Long-term Mental Health Outcomes of Bariatric Surgery

减肥手术的长期心理健康结果

• 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
• 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

 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（由适用提供）：大量随机试验和观察性研究发现，roux-en-y胃旁路，可调胃带和垂直套筒过性切除术会导致急剧的体重减轻，并改善了许多慢性病的控制。结果，在过去的二十年中，减肥手术率有所提高。减肥手术具有短期益处，但对长期结局，尤其是心理健康结果的了解较少。新兴的证据表明，减肥手术可能会诱发新的发作阿片类药物使用障碍（OUD）或酒精遗产（AM），并加剧现有的AM或OUD。肥胖的人的AM比超重和正常体重的人更高，手术后两年似乎更糟。肥胖者的抑郁症发生率也更高，手术后1 - 2年似乎降低了。减肥手术在短期内可能会对OUD和AM产生不利影响，但是在减肥手术后5年对这些结果几乎一无所知，因为少数研究这些结果的研究仅限于1 - 2年的随访，主要是非US的苏联人群，并且缺乏非外表患者，无法说明平均值。在男性或老年患者的减肥手术后，AM，处方阿片类药物或抑郁症也存在一个主要的证据差距，因为检查这些结果的少数研究主要是在年轻的女性患者中积累。此外，没有证据表明这些问题是否可以使手术对体重变化的影响是否超过3年。我们已经对减肥手术后的退伍军人结局进行了几项研究。我们以我们在2002 - 2011年接受减肥手术和> 7,000个非手术控制的2,257名退伍军人的匹配人群的经验，我们建议解决有关AM，OUD和抑郁症的5年后抑郁率治疗的关键证据差距四个具体目标：目标1：基于AM的长期患者的长期趋势：而且没有公认的AM的历史。 AIM 2：检查减肥手术患者的处方OID MISSUSE的长期变化，并与基线时有或没有OID MISSUSE的患者相匹配。 AIM 3：检查减肥手术患者中的长期抑郁治疗率，并与基线时有和没有抑郁症治疗的患者相匹配。目标4：检查基线AM，处方阿片类药物的使用和抑郁治疗是否适应减肥手术对长期体重变化的影响。次要目的：检查AM的长期变化，处方阿片类药物使用和抑郁治疗是否与接受RYGB，AGB或VSG的患者不同。