Background

The long-term effects of bariatric surgery on the mental health of adolescents with severe obesity remain uncertain. We aimed to describe the prevalence of psychiatric health-care visits and filled prescription psychiatric drugs among adolescents with severe obesity undergoing bariatric surgery in the 5 years preceding surgery and throughout the first 10 years after surgery, and to draw comparisons with matched adolescents in the general population.

Methods

Adolescents with severe obesity and who underwent bariatric surgery were identified through the Scandinavian Obesity Surgery Registry. We included adolescents who had bariatric surgery between 2007 and 2017 and were younger than 21 years at time of surgery. Each adolescent patient was matched with ten adolescents from the general population by age, sex, and county of residence. Specialist psychiatric care and filled psychiatric prescriptions were retrieved from nationwide data registers.

Findings

1554 adolescents (<21 years) with severe obesity underwent bariatric surgery between 2007 and 2017, 1169 (75%) of whom were female. At time of surgery, the mean age was 19·0 years [SD 1·0], and the mean BMI was 43·7 kg/m² (SD 5·5). 15 540 adolescents from the general population were matched with adolescents in the surgery group. 5 years before the matched index date, 95 (6·2%) of 1535 surgery patients and 370 (2·5%) of 14 643 matched adolescents had a psychiatric health-care visit (prevalence difference 3·7%; 95% CI 2·4–4·9), whereas 127 (9·8%) of 1295 surgery patients and 445 (3·6%) of 12 211 matched adolescents filled a psychiatric drug prescription (prevalence difference 6·2%; 95% CI 4·5–7·8). The year before the matched index date, 208 (13·4%) of 1551 surgery patients and 844 (5·5%) of 15 308 matched adolescents had a psychiatric health-care visit (prevalence difference 7·9%; 95% CI 6·2–9·6), whereas 319 (20·6%) of 1551 surgery patients and 1306 (8·5%) of 15 308 matched adolescents filled a psychiatric drug prescription (prevalence difference 12·0%; 10·0–14·1). The prevalence difference in psychiatric health-care visits peaked 9 years after the matched index date (12·0%; 95% CI 9·0–14·9), when 119 (17·6%) of 675 surgery patients and 377 (5·7%) of 6669 matched adolescents had a psychiatric health-care visit. The prevalence difference in filled psychiatric drug prescription was highest 10 years after the matched index date (20·4%; 15·9–24·9), when 171 (36·5%) of 469 surgery patients and 739 (16·0%) of 4607 matched adolescents filled a psychiatric drug prescription. The year before the matched index date, 19 (1·2%) of 1551 surgery patients and 155 (1·0%) of 15304 matched adolescents had a health-care visit associated with a substance use disorder diagnosis (mean difference 0·2%, 95% CI –0·4 to 0·8). 10 years after the matched index date, the prevalence difference had increased to 4·3% (95% CI 2·3–6·4), when 24 (5·1%) of 467 surgery patients and 37 (0·8%) of 4582 matched adolescents had a health-care visit associated with a substance use disorder diagnosis.

Interpretation

Psychiatric diagnoses and psychiatric drug prescriptions were more common among adolescents with severe obesity who would later undergo bariatric surgery than among matched adolescents from the general population. Both groups showed an increase in prevalence in psychiatric diagnoses and psychiatric drug prescriptions leading up to the time of surgery, but the rate of increase in the prevalence was higher among adolescents with severe obesity than among matched adolescents. With the exception of health-care visits for substance use disorders, these prevalence trajectories continued in the 10 years of follow-up. Realistic expectations regarding mental health outcomes should be set preoperatively.

Funding

Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare.

中文翻译：

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严重肥胖青少年减肥手术前 5 年至术后 10 年的心理健康状况：一项瑞典全国队列研究，采用匹配的人群对照

背景

减肥手术对严重肥胖青少年心理健康的长期影响仍不确定。我们的目的是描述接受减肥手术的严重肥胖青少年在手术前 5 年和手术后 10 年期间接受精神科保健就诊和服用处方精神科药物的情况，并与一般情况下匹配的青少年进行比较。人口。

方法

通过斯堪的纳维亚肥胖手术登记处确定了严重肥胖和接受减肥手术的青少年。我们纳入了 2007 年至 2017 年间接受减肥手术且手术时年龄小于 21 岁的青少年。每个青少年患者都与来自一般人群的十名青少年按年龄、性别和居住县进行匹配。从全国数据登记册中检索了专业精神科护理和填写的精神科处方。

发现

2007年至2017年间，1554名严重肥胖青少年（<21岁）接受了减肥手术，其中1169名（75%）是女性。手术时，平均年龄为 19·0 岁 [SD 1·0]，平均 BMI 为 43·7 kg/m ² (SD 5·5)。来自普通人群的 15 540 名青少年与手术组的青少年进行了匹配。在匹配索引日期前 5 年，1535 名手术患者中的 95 名 (6·2%) 和 14 643 名匹配青少年中的 370 名 (2·5%) 进行过精神科保健就诊（患病率差异 3·7%；95% CI 2·4–4·9），而 1295 名手术患者中的 127 名（9·8%）和 12 211 名匹配青少年中的 445 名（3·6%）服用了精神科药物（患病率差异 6·2%；95% CI 4·5–7·8）。在匹配索引日期前一年，1551 名手术患者中的 208 名 (13·4%) 和 15 308 名匹配青少年中的 844 名 (5·5%) 进行了精神科保健就诊（患病率差异 7·9%；95% CI 6·2–9·6)，而 1551 名手术患者中的 319 名 (20·6%) 和 15 308 名匹配青少年中的 1306 名 (8·5%) 服用了精神科药物处方（患病率差异 12·0%；10·0 –14·1)。精神科医疗就诊的患病率差异在匹配索引日期后 9 年达到峰值（12·0%；95% CI 9·0–14·9），当时 675 名手术患者中有 119 名（17·6%），377 名（12·0%；95% CI 9·0–14·9）。 6669 名匹配的青少年中有 5·7%) 接受过精神科保健就诊。匹配索引日期后 10 年，精神科药物处方的患病率差异最高（20·4%；15·9–24·9），当时 469 名手术患者中的 171 名（36·5%）和 739 名（16·0） %) 4607 名匹配的青少年服用了精神科药物处方。在匹配索引日期前一年，1551 名手术患者中的 19 名 (1·2%) 和 15304 名匹配青少年中的 155 名 (1·0%) 进行了与物质使用障碍诊断相关的医疗保健就诊（平均差 0·2 %，95% CI –0·4 至 0·8)。匹配索引日期后 10 年，患病率差异增加至 4·3% (95% CI 2·3–6·4)，467 名手术患者中有 24 名 (5·1%) 和 37 名 (0·8%) ）对 4582 名匹配的青少年进行了与物质使用障碍诊断相关的医疗保健就诊。

解释

与普通人群中的匹配青少年相比，后来接受减肥手术的严重肥胖青少年的精神病诊断和精神药物处方更为常见。两组患者在手术前的精神科诊断和精神科药物处方的患病率均有所增加，但严重肥胖青少年的患病率增长率高于匹配的青少年。除了因药物滥用障碍而进行的医疗保健就诊之外，这些患病率轨迹在 10 年的随访中持续存在。应在术前设定有关心理健康结果的现实期望。

资金

瑞典研究委员会、瑞典健康、工作生活和福利研究委员会。