Mental health in individuals who have undergone metabolic bariatric surgery: a cross-sectional study using mediation analysis

This study investigated factors associated with mental health outcomes in individuals who have undergone Metabolic Bariatric Surgery (MBS). A sample of 238 adults with history of MBS was assessed with the 21-item Depression and Anxiety Stress Scale (DASS-21), Difficulties in Emotion Regulation Scale (DERS-SF), and the 24-item Body Investment Scale (BIS). Regression and mediation models were employed to investigate factors associated with mental health outcomes. Higher levels of DASS-Depression (β = 2.09, p = 0.03), and DASS-Stress scores (β = 2.49, p = 0.01) were found in individual who have undergone MBS longer ago, in comparison with individuals who underwent MBS more recently. DERS-SF emotion regulation dimensions Strategies (Boot β = 0.81; 95%CI: [0.21, 1.93]; p = 0.005), and BIS dimension Body-Image (Boot β = 1.10; 95%CI: [0.48, 2.03]; p < 0.001), were found to significantly mediate the association between obesity and DASS-21 Depression. BIS-Body image also mediated the association between obesity and DASS-21 Anxiety (Boot β = 0.67; 95%CI: [0.14, 1.38]; p = 0.009) and DASS-21 Stress (Boot β = 1.97; 95%CI: [0.57, 3.86]; p < 0.002). Mental health problems might be present in individuals who have undergone MBS long time ago, despite potential treatment benefits, with presence of obesity and specific emotion regulation and body-investment difficulties being associated with greater depression, anxiety and stress symptomatology.