When insurance is not a barrier: psychological factors predicting whether bariatric candidates undergo surgery.

BACKGROUND: Despite the effectiveness of bariatric surgery, utilization rates have increased only marginally over the last 2 decades; candidates who are eligible for bariatric surgery regularly fail to undergo surgery. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) has previously been used to assist in identification of those who will not move forward with surgery after being identified as eligible. However, medical insurance has been identified as a significant barrier to surgery; research in those who have universal healthcare may yield different results. OBJECTIVES: Determine if MMPI-RF scales are associated with failure to undergo bariatric surgery in patients eligible to have the procedure. SETTING: Large military hospital in the Northwestern U.S. METHODS: This study used archival data for 279 patients psychologically screened for eligibility for bariatric surgery. All assessments took place between January 2017 and December 2019. T-tests and chi-square tests were used to compare groups of patients who did and did not have surgery on relevant medical and demographic variables. Profile analyses of patient MMPI-2-RF scores were conducted to examine scale associations with undergoing surgery. RESULTS: A total of 86 bariatric surgery candidates (30.8%) did not undergo surgery. Results showed that sex, age, employment status, and arthritis were different between groups. Additionally, MMPI-2-RF scales were different between groups, including somatic complaints, neurological complaints, cynicism, and helplessness/hopelessness. CONCLUSIONS: MMPI-2-RF scales were associated with not having bariatric surgery, although not all scales exceeded clinical cut-offs. Findings indicate psychological and psychosocial differences, rather than psychopathology per se, may play a role in who undergoes bariatric surgery.

The role of obesity severity in Minnesota multiphasic personality inventory-2-restructured form prediction of 12-month bariatric surgery outcomes.

BACKGROUND: The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) has been widely used in bariatric surgery samples. However, questions remain regarding its utility when predicting changes in body mass index over time following bariatric surgery. OBJECTIVES: Examine whether MMPI-2-RF scales differentially predict 12-month changes in body mass index (BMI) following bariatric surgery when comparing patients with Class III or higher versus Class II or lower obesity. SETTING: Military hospital in the Northwestern United States. METHODS: This retrospective study evaluated data from 193 bariatric surgery patients who completed the MMPI-2-RF as part of presurgical evaluation requirements. Hierarchical linear modeling was used to predict body mass index over a 12-month postsurgical period based on MMPI-2-RF scales. Loss to follow-up rate was 30% during this period. RESULTS: Among patients with Class II or lower obesity, the Symptom Validity, Adjustment Validity, Response Bias, Cynicism, Aggression, Stress/Worry, and Anger Proneness scales showed a significant relationship to BMI after bariatric surgery. Among patients with Class III or higher obesity, the Infrequent Psychopathology Responses, Emotional / Internalizing Dysfunction, Ideas of Persecution, Multiple Specific Fears, and Inefficacy scales showed a significant relationship to body mass index after bariatric surgery. CONCLUSIONS: Certain MMPI-2-RF scales may have better utility in predicting bariatric surgery outcomes based on the patient's obesity severity. The interaction of metabolic and personality factors may play a significant role in weight change following bariatric surgery.

Psychological Profiles and 12-Month Weight Outcomes of Women Evaluated for Reoperative Bariatric Surgery.

BACKGROUND: The use of psychological screening instruments prior to bariatric surgery has been well established. However, there is currently no specific literature on psychological screening of candidates for reoperative bariatric surgery. METHODS: This study evaluated archival data for 40 women who were candidates for reoperative bariatric surgery and completed the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Profile analysis examined differences between patient groups who did and did not undergo reoperative surgery. MMPI-2-RF profiles for reoperative patients then were compared to previous samples of preoperative and postoperative patients. Hierarchical linear modeling was used to predict BMI following reoperative surgery over a 12-month period based on MMPI-2-RF scales while controlling for age and initial BMI. RESULTS: Profile analysis results showed no significant differences on MMPI-2-RF scale scores between reoperative candidates who did and did not undergo a second surgery. With some minor differences attributed to minimization of symptoms, there were no systematic differences in MMPI-2-RF scale scores for reoperative surgery patients compared to preoperative and postoperative patient groups. BMI outcomes over a 12-month period showed that age and initial BMI were significantly better predictors than MMPI-2-RF scores. CONCLUSIONS: Administration of MMPI-2-RF for reoperative bariatric surgery patients likely is equivalent to its typical use in preoperative screening. Only the MMPI-2-RF Disconstraint scale showed any relationship to BMI outcomes over time following reoperative surgery.

Millon Behavioral Medicine Diagnostic Scales Do Not Predict Long-term Weight Loss Outcomes in Bariatric Surgery Patients.

