"Estudio de un perfil específico de estilo de afrontamiento predictivo de pronósitico ""excelente"" en pacientes con obesidad mórbida candidatos a cirugía bariátrica"

Abstract

ABSTRACT OBJECTIVES Overall objective: To develop a Psychological Assessment Tool which enables us to identify patients with morbid obesity in the pre-operative period, who will be 'Excellent' candidates for successful bariatric surgery. Specific objectives: 1. To analyse the clinical and socio-demographic characteristics of patients who are candidates for bariatric surgery. 2. To check the predictive capability of such variables as an 'Excellent' prognosis within the sample studied. 1. To describe the specific dynamic coping styles of patients who have an 'Excellent' prognosis. 2. To establish the relationship between the clinical and socio-demographic variables and the psychological profile obtained. MATERIAL AND METHODS This study looks at one hundred patients with morbid obesity prior to undergoing bariatric surgery and two years post-surgery. To achieve this end, the following instruments have been used: An interview; The International Personality Disorder Exam IPDE; The Module DSM-IV; The State - Trait Anxiety Inventory STAI; the Beck Depression Inventory BDI; The Eating Attitudes Test EAT- 26 and the Vocabulary subtest of Wechsler Intelligence Scale for adults WAIS - III. A binary logistic regression has been used to determine the clinical and socio-demographic variables from the interview and psychological variables that best predict the outcomes from surgery, using the following predictive criteria, PEBMIL, Percentage of excess BMI lost, dividing subjects into "excellent" or "good" candidates for surgery. RESULTS: Our sample is characterised by a predominance of women (70%), with an average age of 39, living with a partner (69%), with children (64%), non-urban home (68%), who carry out low or medium qualification work activities (75%), active (62%), without education or with primary education (91%). 41% are smokers, 58% are dieters and (75%) have a sendentary life style. There is a 74% pre-comorbidity within the sample (diabetes 32%, high blood pressure 49% and Obstructive Sleep Apnoea 41%), initial average weight of 124 Kilos and an initial average BMI of 45, 84 Kilos/m2. 30% have psychopathology. After 2 years: Middle weight: 77, 53 Kilos. BMI: 28, 61 Kilos/ m2 and the average PEIMCP, 82, 48%. 70% of patients have reduced their co-morbidities. When taking into account variables such as younger age, no diabetes or HTA, no presenting disorders, no prior active eating disorders, physical exercise after surgery, the patient profile points towards an 'Excellent' prognosis. The specific coping styles predictive of an 'Excellent' prognosis in morbidly obese candidates for bariatric surgery includes the following items: 'I lost complete interest in sex', 'I feel calm', 'Right now I feel good', 'I feel rested', I feel confused and overwrought', 'Great'. The profile for a 'good' prognosis includes the following: 'My appetite has decreased', 'I like being the centre of attention', 'I have confidence in myself', 'I often seek advice or recommendations on decisions of everyday life', 'My feelings are like the weather, they are always changing'. CONCLUSIONS On one side we have a profile of 'Excellence' defined by a state of self-acceptance, which includes a regulatory function for the feelings of bewilderment and being overwrought, against the perceived threat of the therapeutic process. This is associated with a separate coping style incorporating autonomy and a high degree of self. On the other side, we have a known 'Good' prognosis profile characterised by what we define as a functional state of self-sufficiency, with a compensatory modulating function for the state of insecurity and helplessness, associated with a regressive and dependent coping style.