Congruence between clinical and research-based psychiatric assessment in bariatric surgical candidates
Received 25 September 2009; received in revised form 16 January 2010; accepted 23 January 2010. published online 08 February 2010. Uncorrected Proof
Abstract
Background
Mental health professionals have become increasingly involved in working with bariatric surgical candidates, particularly in performing preoperative psychological evaluations to clear candidates for surgery. The objective of the present study was to examine the concordance of the psychiatric diagnoses obtained during routine clinical evaluation before bariatric surgery and the diagnoses obtained separately at a research facility using the Structured Clinical Interview for DSM (Diagnostic and Statistical Manual of Mental Disorders)-IV axis I disorders.
Methods
The study included 68 consecutively enrolled bariatric surgical candidates who had participated in the Longitudinal Assessment of Bariatric Surgery-3 study. The Structured Clinical Interview for DSM disorders data obtained from the research assessments were compared with the diagnostic data from the routine preoperative psychiatric evaluations. The congruence of the current and lifetime diagnoses was assessed using Cohen's coefficient kappa.
Results
Considerable variability was found among the major diagnostic categories, with generally poor agreement found for the current diagnoses. The kappa coefficients tended to be larger for the lifetime diagnoses. The agreement was moderate for any lifetime mood disorder, with a kappa value of 0.45. Regarding any lifetime anxiety, substance use, and eating disorder, the clinical diagnoses rarely concurred with the results from the Structured Clinical Interview for DSM disorders, with a kappa statistic of 0.30, 0.36, and 0.32, respectively.
Conclusion
The congruence between the diagnoses assigned during the routine clinical psychiatric evaluations and research assessment using the Structured Clinical Interview for DSM disorders was surprisingly low. These conclusions should be considered tentative, given the interval and the possibility of treatment having occurred between the 2 evaluations. Overall, these data raise interesting questions concerning the use of unstructured psychiatric evaluations before bariatric surgery.
aNeuropsychiatric Research Institute, Fargo, North Dakota
bDepartment of Psychosomatic Medicine and Psychotherapy, University of Erlangen-Nuremberg, Erlangen, Germany
cDepartment of Psychology, University of North Dakota, Grand Forks, North Dakota
Reprint requests: Astrid Mueller, M.D., Ph.D., Department of Psychosomatic Medicine and Psychotherapy, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen
Funding for the Longitudinal Assessment of Bariatric Surgery-3 Consortium was provided by the National Institute of Diabetes and Digestive and Kidney Diseases: grant DCC-U01 DK066557; Columbia-Presbyterian, grant U01-DK66667; University of Washington, grant U01-DK66568; Neuropsychiatric Research Institute, grant U01-DK66471; East Carolina University, grant U01-DK66526; University of Pittsburgh Medical Center, grant U01-DK66585; Oregon Health & Science University grant U01-DK66555, and the Office of Research on Women's Health.
ABSTRACT