Depression and Quality of Life Outcomes of Adolescents Post Bariatric Surgery: A Systematic Review

Purpose: This systematic review summarizes the reported changes in depression and quality of life among adolescents post bariatric surgery.  Also appraised were the choice of tools to measure depression and quality of life, length of follow-up, plus age and gender trends in bariatric surgery among adolescents.

Methods: Electronic searches in Medline, Cochrane, CINAHL and Web of Science were searched until November, 2014 for trials assessing depression and quality of life in adolescents after bariatric surgery.  Grey literature and dissertations were not included.

Results: Ten studies , comprising of 347 subjects with an age range of 11 - 20 years, met the inclusion criteria.  Studies were conducted in Austria, Sweden, Australia and the United States.  Beck's Depression Inventory (BDI - II) was used 5 times  and the BD-I once.  Utilized were 12 Quality of Life inventories, with 2 different questionnaires used occasionally in the same study. Adolescents from the majority of published studies post bariatric surgery showed a positive reduction in depression and improvements in quality of life regardless of the amount of weight lost or type of surgery performed.  However, studies varied greatly in the instruments selected, with some being validated for adults but not adolescents.  The follow-up time varied greatly, with six studies measuring changes only within the first year, making it difficult to demonstrate whether the positive psychological benefits persisted, especially if weight regain occurred.  Cohorts were small and a 2:1 female/male ratio.  The average age of the patients was 15.5 years although samples as old as 19 – 20 years were included as adolescents.

Conclusion: Standardization of age parameters for adolescent measurement tools is necessary for accurate comparisons.  Mixed method studies utilizing quantifiable instruments specific for adolescents are optimal to measure psychosocial health both before and after bariatric surgery, along with qualitative questionnaires for in-depth data.  Larger, longer, multicenter follow-up studies are necessary to help determine which variables predict success with bariatric surgery and could alert health professionals to those needing extra psychological support post-surgery.