- 學位論文
接受減重手術病人之精神健康追蹤探討
Mental Health of Patients Seeking Obesity Surgical Treatment: A Longitudinal Study
摘要
背景及研究目的: 肥胖為目前非常重要的健康議題，肥胖者罹患慢性疾病之機會大增，進而造成失能或死亡，肥胖也和憂鬱等精神疾病有關。病態性肥胖之病人，需要以外科減重手術治療而且有更多的精神健康問題。因此減重手術被建議需要有手術前的心理評估。但目前對於心理因子是否能夠預測手術結果仍有分歧。故仍需進一步研究來釐清心理因子對減重治療之影響。而亞洲在關於減重手術病人之心理健康部份的研究，仍非常少。所以本研究欲探討接受減重手術之後，病人相關的精神健康的變化，期望能了解肥胖病人的精神健康因素對於減重手術的影響。 研究方法: 以立意取樣收集減重手術之後至少一年以上的病人，並收集其手術前後之生理指標，手術前後之精神健康指標(華人健康量表，CHQ; 台灣人憂鬱量表，TDQ)，手術前精神科疾病診斷等。比較手術前後生理及精神健康的變化。 結果與結論: 共收集了147位個案，病人的體重，生理狀況，精神健康均有顯著改善：手術後BMI平均減少13.46 (SD 8.28)，手術後CHQ分數減少了1.52 (SD 2.80)，TDQ減少了5.08 (SD 8.58)。 而接受減重手術的病人手術前任一精神疾病的終生盛行率超過40%。手術前有無精神疾病和減重成效無關。但有術前精神疾病者之精神健康狀況術後之CHQ及TDQ仍較高。手術前CHQ分數可預測術後減重成效(ESWL%)，而ESWL%也可預測手術前後CHQ的改善。手術後的BMI越重，其手術前後TDQ的改善也越少。 減重手術病人有高比例有精神疾病，且手術之後精神健康雖改善但仍無法完全改善，而體重健康和精神健康有其關聯，故必須於術後照顧時持續關注其精神健康。
並列摘要
Background: Obesity is a integrating central issue of human health, because obesity is proportional to risk-increase of chronic physical disease, and disability and death. In addition to physical stress, obesity is also associated with mental health. The bariatric surgery approach has demonstrated to be effective in treating morbid obesity. However, psychiatric problem associated with patients who take this approach also needs to be considered. Indeed, the need of psychological evaluation before bariatric surgery is strongly suggested. In past studies, the effect of psychological factor to the surgical results remains to be established. However, there were only a few mental health studies of patient received bariatric surgery in Asia. Here in, we aim to (i) Evaluate the changes of physical and psychiatric health prior and subsequent to surgery, (ii) Look into the possibility whether the psychiatric health can predict the bariatric surgery results. Methods: First, we enrolled the patients who had received bariatric surgery at least for one year. Second, we collected and compared: (i) the physical condition and psychiatric health condition (Chinese Health Questionnaire, CHQ; Taiwanese Depressive Questionnaire, TDQ) changes before and after surgery, and (ii) the psychiatric diagnosis before surgery, to evaluate and establish their relationships. Results and Conclusions: Totally 147 cases were recruited. It is clear that the physical condition and psychiatric health were improved after surgery and parameter as illustrated as followed: after surgery, (i) average BMI decreases by 13.46 (SD 8.28), (ii) CHQ decreases by 1.52 (SD 2.80), (iii) TDQ decreases by 5.08 (SD 8.58). The life-time prevalence of any psychiatric disorder in these patients was higher than 40%. There was no difference of excess weight loss (ESWL%) between the people with and without psychiatric disorder. But the patients with psychiatric disorder still hold higher CHQ and TDQ scores after surgery. Pre-operation CHQ scores could predict the ESWL%, and the ESWL% was also related to CHQ changes after surgery. The post-operation BMI were negative association with TDQ changes. In summary, the patients received bariatric surgery had high psychiatric disorder prevalence, and even the improvements after surgery were not total recovered. We still need to pay attention to the further study as well as treatment plan of psychiatric health in bariatric patients in the future.
參考文獻
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