Long-term Mental Health Outcomes of Bariatric Surgery

 描述(申请人提供)：大量随机试验和观察性研究发现，Roux-en-Y胃分流术、可调节胃束带和垂直袖状胃切除术可显著减轻体重并改善对许多慢性病的控制。因此，减肥手术的比率在过去20年里有所上升。减肥手术有短期好处，但对长期结果，特别是精神健康结果知之甚少。新的证据表明，减肥手术可能会导致新的阿片类药物使用障碍(OUD)或酒精滥用(AM)，并加剧现有的AM或OUD。与超重和正常体重的人相比，肥胖的人患AM的几率更高，而且AM在手术后两年似乎会恶化。肥胖者患抑郁症的比例也更高，手术后1-2年，抑郁症的发病率似乎有所下降。减肥手术可能在短期内对OUD和AM有不利影响，但对于减肥手术后5年的这些结果几乎一无所知，因为检验这些结果的少数研究仅限于主要非美国手术队列的1-2年随访，并且缺乏非手术患者来解释回归到平均值的原因。在男性或老年患者的减肥手术后，AM、处方阿片类药物滥用或抑郁也存在重大证据缺口，因为检查这些结果的为数不多的研究大多由年轻女性患者组成。此外，没有证据表明这些问题是否会缓和手术对3年后体重变化的影响。我们已经对退伍军人减肥手术后的结果进行了几项研究。基于我们对2002-2011年接受减肥手术的2257名退伍军人和7000名非手术对照的配对队列的经验，我们建议在四个具体目标中解决关于手术后5年AM、OUD和抑郁症治疗的关键证据差距：目标1：检查减肥手术患者和匹配的有和没有公认AM病史的非手术患者AM患病率的长期趋势目的2：检测减肥手术患者和配对的阿片类药物滥用患者中处方阿片类药物滥用的长期变化。目的3：在基线条件下，检查减肥手术患者以及接受和不接受抑郁治疗的匹配患者的长期抑郁治疗率。目的4：检查基线AM、处方阿片类药物使用和抑郁症治疗是否缓和了减肥手术对长期体重变化的影响。次要目的：检查接受RYGB、AGB或VSG的患者术后AM、处方阿片类药物使用和抑郁治疗的长期变化是否有所不同。

 DESCRIPTION (provided by applicant): Numerous randomized trials and observational studies have found that Roux-en-Y gastric bypass, adjustable gastric banding, and vertical sleeve gastrectomy cause dramatic weight loss and improved control of many chronic conditions. As a result, rates of bariatric surgery have increased over the past two decades. Bariatric surgery has short term benefits but less is known about long-term outcomes, particularly mental health outcomes. Emerging evidence suggests that bariatric surgery may induce new onset opioid use disorder (OUD) or alcohol misuse (AM) and exacerbate existing AM or OUD. Obese people have greater rates of AM than overweight and normal weight people and AM appears to worsen two years after surgery. Obese people also have greater rates of depression, which appears to decrease 1-2 years after surgery. Bariatric surgery may have adverse effects on OUD and AM in the short term, but almost nothing is known about these outcomes 5 years after bariatric surgery, because the few studies examining these outcomes were limited to 1- 2 year follow-up of predominantly non-US surgical cohorts and lacked non-surgical patients to account for regression to the mean. There is also a major evidence gap for AM, prescription opioid misuse or depression after bariatric surgery in men or older patients because the few studies examining these outcomes were mostly comprised of younger female patients. Further, there is no evidence whether these issues moderate the effect of surgery on weight change beyond 3 years. We have conducted several studies of veterans' outcomes following bariatric surgery. Building on our experience with matched cohorts of 2,257 veterans undergoing bariatric surgery in 2002-2011 and >7,000 non- surgical controls, we propose to address critical evidence gaps about 5-year post-surgical rates of AM, OUD and depression treatment in four specific aims: Aim 1: Examine long-term trends in the prevalence of AM (based on a validated screen) among bariatric surgery patients and matched non-surgical patients with and without a history of recognized AM. Aim 2: Examine long-term change in prescription opioid misuse among bariatric surgery patients and matched patients with and without opioid misuse at baseline. Aim 3: Examine long-term rates of depression treatment among bariatric surgery patients and matched patients with and without depression treatment at baseline. Aim 4: Examine whether baseline AM, prescription opioid use, and depression treatment moderate the effect of bariatric surgery on long-term weight change. Secondary Aim: Examine whether long-term changes in AM, prescription opioid use and depression treatment after surgery differ by patients undergoing RYGB, AGB or VSG.