Multimethod psychological assessment of women undergoing bariatric surgery

• Autor(a) principal: Colombarolli, Maíra Stivaleti
• Data de Publicação: 2023
• Tipo de documento: Tese
• Idioma: eng
• Título da fonte: Biblioteca Digital de Teses e Dissertações da USP
• Texto Completo: https://www.teses.usp.br/teses/disponiveis/59/59141/tde-05062023-161315/
• topic: Avaliação multimétodo; Avaliação psicológica; Cirurgia bariátrica; Obesidade; Rorschach

Obesity is a complex condition in which excessive body weight causes negative consequences for health, and is associated with increase of mortality. Treatment strategies for severe obesity include the bariatric surgery (BS), an intervention in which patients\' undergo anatomical and metabolic modifications that promote restriction of food intake and absorption, leading to weight loss (WL). Psychological aspects such as affective and cognitive functioning and personality characteristics, are related to the development and severity of obesity. Psychological assessment is part of the procedures of preparation for BS and usually focus on the presence of psychopathology, which is a risk for insufficient WL. This research aimed to investigate aspects of psychological functioning in patients undergoing BS, in three different studies. The objective of Study 1 was to conduct a meta-analytic review of studies that assessed longitudinal psychological outcomes of patients submitted to bariatric surgery. We identified 751 studies, of which 26 were reviewed, and 12 were included in the meta-analysis. Study 2 compared psychological characteristics related to emotion regulation, executive functions and personality characteristics using a multimethod psychological assessment of 50 women with severe obesity (class III) undergoing BS and 29 normal-weight controls. Participants were assessed using the Difficulties in Emotion Regulation Scale (DERS), the Trail Making Test (TMT) and the Rorschach Performance Assessment System (R-PAS). Study 3 examined the association of various measures of emotion regulation, executive functions and personality to surgery status of 50 women applying for BS, from which 27 dropout of the treatment, and 23 proceeded to BS, and had their WL at 6, 12 and 18 months followed. The main results of Study 1 were that symptoms of anxiety, depression, binge eating, and body image are consistently reduced after surgery, with depressive symptoms accounting for the greater reduction. However, examination of longer follow-ups suggested that psychological functioning returns to baseline after 60 months. On Study 2, we found that patients with obesity self-reported lower levels of mental illness, although they showed poorer performance on the maximal performance test and increased defensiveness on the typical performance test, indicating that self-report measures are subject to positive impression management. In Study 3, patients who dropped out from treatment had higher initial BMI and worse cognitive flexibility, while for the patients that proceed to surgery, indicators of emotional and cognitive functioning in all measures were associated with WL at 6 and 12 months after surgery, but only R-PAS variables related to psychological resources appeared to be associated with WL at 18 months of surgery. These results suggest that psychological assessment pre-BS should include different types of assessment measures, including maximum and a typical-performance measures, to improve effectiveness of the assessment and reduce effects of positive impression management. Multimethod approach may also contribute to a better understanding of long-term outcomes of BS by providing information on psychological aspects related to insufficient WL.