Outcomes of Bariatric Surgery among Patients with Bipolar Disorder

双相情感障碍患者减肥手术的结果

• 批准号: 8177335
• 负责人: Ameena T Ahmed
• 金额: $ 18.94万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-20 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8177335
• 关键词: Adult; Affect; Age; Behavioral; Bipolar Disorder; Body Weight decreased; California; Cardiovascular Diseases; Cholesterol; Clinic; Cohort Studies; Comorbidity; Data; Decision Making; Diabetes Mellitus; Diagnosis; Dyslipidemias; Excess Mortality; General Population; Goals; High Prevalence; Hospitalization; Hypertension; Knowledge; Life Style; Light; Linear Regressions; Logistic Regressions; Major Depressive Disorder; Metabolic; Mood Disorders; Morbid Obesity; Obesity; Obesity associated disease; Operative Surgical Procedures; Outcome; Outpatients; Patients; Physicians; Population; Prevalence; Procedures; Publishing; Resolution; Risk; Symptoms; Visit; Weight; bariatric surgery; base; blood pressure regulation; clinical decision-making; cohort; diabetes control; effective therapy; evidence base; follow-up; high risk; meetings; mortality; obesity risk; programs; psychologic; success; weight loss intervention; years of life lost

DESCRIPTION (provided by applicant): The overarching goal of this proposal is to determine how bariatric surgery affects psychiatric and metabolic outcomes among patients with bipolar disorder (BD). BD patients are at increased risk of obesity and suffer increased rates of obesity-related comorbidities. They have an estimated 25 years life lost, largely due to cardiovascular disease. There is an urgent need for knowledge about how best to treat obesity and mitigate associated comorbidities among bipolar disorder patients. Bariatric surgery is the most effective treatment for morbid obesity. Although BD patients suffer disproportionately from obesity, there is virtually no published data on how bariatric surgery affects psychiatric or metabolic course in this population. We propose a retrospective cohort study to examine psychiatric and metabolic outcomes during up to 3 years follow-up among all H100,000 morbidly obese adult patients (2000 BD, 13,000 major depressive disorder, 85,000 neither affective disorder) age 18-69 in Kaiser Permanente Northern California, between 2006 and 2009. Within the cohort, 5149 patients (171 BD, 1999 major depressive disorder, 2979 neither affective disorder) underwent bariatric surgery during the study period. We propose three aims: (1) Determine if predictors of referral to bariatric surgery, and of undergoing bariatric surgery, differ by affective disorder diagnosis (BD, major depressive disorder, neither); (2) Among n=2000 morbidly obese bipolar disorder patients who meet criteria for bariatric surgery, determine if bariatric surgery affects psychiatric course (risk of psychiatric hospitalization, outpatient psychiatric utilization); and (3) Among n=5149 patients who underwent bariatric surgery (171 BD, 1999 major depression, 2979 neither affective disorder), determine if affective disorder is associated with weight loss and metabolic outcomes (diabetes, hypertension, dyslipidemia). We will employ longitudinal data representation from the counterfactual statistical framework. Multiple linear regression will be employed for linear outcomes (weight loss, number of outpatient visits), and multiple logistic regression will be employed for dichotomous outcomes. This study will be the first to present data on outcomes of bariatric surgery among bipolar disorder patients. Current, there are no BD-specific data on which to base clinic decision making in this population. As the excess mortality in BD is largely due to cardiovascular disease, this study will provide essential information to guide clinical decision making for morbidly obese BD patients and their physicians. PUBLIC HEALTH RELEVANCE: People with bipolar disorder suffer higher risk of obesity and associated diseases such as diabetes and cardiovascular disease. We propose to study how the most effective obesity therapy, bariatric surgery, affects psychiatric course, weight loss, and improvement in obesity-associated diseases (diabetes, hypertension, high cholesterol) among bipolar disorder patients. Ours will be the first study of bariatric surgery outcomes in bipolar disorder, and will provided much-needed information to help bipolar disorder patients and their physicians make decisions about treatment options for morbid obesity.

描述（由申请人提供）：本提案的总体目标是确定减肥手术如何影响双相情感障碍（BD）患者的精神和代谢结局。BD患者肥胖的风险增加，并且肥胖相关合并症的发生率增加。他们估计有25年的寿命损失，主要是由于心血管疾病。目前迫切需要了解如何最好地治疗肥胖和减轻双相情感障碍患者的相关合并症。减肥手术是治疗病态肥胖最有效的方法。虽然BD患者不成比例地患有肥胖症，但几乎没有关于减肥手术如何影响这一人群的精神或代谢过程的公开数据。我们提出了一项回顾性队列研究，以检查2006年至2009年期间在北方加州的Kaiser Permanente所有10万例18-69岁的病态肥胖成年患者（2000例BD，13，000例重度抑郁症，85，000例非情感性障碍）中长达3年随访期间的精神和代谢结局。在队列中，5149例患者（171例BD，1999例重度抑郁症，2979例非情感性障碍）在研究期间接受了减肥手术。我们提出三个目标：（1）确定是否转介到减肥手术和接受减肥手术的预测因子，因情感障碍诊断而不同（BD，重性抑郁障碍，两者都不）;（2）在n=2000例符合减肥手术标准的病态肥胖双相情感障碍患者中，确定减肥手术是否影响精神病病程（精神病住院风险、门诊精神病利用）;（3）在n=5149例接受减肥手术的患者中，（171 BD，1999重度抑郁症，2979非情感障碍），确定情感障碍是否与体重减轻和代谢结果（糖尿病，高血压，血脂异常）相关。我们将采用来自反事实统计框架的纵向数据表示。将采用多元线性回归分析线性结局（体重减轻、门诊访视次数），将采用多元logistic回归分析二分结局。这项研究将是第一个提供双相情感障碍患者减肥手术结果的数据。目前，尚无BD特定数据可作为该人群临床决策的依据。由于BD的死亡率过高主要是由于心血管疾病，因此本研究将为指导病态肥胖BD患者及其医生的临床决策提供重要信息。 公共卫生关系：患有双相情感障碍的人患肥胖症和相关疾病如糖尿病和心血管疾病的风险更高。我们建议研究如何最有效的肥胖治疗，减肥手术，影响精神疾病的过程中，体重减轻，并改善肥胖相关疾病（糖尿病，高血压，高胆固醇）的双相情感障碍患者。我们的研究将是双相情感障碍减肥手术结果的第一项研究，并将提供急需的信息，以帮助双相情感障碍患者和他们的医生决定病态肥胖的治疗方案。