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Psychologists’ Evaluation of Bariatric Surgery Candidates Influenced by Patients’ Attachment Representations and Symptoms of Depression and Anxiety

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Abstract

This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists’ evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric surgery completed questionnaires to measure adult attachment and levels of depression and anxiety. Psychologists rated patients’ suitability for bariatric surgery using the Cleveland Clinic Behavioural Rating System (CCBRS), unaware of the results of the completed questionnaires. Attachment anxiety (OR = 2.50, p = .01) and attachment avoidance (OR = 3.13, p = .001) were found to be associated with less positive evaluations on the CCBRS by the psychologists, and symptoms of depression and anxiety mediated this association. This study strongly supports the notion that patients’ attachment representations influence a psychologist’s evaluation in an indirect way by influencing the symptoms of depression and anxiety patients report during an assessment interview. The clinical implications of these findings are discussed.

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References

  • Adams, T. D., Davidson, L. E., Litwin, S. E., Kolotkin, R. L., LaMonte, M. J., Pendleton, R. C., … Hunt, S. C. (2012). Health benefits of gastric bypass surgery after 6 years. JAMA, 308, 1122–1131.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Baron, R. K. D., & Kenny, D. A. (1986). The moderator mediator variable distinction in social psychological-research—Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  CAS  PubMed  Google Scholar 

  • Bauchowitz, A. U., Gonder-Frederick, L. A., Olbrisch, M. E., Azarbad, L., Ryee, M. Y., Woodson, M., … Schirmer, B. (2005). Psychosocial evaluation of bariatric surgery candidates: A survey of present practices. Psychosomatic Medicine, 67, 825–832.

    Article  PubMed  Google Scholar 

  • Bowlby, J. (1982). Attachment and loss: Retrospect and prospect. American Journal of Orthopsychiatry, 52, 664–678.

    Article  CAS  PubMed  Google Scholar 

  • Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult attachment: An integrative overview. Attachment theory and close relationships. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 46–76). New York: Guilford Press.

    Google Scholar 

  • Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004). Bariatric surgery: A systematic review and meta-analysis. JAMA, 292, 1724–1737.

    Article  CAS  PubMed  Google Scholar 

  • Carlsson, L. M., Peltonen, M., Ahlin, S., Anveden, A., Bouchard, C., Carlsson, B., … Sjostrom, L. (2012). Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. New England Journal of Medicine, 367, 695–704.

    Article  CAS  PubMed  Google Scholar 

  • Ciechanowski, P., Russo, J., Katon, W., Von, K. M., Ludman, E., Lin, E., … Bush, T. (2004). Influence of patient attachment style on self-care and outcomes in diabetes. Psychosomatic Medicine, 66, 720–728.

    Article  PubMed  Google Scholar 

  • Colquitt, J., Clegg, A., Loveman, E., Royle, P., & Sidhu, M. K. (2005). Surgery for morbid obesity. Cochrane Database Systematic Reviews (4), CD003641.

  • Doron, G., Moulding, R., Nedeljkovic, M., Kyrios, M., Mikulincer, M., & Sar-El, D. (2012). Adult attachment insecurities are associated with obsessive compulsive disorder. Psychology and Psychotherapy, 85, 163–178.

    Article  PubMed  Google Scholar 

  • Fabricatore, A. N., Crerand, C. E., Wadden, T. A., Sarwer, D. B., & Krasucki, J. L. (2006). How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obesity Surgery, 16, 567–573.

    Article  PubMed  Google Scholar 

  • Fabricatore, A. N., & Wadden, T. A. (2006). Obesity. Annual Review of Clinical Psychology, 2, 357–377.

    Article  PubMed  Google Scholar 

  • Fried, M., Hainer, V., Basdevant, A., Buchwald, H., Deitel, M., Finer, N., … Widhalm, K. (2007). Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obesity Surgery, 17, 260–270.

    Article  PubMed  Google Scholar 

  • Haslam, D. W., & James, W. P. (2005). Obesity. Lancet, 366, 1197–1209.

    Article  PubMed  Google Scholar 

  • Heinberg, L. J., Ashton, K., & Windover, A. (2010). Moving beyond dichotomous psychological evaluation: The Cleveland Clinic Behavioral Rating System for weight loss surgery. Surgery for Obesity and Related Diseases, 6, 185–190.

