Introduction:
Poor psychological health is common among adults with extreme obesity (body mass index (BMI)
>
40 kg/m
2
). While prior studies report an association between psychological conditions (i.e., depression) and risk of hypertension, less is known about this association among adults with extreme obesity. Additionally, the association between other forms of poor psychological health (i.e., anxiety) and hypertension among this population have yet to be studied.
Methods:
Participants (n=281) were recruited from a large academic medical center in an urban environment who were scheduled for bariatric surgery. Informed consent was obtained from all participants. Hypertension diagnosis (yes/no) was identified from the electronic medical record of the participants within eight weeks of psychological assessment. Psychiatric diagnoses were assessed by structured clinical interview and included major depression, bipolar disorder, alcohol use disorder, substance use disorder, post-traumatic stress syndrome (PTSD), anxiety, and eating disorders. Prevalence of hypertension by psychiatric diagnosis was compared using chi-square tests. Multivariable adjusted odds ratios (aOR) for the association between poor psychological health and hypertension were calculated using logistic regression. Regression models were adjusted for age, BMI, gender, race, marital status, education, and employment status. In order to avoid collinearity, each psychiatric diagnosis was included in its own model.
Results:
The mean age of participants was 41.5 (SD=11.0) and BMI was 45.9 kg/m
2
(SD=6.2). The majority (61.2%) of participants were black and 86.5% were women. Across the sample, 42.6% of participants were married, 75.5% had more than a high school education, and 77.9% were employed. Hypertension prevalence was 44.8%. Approximately 64.4% of participants had at least one lifetime psychiatric diagnosis. Prevalence of individual lifetime diagnosis was 41.6% for major depressive disorder, 41.0% for affective/bipolar disorder, 23.2% for alcohol use disorder, 16.8% for substance use disorder, 13.6% for PTSD, 10.4% for anxiety, and 3.2% for eating disorders. Unadjusted prevalence of hypertension was higher among participants with a diagnosis of anxiety (65.4% vs. 43.3%; p=0.03) compared to those without diagnosis. Multivariable adjusted odds of hypertension were higher among participants with a diagnosis of anxiety (aOR=6.28; 95% CI: 2.07-19.04; p-value=0.001) compared to those without.
Conclusions:
Among a diverse sample of patients with extreme obesity who presented for bariatric surgery, a lifetime diagnosis of anxiety, but not other commonly seen psychiatric diagnoses, was associated with increased odds of hypertension.
Substance use after bariatric surgery: A review
