Skip to main content

Advertisement

SpringerLink
Log in

Distress Tolerance and Psychological Comorbidity in Patients Seeking Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Introduction/Purpose

Distress intolerance is characterized by a low threshold for negative emotional experiences and lack of emotion regulation and has been shown to predict various health outcomes. As such, the primary aim of this study was to determine the association between distress tolerance and psychological variables (eating behaviors, mood, substance use, trauma history), completion of bariatric surgery, and post-bariatric surgery weight loss outcomes and follow up with a provider.

Materials and Methods

Two hundred forty-eight patients (75 % female, 89 % Caucasian) underwent a multidisciplinary evaluation for bariatric surgery and were assessed for psychiatric disorders via semi-structured clinical interview and psychometric questionnaires.

Results

Low distress tolerance was associated with symptoms of depression (p ≤ 0.001), anxiety (p ≤ 0.001), disordered eating behaviors (p ≤ 0.001), substance abuse (p ≤ 0.001), a history of being the victim of childhood sexual abuse (p ≤ 0.001), and with high BMI (p < .05). Patients endorsing higher levels of distress tolerance were more likely to undergo bariatric surgery (p < .01). Distress tolerance was not related to 2-year post-surgical weight loss outcomes or follow up with a provider.

Conclusion

The ability to tolerate negative affect may be a variable that differentiates which patients undergo bariatric surgery rather than early postoperative outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.

    Article  CAS  PubMed  Google Scholar 

  2. Courcoulas AP, Yanovski SZ, Bonds D, et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014;149(12):1323–9.

    Article  PubMed  Google Scholar 

  3. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. Jama. 2013;310(22):2416–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Batsis JA, Lopez-Jimenez F, Collazo-Clavell ML, et al. Quality of life after bariatric surgery: a population-based cohort study. Am J Med. 2009;1055(11):e1–e10.

    Google Scholar 

  5. Batsis JA, Clark MM, Grothe K, et al. Self-efficacy after bariatric surgery for obesity. A population-based cohort study. Appetite. 2009;52(3):637–45.

    Article  PubMed  Google Scholar 

  6. Miranda WR, Batsis JA, Sarr MG, et al. Impact of bariatric surgery on quality of life, functional capacity, and symptoms in patients with heart failure. Obes Surg. 2013;23(7):1011–5.

    Article  PubMed  Google Scholar 

  7. Kolotkin RL, Davidson LE, Crosby RD, et al. Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups. Surg Obes Relat Dis. 2012;8(5):625–33.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lindekilde N, Gladstone BP, Lubeck M, et al. The impact of bariatric surgery on quality of life: a systematic review and meta-analysis. Obes Rev. 2015;16(8):639–51.

    Article  CAS  PubMed  Google Scholar 

  9. Wolfe BM, Morton JM. Weighing in on bariatric surgery: procedure use, readmission rates, and mortality. Jama. 2005;294(15):1960–3.

    Article  CAS  PubMed  Google Scholar 

  10. Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1):70–89.

    Article  PubMed  Google Scholar 

  11. Sadhasivam S, Larson CJ, Lambert PJ, et al. Refusals, denials, and patient choice: reasons prospective patients do not undergo bariatric surgery. Surg Obes Relat Dis. 2007;3(5):531–5.

    Article  PubMed  Google Scholar 

  12. Balsiger BM, Kennedy FP, Abu-Lebdeh HS, et al. Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity. Mayo Clin Proc. 2000;75(7):673–80.

    Article  CAS  PubMed  Google Scholar 

  13. Benotti PN, Still CD, Wood GC, et al. Preoperative weight loss before bariatric surgery. Arch Surg. 2009;144(12):1150–5.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wee CC, Mukamal KJ, Huskey KW, et al. High-risk alcohol use after weight loss surgery. Surg Obes Relat Dis. 2014;10(3):508–13.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Simmons JG RM. The Distress Tolerance Scale: development and validation of a self-report measure. Motiv Emot. 2005;29(2):83–102.

    Article  Google Scholar 

  16. O’Cleirigh C, Ironson G, Smits JA. Does distress tolerance moderate the impact of major life events on psychosocial variables and behaviors important in the management of HIV? Behav Ther. 2007;38(3):314–23.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kutz A, Marshall E, Bernstein A, et al. Evaluating emotional sensitivity and tolerance factors in the prediction of panic-relevant responding to a biological challenge. J Anxiety Disord. 2010;24(1):16–22.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Perkins KA, Karelitz JL, Giedgowd GE, et al. Differences in negative mood-induced smoking reinforcement due to distress tolerance, anxiety sensitivity, and depression history. Psychopharmacology (Berl). 2010;210(1):25–34.

    Article  CAS  Google Scholar 

  19. Buckner JD, Keough ME, Schmidt NB. Problematic alcohol and cannabis use among young adults: the roles of depression and discomfort and distress tolerance. Addict Behav. 2007;32(9):1957–63.

    Article  PubMed  Google Scholar 

  20. Galen LW, Henderson MJ, Coovert MD. Alcohol expectancies and motives in a substance abusing male treatment sample. Drug Alcohol Depend. 2001;62(3):205–14.

    Article  CAS  PubMed  Google Scholar 

  21. Simons JS, Gaher RM, Correia CJ, et al. An affective-motivational model of marijuana and alcohol problems among college students. Psychol Addict Behav. 2005;19(3):326–34.