    Article  PubMed  Google Scholar 

  • Heinberg, L. J., Ashton, K., Windover, A., & Merrell, J. (2011). Older bariatric surgery candidates: Is there greater psychological risk than for young and midlife candidates? Surgery for Obesity and Related Diseases, 8, 616–622.

    Article  PubMed  Google Scholar 

  • Hinnen, C., Schreuder, I., Jong, E., Duijn, M. V., Dahmen, R., & van Gorp, E. C. (2012). The contribution of adult attachment and perceived social support to depressive symptoms in patients with HIV. AIDS Care, 24, 1535–1542.

    Article  PubMed  Google Scholar 

  • Hsu, L. K., Benotti, P. N., Dwyer, J., Roberts, S. B., Saltzman, E., Shikora, S., … Rand, W. (1998). Nonsurgical factors that influence the outcome of bariatric surgery: A review. Psychosomatic Medicine, 60, 338–346.

    CAS  PubMed  Google Scholar 

  • Kiesewetter, S., Kopsel, A., Mai, K., Stroux, A., Bobbert, T., Spranger, J., … Kallenbach-Dermutz, B. (2012). Attachment style contributes to the outcome of a multimodal lifestyle intervention. Biopsychosocial Medicine, 6, 3.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kobak, R. R., & Sceery, A. (1988). Attachment in late adolescence: Working models, affect regulation, and representations of self and others. Child Development, 59, 135–146.

    Article  CAS  PubMed  Google Scholar 

  • Kopelman, P. G. (2007). Medical management of obesity. British Journal of Hospital Medicine (London), 68, 89–93.

    Google Scholar 

  • Kurdek, L. A. (2002). On being insecure about the assessment of attachment styles. Journal of Social and Personal Relationships, 19, 811–834.

    Article  Google Scholar 

  • Lawrence, V. J., & Kopelman, P. G. (2004). Medical consequences of obesity. Clinical Dermatology, 22, 296–302.

    Article  Google Scholar 

  • Maunder, R. G., & Hunter, J. J. (2001). Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosomatic Medicine, 63, 556–567.

    CAS  PubMed  Google Scholar 

  • Maunder, R. G., & Hunter, J. J. (2009). Assessing patterns of adult attachment in medical patients. General Hospital Psychiatry, 31, 123–130.

    Article  PubMed  Google Scholar 

  • Maunder, R. G., Panzer, A., Viljoen, M., Owen, J., Human, S., & Hunter, J. J. (2006). Physicians’ difficulty with emergency department patients is related to patients’ attachment style. Social Science and Medicine, 63, 552–562.

    Article  PubMed  Google Scholar 

  • Melissas, J. (2008). IFSO guidelines for safety, quality, and excellence in bariatric surgery. Obesity Surgery, 18, 497–500.

    Article  PubMed  Google Scholar 

  • Mikulincer, M. (1998). Adult attachment style and individual differences in functional versus dysfunctional experiences of anger. Journal of Personality and Social Psychology, 74, 513–524.

    Article  CAS  PubMed  Google Scholar 

  • Mikulincer, M., Florian, V., & Weller, A. (1993). Attachment styles, coping strategies, and posttraumatic psychological distress: The impact of the Gulf War in Israel. Journal of Personality and Social Psychology, 64, 817–826.

    Article  CAS  PubMed  Google Scholar 

  • Mikulincer, M., & Shaver, P. R. (2012). An attachment perspective on psychopathology. World Psychiatry, 11, 11–15.

    Article  PubMed Central  PubMed  Google Scholar 

  • Pawlow, L. A., O’Neil, P. M., White, M. A., & Byrne, T. K. (2005). Findings and outcomes of psychological evaluations of gastric bypass applicants. Surgery for Obesity and Related Diseases, 1, 523–527.

    Article  PubMed  Google Scholar 

  • Riggs, S. A., Vosvick, M., & Stallings, S. (2007). Attachment style, stigma and psychological distress among HIV+ adults. Journal of Health Psychology, 12, 922–936.

    Article  PubMed  Google Scholar 

  • Ritz, S. J. (2006). The bariatric psychological evaluation: A heuristic for determining the suitability of the morbidly obese patient for weight loss surgery. Bariatric Nursing and Surgical Patient Care, 1, 97–105.

