ADHD, Impulsivity, and Affective Symptoms in Metabolic and Bariatric Surgery Candidates

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized among metabolic and bariatric surgery candidates and has been associated with affective burden, impulsivity, and difficulties with treatment adherence. This study assessed the prevalence of ADHD diagnosed with a structured clinical interview and examined its associations with depressive symptoms, anxiety, and impulsivity in adults undergoing preoperative psychological evaluation for metabolic and bariatric surgery. METHODS: Seventy adults with obesity undergoing routine bariatric qualification were assessed for ADHD using the Diagnostic Interview for ADHD in Adults, DSM-5 version (DIVA-5), and completed the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Barratt Impulsiveness Scale-11 (BIS-11). Group comparisons were conducted between participants with and without ADHD. Two multivariable linear regression models examined predictors of depressive symptom severity and anxiety severity, including age, sex, BMI, ADHD diagnosis, and impulsivity. RESULTS: ADHD was diagnosed in 18.6% of participants (13/70). Compared with participants without ADHD, those with ADHD reported significantly higher depressive symptoms, anxiety symptoms, and impulsivity, and more frequently met criteria for depressive and anxiety disorders. In multivariable analyses, female sex, ADHD diagnosis, and impulsivity independently predicted depressive symptom severity, whereas female sex and ADHD diagnosis predicted anxiety severity. CONCLUSION: ADHD was relatively common in this sample of metabolic and bariatric surgery candidates and was independently associated with greater depressive and anxiety symptom severity. Impulsivity provided additional explanatory value for depressive symptoms beyond ADHD diagnosis. These findings support targeted screening for ADHD symptoms and impulsivity during preoperative psychological evaluation to identify patients who may benefit from enhanced psychological support before metabolic and bariatric surgery.