. Bariatric surgery may have adverse effects on OUD and AM in the short term, but almost nothing is known about these outcomes 5 years after bariatric surgery, because the few studies examining these outcomes were limited to 1- 2 year follow-up of predominantly non-US surgical cohorts and lacked non-surgical patients to account for regression to the mean. There is also a major evidence gap for AM, prescription opioid misuse or depression after bariatric surgery in men or older patients because the few studies examining these outcomes were mostly comprised of younger female patients. Further, there is no evidence whether these issues moderate the effect of surgery on weight change beyond 3 years. We have conducted several studies of veterans' outcomes following bariatric surgery. Building on our experience with matched cohorts of 2,257 veterans undergoing bariatric surgery in 2002-2011 and >7,000 non- surgical controls, we propose to address critical evidence gaps about 5-year post-surgical rates of AM, OUD and depression treatment in four specific aims: Aim 1: Examine long-term trends in the prevalence of AM (based on a validated screen) among bariatric surgery patients and matched non-surgical patients with and without a history of recognized AM. Aim 2: Examine long-term change in prescription opioid misuse among bariatric surgery patients and matched patients with and without opioid misuse at baseline. Aim 3: Examine long-term rates of depression treatment among bariatric surgery patients and matched patients with and without depression treatment at baseline. Aim 4: Examine whether baseline AM, prescription opioid use, and depression treatment moderate the effect of bariatric surgery on long-term weight change. Secondary Aim: Examine whether long-term changes in AM, prescription opioid use and depression treatment after surgery differ by patients undergoing RYGB, AGB or VSG.

描述（由申请人提供）：大量随机试验和观察性研究发现，Roux-en-Y 胃绕道手术、可调节胃束带术和垂直袖状胃切除术可显着减轻体重并改善对许多慢性疾病的控制。减肥手术在过去二十年中有所增加，但对长期结果（尤其是心理健康结果）知之甚少。 (OUD) 或酒精滥用 (AM) 并加剧现有的 AM 或 OUD 肥胖者的 AM 发生率高于超重和正常体重的人，并且肥胖者在手术后两年内出现抑郁症的比率似乎也更高。减肥手术可能会在短期内对 OUD 和 AM 产生不利影响，但对于减肥手术 5 年后的这些结果几乎一无所知，因为检查这些结果的研究仅限于 1-2 年。 2年主要对非美国手术人群进行随访，缺乏非手术患者来解释均值回归。男性或老年患者减肥手术后的 AM、处方阿片类药物滥用或抑郁症也存在重大证据差距，因为这种情况很少。此外，没有证据表明这些问题会减轻手术对 3 年后体重变化的影响。根据我们的经验，我们对退伍军人的体重变化进行了多项研究。与匹配的队列2002-2011 年有 2,257 名退伍军人接受减肥手术和超过 7,000 名非手术对照，我们建议通过四个具体目标来解决关于术后 5 年 AM、OUD 和抑郁症治疗率的关键证据差距：目标 1：检查长期减肥手术患者和有或无公认 AM 病史的匹配非手术患者中 AM 患病率的长期趋势（基于经过验证的筛查）：检查减肥手术患者和基线时有或没有阿片类药物滥用的匹配患者的处方阿片类药物滥用的长期变化。目标 3：检查减肥手术患者和基线时有或没有抑郁症治疗的匹配患者的长期抑郁治疗率。目标 4：检查基线 AM、处方阿片类药物使用和抑郁症治疗是否会减轻减肥手术对长期体重变化的影响次要目标：检查手术后 AM、处方阿片类药物使用和抑郁症治疗的长期变化是否存在差异。患者正在接受RYGB、AGB 或 VSG。