    Article  Google Scholar 

  • Rodin, G., Walsh, A., Zimmermann, C., Gagliese, L., Jones, J., Shepherd, F. A., … Mikulincer, M. (2007). The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer. Psychooncology, 16, 1080–1091.

    Article  PubMed  Google Scholar 

  • Sadhasivam, S., Larson, C. J., Lambert, P. J., Mathiason, M. A., & Kothari, S. N. (2007). Refusals, denials, and patient choice: Reasons prospective patients do not undergo bariatric surgery. Surgery for Obesity and Related Diseases, 3, 531–535.

    Article  PubMed  Google Scholar 

  • Sarwer, D. B., Wadden, T. A., & Fabricatore, A. N. (2005). Psychosocial and behavioral aspects of bariatric surgery. Obesity Research, 13, 639–648.

    Article  PubMed  Google Scholar 

  • Snyder, A. G. (2009). Psychological assessment of the patient undergoing bariatric surgery. Ochsner Journal, 9, 144–148.

    PubMed  Google Scholar 

  • Sobel, M. E. (1990). Effect analysis and causation in linear structural equation models. Psychometrika, 55, 495–515.

    Article  Google Scholar 

  • Sockalingam, S., Wnuk, S., Strimas, R., Hawa, R., & Okrainec, A. (2011). The association between attachment avoidance and quality of life in bariatric surgery candidates. Obesity Facts, 4, 456–460.

    Article  PubMed  Google Scholar 

  • Tsuda, S., Barrios, L., Schneider, B., & Jones, D. B. (2009). Factors affecting rejection of bariatric patients from an academic weight loss program. Surgery for Obesity and Related Diseases, 5, 199–202.

    Article  PubMed  Google Scholar 

  • van Hout, G. C., Vreeswijk, C. M., & van Heck, G. L. (2008). Bariatric surgery and bariatric psychology: Evolution of the Dutch approach. Obesity Surgery, 18, 321–325.

    Article  PubMed  Google Scholar 

  • Visscher, T. L., & Seidell, J. C. (2001). The public health impact of obesity. Annual Review of Public Health, 22, 355–375.

    Article  CAS  PubMed  Google Scholar 

  • Wadden, T. A., & Sarwer, D. B. (2006). Behavioral assessment of candidates for bariatric surgery: A patient-oriented approach. Surgery for Obesity and Related Diseases, 2, 171–179.

    Article  PubMed  Google Scholar 

  • Walfish, S., Vance, D., & Fabricatore, A. N. (2007). Psychological evaluation of bariatric surgery applicants: Procedures and reasons for delay or denial of surgery. Obesity Surgery, 17, 1578–1583.

    Article  PubMed  Google Scholar 

  • Ward, M. J., Lee, S. S., & Polan, H. J. (2006). Attachment and psychopathology in a community sample. Attachment and Human Development, 8, 327–340.

    Article  PubMed  Google Scholar 

  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavia, 67, 361–370.

    Article  CAS  Google Scholar 

Download references

Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Conflict of interest

Floor Aarts, Chris Hinnen, Victor E.A. Gerdes, Yair Acherman and Dees P.M. Brandjes declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands

    Floor Aarts, Victor E. A. Gerdes & Dees P. M. Brandjes

  2. Department of Medical Psychology/Hospital Psychiatry, Slotervaart Hospital, Amsterdam, The Netherlands

    Floor Aarts & Chris Hinnen

  3. Section Health Psychology, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

    Chris Hinnen

  4. Department of Surgery, Slotervaart Hospital, Amsterdam, The Netherlands

    Yair Acherman

  5. Department of Vascular Medicine, Academic Medical Centre (AMC), Amsterdam, The Netherlands

    Victor E. A. Gerdes & Dees P. M. Brandjes

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  1. Floor Aarts
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Correspondence to Floor Aarts.

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Aarts, F., Hinnen, C., Gerdes, V.E.A. et al. Psychologists’ Evaluation of Bariatric Surgery Candidates Influenced by Patients’ Attachment Representations and Symptoms of Depression and Anxiety. J Clin Psychol Med Settings 21, 116–123 (2014). https://doi.org/10.1007/s10880-014-9385-4

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  • DOI: https://doi.org/10.1007/s10880-014-9385-4

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