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      Self-Harm Before and Six Months After Obesity Surgery

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          Abstract

          Purpose

          Previous research on obesity surgery (OS) showed that patients do not only experience weight loss but also improvements in certain mental health outcomes (e.g., depression) after OS. However, self-harm behaviors might increase after OS. Regarding self-harm, the literature is mostly limited to studies using data from hospital or emergency room charts. This longitudinal study examined self-reported self-harm behaviors and potential psychopathological correlates before and after OS.

          Materials and Methods

          Pre-surgery patients ( N = 220) filled out a set of questionnaires before and approximately six months after OS. Self-harm behaviors were captured with the Self-Harm Inventory. The assessments further included standardized instruments to measure symptoms of depression, anxiety, eating disorders, alcohol use, and suicidal ideations.

          Results

          Any self-harm was reported by 24.6% before and by 25.0% after OS. No differences in the number of self-harm behaviors or prevalence of any self-harm before and after OS were found. Overall, 11.4% experienced self-harm behaviors at both times. A subset showed self-harm behaviors only before (13.2%) OS and another subset only after OS (13.6%). These two groups were about the same size. Self-harm behaviors showed strong associations with psychopathology after OS, especially with depression and suicidal ideation.

          Conclusion

          No increase in self-harm behaviors after OS emerged. Still, a subgroup showed self-harm behaviors after OS closely linked to further psychopathology. This mirrors the need to implement screening for self-harm before and after OS into OS care. Further studies with longer follow up periods are needed to extend these findings.

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          Most cited references77

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          The PHQ-9: validity of a brief depression severity measure.

          While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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            A power primer.

            One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided here. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests: (a) the difference between independent means, (b) the significance of a product-moment correlation, (c) the difference between independent rs, (d) the sign test, (e) the difference between independent proportions, (f) chi-square tests for goodness of fit and contingency tables, (g) one-way analysis of variance, and (h) the significance of a multiple or multiple partial correlation.
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              A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
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                Author and article information

                Contributors
                Thomas.Tobias@mh-hannover.de
                Journal
                Obes Surg
                Obes Surg
                Obesity Surgery
                Springer US (New York )
                0960-8923
                1708-0428
                13 August 2024
                13 August 2024
                2024
                : 34
                : 10
                : 3579-3591
                Affiliations
                [1 ]Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, ( https://ror.org/00f2yqf98) Carl-Neuberg-Straße 1, 30625 Hanover, Germany
                [2 ]Department of General, Visceral, and Bariatric Surgery, DRK Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161 Hanover, Germany
                [3 ]GRID grid.412811.f, ISNI 0000 0000 9597 1037, Department of General, Visceral, and Bariatric Surgery, , KRH Nordstadt, ; Haltenhoffstr. 41, 30167 Hanover, Germany
                [4 ]Department of General, Visceral, and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Straße 24, 38124 Brunswick, Germany
                [5 ]Department of General, Visceral, and Bariatric Surgery, AMC-WolfartKlinik, Waldstraße 7, 82166 Gräfelfing, Germany
                [6 ]Department of General, Visceral, and Bariatric Surgery, Dr. Lubos Kliniken Bogenhausen, Denninger Str. 44, 81679 Munich, Germany
                Author information
                http://orcid.org/0000-0002-4665-7011
                Article
                7439
                10.1007/s11695-024-07439-3
                11481644
                39134834
                a920e098-9037-4729-98e2-d6d526dfa53d
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 19 April 2024
                : 12 June 2024
                : 14 June 2024
                Funding
                Funded by: Medizinische Hochschule Hannover (MHH) (3118)
                Categories
                Original Contributions
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2024

                Surgery
                self-harm,eating pathology,anxiety,depression,alcohol use,obesity surgery
                Surgery
                self-harm, eating pathology, anxiety, depression, alcohol use, obesity surgery

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