    Article  PubMed  Google Scholar 

  22. Anestis MD, Selby EA, Fink EL, et al. The multifaceted role of distress tolerance in dysregulated eating behaviors. Int J Eat Disord. 2007;40(8):718–26.

    Article  PubMed  Google Scholar 

  23. Kozak AT, Fought A. Beyond alcohol and drug addiction. Does the negative trait of low distress tolerance have an association with overeating? Appetite. 2011;57(3):578–81.

    Article  PubMed  Google Scholar 

  24. Yanos BR, Saules KK, Schuh LM, et al. Predictors of Lowest Weight and Long-Term Weight Regain Among Roux-en-Y Gastric Bypass Patients. Obes Surg. 2015;25(8):1364–70.

    Article  PubMed  Google Scholar 

  25. de Zwaan M, Enderle J, Wagner S, et al. Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord. 2011;133(1–2):61–8.

    Article  PubMed  Google Scholar 

  26. Grothe KB, Mundi MS, Himes SM, et al. Bipolar disorder symptoms in patients seeking bariatric surgery. Obes Surg. 2014;24(11):1909–14.

    Article  PubMed  Google Scholar 

  27. Conason A, Teixeira J, Hsu CH, et al. Substance use following bariatric weight loss surgery. JAMA Surg. 2013;148(2):145–50.

    Article  PubMed  Google Scholar 

  28. Wadden TA, Faulconbridge LF, Jones-Corneille LR, et al. Binge eating disorder and the outcome of bariatric surgery at one year: a prospective, observational study. Obesity (Silver Spring). 2011;19(6):1220–8.

    Article  PubMed Central  Google Scholar 

  29. Colles SL, Dixon JB. Night eating syndrome: impact on bariatric surgery. Obes Surg. 2006;16(7):811–20.

    Article  PubMed  Google Scholar 

  30. Fischer S, Chen E, Katterman S, et al. Emotional eating in a morbidly obese bariatric surgery-seeking population. Obes Surg. 2007;17(6):778–84.

    Article  PubMed  Google Scholar 

  31. Association AP. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington. London: Washington DC; 2013.

    Google Scholar 

  32. Beck AT, Steer RA, Brown G. Manual for the Beck Depression Inventory-II. 2nd ed. San Antonio, TX: Psychological Corporation; 1996.

    Google Scholar 

  33. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder. JAMA Intern Med. 2006;166(10):1092–7.

    Article  Google Scholar 

  34. Bernstein DP, Fink L, Handelsman L, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatr. 1994;151(8):1132–6.

    Article  CAS  PubMed  Google Scholar 

  35. Clark MM, Abrams DB, Niaura RS, et al. Self-efficacy in weight management. J Consult Clin Psychol. 1991;59(5):739–44.

    Article  CAS  PubMed  Google Scholar 

  36. Clark MM, Hanna BK, Mai JL, et al. Sexual abuse survivors and psychiatric hospitalization after bariatric surgery. Obes Surg. 2007;17(4):465–9.

    Article  PubMed  Google Scholar 

  37. Cunningham JL, Merrell CC, Sarr M, et al. Investigation of antidepressant medication usage after bariatric surgery. Obes Surg. 2012;22(4):530–5.

    Article  PubMed  Google Scholar 

  38. King WC, Chen JY, Mitchell JE, et al. Prevalence of alcohol use disorders before and after bariatric surgery. Jama. 2012;307(23):2516–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Cuellar-Barboza AB, Frye MA, Grothe K, et al. Change in consumption patterns for treatment-seeking patients with alcohol use disorder post-bariatric surgery. J Psychosom Res. 2015;78(3):199–204.

    Article  PubMed  Google Scholar 

  40. Raebel MA, Newcomer SR, Reifler LM, et al. Chronic use of opioid medications before and after bariatric surgery. Jama. 2013;310(13):1369–76.

    Article  CAS  PubMed  Google Scholar 

  41. Himes SM, Grothe KB, Clark MM, et al. Stop regain: a pilot psychological intervention for bariatric patients experiencing weight regain. Obes Surg. 2015;25(5):922–7.

    Article  PubMed  Google Scholar 

  42. Pontiroli AE, Fossati A, Vedani P, et al. Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients. Obes Surg. 2007;17(11):1492–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Behavioral Health, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA

    Afton M. Koball

  2. Department of Psychiatry and Behavioral Medicine, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA

    Susan M. Himes

  3. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA

    Leslie Sim, Matthew M. Clark, Karen Graszer & Karen B. Grothe

  4. Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Maria L. Collazo-Clavell & Manpreet Mundi

  5. Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Todd Kellogg

Authors
  1. Afton M. Koball
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan M. Himes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leslie Sim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew M. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria L. Collazo-Clavell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Manpreet Mundi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Todd Kellogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Karen Graszer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Karen B. Grothe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen B. Grothe.

Ethics declarations

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”

Conflict of Interest

The authors declare that they have no competing interests.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koball, A.M., Himes, S.M., Sim, L. et al. Distress Tolerance and Psychological Comorbidity in Patients Seeking Bariatric Surgery. OBES SURG 26, 1559–1564 (2016). https://doi.org/10.1007/s11695-015-1926-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1926-x

Keywords

Search

Navigation