BACKGROUND: Psychological factors identified during presurgical screening have the potential to identify which patients may respond better to bariatric surgery, and which patients may need additional assistance. Previous research has validated a number of potential instruments for use in presurgical screening. METHOD: This study evaluated archival data for 224 patients for a 60-month period following bariatric surgery to examine how presurgical scores on the Millon Behavioral Medicine Diagnostic predict body mass index (BMI) over time. Follow-up data was available on 96% of these patients at 12 months and 63% of these patients at 60 months. Hierarchical linear modeling was used to predict BMI based on demographic and psychopathology factors using linear and nonlinear coefficients while controlling for demographic factors and initial BMI. RESULTS: Results overall showed that demographic factors and initial BMI were significantly better predictors of BMI outcomes following bariatric surgery. Millon Behavioral Medicine Diagnostic scales did not significantly contribute to any models predicting outcomes. CONCLUSIONS: Although the Millon Behavioral Medicine Diagnostic has been recommended for presurgical screening prior to bariatric surgery, the current findings suggest that this measure and its specific scales do not predict BMI outcomes following bariatric surgery over time.

The relationship of presurgical Personality Assessment Inventory scales to BMI following bariatric surgery.

OBJECTIVE: Notwithstanding the efficacy of bariatric surgery in reducing the negative sequelae of obesity, psychological factors may play a significant role in long-term weight maintenance following surgery. Previous research on these factors has shown mixed outcomes, indicating the need for further study in samples undergoing bariatric surgery. METHOD: This study evaluated archival data for 194 patients from a single-payer system for a 60-month period following bariatric surgery to examine how presurgical scores on the Personality Assessment Inventory predict body mass index (BMI) over time. Follow-up data was available on 97% of these patients at 12 months and 62% of these patients at 60 months. Hierarchical linear modeling was used to predict BMI based on demographic and psychopathology factors using linear and nonlinear coefficients while controlling for initial BMI. RESULTS: Results showed that Personality Assessment Inventory scales assessing anxiety-related disorders, mania, and alcohol problems showed a relationship to BMI outcomes over time. Contrary to expectations, moderate elevations on anxiety-related disorders and mania were associated with a greater initial linear trend for BMI decrease, with a steeper slope for weight regain after approximately 3 years. Patients endorsing any scores above the minimum on the alcohol problems scale showed poorer BMI outcomes. CONCLUSIONS: This study extends previous research on psychological factors and weight outcomes over time among patients undergoing bariatric surgery. In contrast to a focus on clinical elevations when using broadband measures of psychopathology, these results suggest a more nuanced pattern of weight loss and subsequent regain associated with certain subclinical elevations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preoperative Psychological Assessment and Weight Loss Outcomes in Bariatric Surgery Patients at a Military Treatment Facility: A Retrospective Profile Analysis.

INTRODUCTION: Research on effectiveness of preoperative psychological measures as predictors of weight loss success and weight regain following bariatric surgery has been inconsistent. Despite mixed findings, preoperative psychological assessment instruments are used routinely, including in military medical facilities. Health concerns associated with obesity potentially impact military family readiness, with accompanying utilization of medical resources. Examining psychological factors associated with successful bariatric surgery outcomes may help to optimize care. MATERIALS AND METHODS: This retrospective, observational study sought to identify characteristic elevations on two recommended preoperative psychological assessment instruments for bariatric surgery candidates: the Personality Assessment Inventory (PAI) and the Millon Behavioral Medicine Diagnostic (MBMD). Additionally, profile analysis was performed on assessment scales based on groupings of whether or not patients (N = 194) met their ideal BMI over a 60-month period. The Institutional Review Board at Madigan Army Medical Center approved this study protocol. RESULTS: Means and standard deviations for PAI and the MBMD are presented for this sample of benefits-eligible patients in the military health system. Measures between bariatric outcome groups were not significantly different, but characteristic elevations for bariatric surgery candidates overall were identified. CONCLUSION: The average elevations of scales were not above clinical cutoff, but still indicate characteristic trends in patients undergoing surgery at an MTF. These scales may be important to attend to with bariatric surgery candidates, especially scales which are related to psychopathology, treatment prognosis, and treatment management. Study results about scale elevations on preoperative psychological assessment instruments may help patients better manage bariatric surgery and can lead to enhanced warfighter readiness and decreased utilization of healthcare resources. Future work should examine postoperative behavioral and psychological factors, as the adjustment to lifestyle limitations of bariatric surgery is substantial.

Exploring How Trait Mindfulness Relates to Perceived Stress and Cardiovascular Reactivity.

BACKGROUND: Mindfulness interventions have been associated with less global perceived stress as well as attenuated cardiovascular reactivity. The aim of the present study was to evaluate whether high levels of trait mindfulness would also be associated with these benefits. METHODS: Participants were 99 healthy young adults aged 18-25 years. Self-report measures included the Five Facet Mindfulness Questionnaire and the Perceived Stress Scale. Participants completed a laboratory stress protocol comprised of a resting baseline, a mental arithmetic stress task, and a resting recovery period. Blood pressure, heart rate, and heart rate variability were measured throughout the protocol. Regressions were used to analyze whether trait mindfulness predicted global perceived stress, cardiovascular reactivity, and cardiovascular recovery. RESULTS: Two trait mindfulness facets were found to be associated with less global perceived stress, Acting with Awareness (ß = - .306, p = .002) and Nonjudgment (ß = - .342, p < .001). Exploratory analyses also revealed an interaction between the Observe and Nonreactivity facets (p = .002), such that the Observe facet was associated with less stress only when Nonreactivity scores were also high. Although trait mindfulness was not a significant predictor of the physiological variables (p > .05, Cohen's f2 < .060), exploratory analyses revealed an interaction between the Awareness and Nonjudgment facets (p < .001), such that Awareness is associated with lower diastolic blood pressure reactivity only when Nonjudgment scores are also high. CONCLUSIONS: Like mindfulness interventions, trait mindfulness is associated with less global perceived stress. Interactions between trait mindfulness facets that reflect attention monitoring and acceptance might predict physiological reactivity in certain contexts, though a mindful state might be necessary for most real-time cardiovascular benefits.

