Psychological And Family Correlates And Predictors Of Pass Delay From The Preoperative Psychological Evaluation And Postoperative Bariatric Surgery Outcomes

According to the American Society of Metabolic and Bariatric Surgery (ASMBS) clinical practice guidelines, all patients seeking bariatric surgery are required to have a preoperative psychological evaluation. The purpose of the psychological evaluation is to assess current and untreated mental health diagnoses, disordered eating, substance use and psychosocial history prior to surgery (Mechanick et al., 2020). However, there is no clear guidance on how these areas should be assessed within the evaluation. These guidelines also do not provide guidance on how providers should assess family/relational contexts that may also influence the patients’ ability to modify and maintain health behaviors. This is critical information that is needed to establish consistency of the preoperative psychological evaluation process between centers to ensure equity for bariatric patients in the evaluation process between centers. This current dissertation presents the results of three studies which investigated associations between psychological evaluation pass/delay rates, demographics, current diagnoses (mental health, disordered eating, substance use), postoperative outcomes, impairment/no impairment on that piloted relational screener, and whether a patient completed the behavioral health consultation once screening as impaired. It also explored the preliminary feasibility of piloting a brief relational screener alongside the standard psychological evaluation and referral pathways. The first study provides evidence about which mental health, disordered eating, and substance use diagnoses associate with patient pass and delay rates from the bariatric surgery preoperative psychological evaluation. It also investigated reasons, recommendations, and referrals for delay and denial after the postoperative psychological evaluation. Significant associations between pass/delay rates and demographics, current mental health treatment, and having a current mental health, disordered eating, or substance use diagnosis were found. The second study sought to determine if there were differences between patients who received a pass or delay from their initial preoperative psychological evaluation and postoperative outcomes following bariatric surgery. It also sought to detect how the combination of pass/delay and select mental health diagnoses and patient demographics associate with postoperative weight- related outcomes. Significant associations between pass/delay rates with demographics and mental health, disordered eating, and substance use were found. No significant differences were found between pass/delay and postoperative complications, readmissions, and ER visits. Patients who received a delay from their initial preoperative psychological evaluation had higher weights over 12-months. The third study piloted a voluntary brief family relational screener, delivered at the same time as the standard psychological evaluation, to identify impaired family factors (i.e., family functioning, family support, relationship security, and family life events) and their associations with self-efficacy for making health behavior change and psychological evaluation pass/delay clinical decisions, and ensuing referral to a behavioral health consultation. The study interest rate was 51.1%, and the response/completion rate after determining interest was 85.1%. The majority (75.4%) of patients in the study screened as impaired on at least one assessment within the screener and were eligible for the behavioral health consultation. Forty-eight percent of patients with noted impairment) completed the behavioral health consultation. Multiple assessments within the relational screener were also significantly associated with self-efficacy scores.