Outcomes of Bariatric Surgery among Patients with Bipolar Disorder

描述(申请人提供)：本提案的首要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果。BD患者患肥胖症的风险增加，与肥胖相关的合并症发生率增加。据估计，他们失去了25年的生命，主要是由于心血管疾病。迫切需要了解如何最好地治疗肥胖症和减轻双相情感障碍患者的相关并发症。减肥手术是治疗病态肥胖最有效的方法。尽管BD患者不成比例地患有肥胖症，但几乎没有发表过关于减肥手术如何影响这一人群的精神或代谢过程的数据。我们建议进行一项回溯性队列研究，以研究2006至2009年间北加利福尼亚州凯撒永久医院所有年龄在18-69岁的H100,000名病态肥胖成人患者(2000名BD，13,000名重度抑郁障碍，85,000名非情感障碍)在长达3年的随访期间的精神和代谢结果。在队列中，5149名患者(171名BD，1999年严重抑郁障碍，2979名非情感障碍患者)在研究期间接受了减肥手术。我们提出了三个目标：(1)确定转诊到减肥手术和接受减肥手术的预测因子是否因情感障碍的诊断(BD，严重抑郁障碍，两者都不)而不同；(2)在符合减肥手术标准的n=2000名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程(精神科住院风险，门诊精神利用)；以及(3)在n=5149名接受减肥手术的患者(171例BD，1999年重度抑郁症，2979例都不是情感障碍)中，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。我们将采用反事实统计框架中的纵向数据表示法。多元线性回归将用于线性结果(体重减轻、门诊次数)，多元Logistic回归将用于二分性结果。这项研究将首次公布双相情感障碍患者减肥手术结果的数据。目前，在这一人群中，没有特定于BD的数据可以作为临床决策的基础。由于BD的超额死亡率主要是由于心血管疾病，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必要的信息。 公共卫生相关性：双相情感障碍患者患肥胖症及相关疾病(如糖尿病和心血管疾病)的风险更高。我们建议研究最有效的肥胖治疗-减肥手术-如何影响双相情感障碍患者的精神病程、体重减轻和肥胖相关疾病(糖尿病、高血压、高胆固醇)的改善。我们将首次对双相情感障碍患者的减肥手术结果进行研究，并将提供急需的信息，以帮助双相情感障碍患者及其医生就病态肥胖的治疗方案做出决定。

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.