Depressive Symptoms are Associated with Heart Rate Variability Independently of Fitness: A Cross-Sectional Study of Patients with Heart Failure.

BACKGROUND: Depression is associated with reduced heart rate variability (HRV) in healthy and cardiac samples, which may be accounted for by physical fitness. In a small sample of cardiac patients, activity and fitness levels attenuated the relationship between HRV and depression. In the current study of heart failure (HF) patients, we hypothesized that depressive symptoms and HRV would be inversely related and physical fitness would attenuate this association. PURPOSE: To determine if previous associations among depressive symptoms, physical fitness, and HRV would replicate in a sample of HF patients. METHODS: The sample consisted of HF patients (N = 125) aged 68.55 ± 8.92 years, 68.8% male, and 83.2% Caucasian. The study was cross-sectional and a secondary analysis of a nonrandomized clinical trial (Trial Identifier: NCT00871897). Depressive symptoms were evaluated using the Beck Depression Inventory (BDI)-II, fitness with the 2 min step test (2MST), and HRV during a 10 min resting laboratory psychophysiology protocol. The dependent variable in hierarchical linear regressions was the root mean square of successive differences. RESULTS: Controlling for sex, age, ß-blocker use, hypertension, and diabetes, higher BDI-II scores significantly predicted lower HRV, ß = -.29, t(92) = -2.79, p < .01. Adding 2MST did not attenuate the relationship in a follow-up regression. CONCLUSION: Depressive symptoms were associated with lower HRV in HF patients, independent of physical fitness. Given the prevalence of depression and suppressed HRV common among HF patients, interventions addressing depressive symptoms and other predictors of poor outcomes may be warranted.

Sleep quality and daytime sleepiness are not associated with cognition in heart failure.

BACKGROUND: Individuals with heart failure (HF) exhibit comorbid impairments in both sleep and cognitive performance. Sleep quality has been associated with impaired cognitive performance in HF patients, but reports are inconsistent. In this study, we examined associations between sleep quality, daytime sleepiness, and cognitive function in HF. METHODS AND RESULTS: Participants were 267 (age = 69.1 ±â€¯9.3) mostly Caucasian (74.9%), male (59.6%) stable HF patients recruited from outpatient settings. This cross-sectional study was a secondary analysis of a prospective observational study. Cognitive function domains assessed included: global cognitive function, attention, memory, and executive function. Sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), respectively. Separate multiple hierarchical linear regressions were conducted to determine associations between cognitive function and sleep quality and daytime sleepiness, after controlling for sex, New York Heart Association (NYHA) class, education, depressive symptoms, and medical comorbidities. Cognitive function was not associated with sleep quality or daytime sleepiness after alpha inflation corrections were applied. CONCLUSIONS: Cognitive function in HF is not associated with sleep quality or daytime sleepiness; other factors may exert greater influence on cognitive performance.

Executive function moderates the relationship between depressive symptoms and resting heart rate variability in heart failure.

Heart failure (HF) is associated with high rates of depression. In turn, depression is associated with reduced heart rate variability (HRV), a marker of parasympathetic dysfunction and poorer cardiac outcomes. Cognitive impairment--especially executive dysfunction--is also highly prevalent in HF, but it is unknown whether executive function (EF) impacts the depression-HRV relationship. The primary objective of this paper is to examine whether EF moderates the relationship between depression and HRV in HF. Participants were 109 HF patients. Depressive symptoms were measured using the Beck Depression Inventory-II. EF was assessed using a composite of age-adjusted T scores on the Frontal Assessment Battery, Trail Making Test B, and Stroop Color Word subtest. Parasympathetic function was assessed using resting high frequency HRV (HF-HRV). Multiple hierarchical regression was used to conduct BDI × EF moderation analyses. BDI scores were associated with reduced resting HF-HRV (p < .05). No main effects were detected between EF and resting HF-HRV (p > .05). However, EF moderated the relationship between BDI scores and resting HF-HRV (ß = 0.59, p < .01). Simple slope analyses revealed that among participants with poorer EF, higher BDI scores were associated with lower resting HF-HRV (p < .001). Structural brain changes common in HF may contribute to lower EF, increased depression, and poorer autonomic functioning. Alternatively, the results may indicate that individuals with intact EF engage in self-care strategies that negate the detrimental impact of depression on autonomic function. Additional work is needed to clarify these possibilities and the potential benefits of treating depression in HF patients with different cognitive abilities.