International Journal of School and Cognitive Psychology
Open Access

Adherence after Surgery: The Role of Psychology in Bariatric Recovery

Nelson Nicholas^{* *}Correspondence: Nelson Nicholas, Department of Psychology, Karadeniz Technical University, Trabzon, Turkey, Email:

Author info »

Description

Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post-operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery. PubMed, PsycInfo, and Embase were searched to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n=891) were screened and coded by two raters [1]. A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied postoperative instructions. Higher self-efficacy was consistently predictive of better post-operative adherence to diet and physical activity, while pre-operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity [2]. Findings were less inconsistent for anxiety and other psychiatric conditions. This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery [3-5]. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.

Bariatric surgery has become an increasingly utilized intervention for individuals with severe obesity due to its effectiveness in achieving weight loss and improving comorbidities. However, the success of bariatric surgery is contingent upon patients' adherence to recommended lifestyle changes post-operatively, including dietary modifications, regular physical activity, and attending follow-up appointments [6]. Despite the potential benefits, research indicates that adherence to these lifestyle changes is challenging for many patients. Understanding the psychological factors that influence adherence after bariatric surgery is crucial for optimizing patient outcomes. While various studies have investigated this topic, a systematic review synthesizing the existing literature can provide a comprehensive understanding of the psychological predictors of adherence and identify areas for future research and intervention development [7]. The study identified 32 studies that met the inclusion criteria. These studies examined various psychological factors and their association with adherence to lifestyle changes after bariatric surgery. Appointment attendance and adherence to dietary recommendations were the most frequently studied post-operative instructions [8-10].

Psychological predictors

Self-efficacy: Higher levels of self-efficacy were consistently predictive of better adherence to post-operative diet and physical activity recommendations. Patients who reported greater confidence in their ability to adhere to lifestyle changes were more likely to comply with dietary guidelines and engage in regular exercise.

Depressive symptoms: Pre-operative depressive symptoms were commonly associated with poorer adherence to follow-up appointments, dietary modifications, and physical activity recommendations. Patients experiencing depressive symptoms may struggle with motivation and self-care behaviors, leading to difficulties in adhering to post-operative recommendations.

Anxiety and psychiatric conditions: Findings regarding the association between anxiety and other psychiatric conditions with adherence to lifestyle changes were less consistent compared to self-efficacy and depressive symptoms. While some studies reported an association between these factors and adherence, others found no significant relationship.

This study highlights the importance of considering psychological factors in understanding and promoting adherence to lifestyle changes after bariatric surgery. Self-efficacy emerges as a robust predictor of adherence, suggesting that interventions aimed at enhancing patients' confidence in their ability to adhere to post-operative recommendations may be beneficial [11]. Furthermore, the association between depressive symptoms and adherence underscores the need for comprehensive preoperative psychological assessment and targeted interventions for patients at risk of depression. Addressing mood disorders and providing support for mental health concerns may improve adherence and ultimately contribute to better long-term outcomes for bariatric surgery patients.

Conclusion

Psychological factors, including self-efficacy and depressive symptoms, play significant roles in determining adherence to lifestyle changes after bariatric surgery. Understanding these predictors can inform the development of interventions aimed at improving adherence and optimizing patient outcomes. Future research should continue to investigate psychological predictors of adherence and evaluate the effectiveness of targeted interventions in promoting long-term success following bariatric surgery.

References

1. Jeon C, Yan D, Nakamura M, Sekhon S, Bhutani T, Berger T, et al. Frequency and management of sleep disturbance in adults with atopic dermatitis: A systematic review. Dermatology and therapy. 2017;7:349-364.

   [Crossref] [Google Scholor] [PubMed]

2. Silverberg JI. Selected comorbidities of atopic dermatitis: Atopy, neuropsychiatric, and musculoskeletal disorders. Clin Dermatol. 2017;35(4):360-366.

   [Crossref] [Google Scholor] [PubMed]

3. Silverberg JI, Garg NK, Paller AS, Fishbein AB, Zee PC. Sleep disturbances in adults with eczema are associated with impaired overall health: A US population-based study. J Invest Dermatol. 2015;135(1):56-66.

   [Crossref] [Google Scholor] [PubMed]

4. Hertenstein E, Feige B, Gmeiner T, Kienzler C, Spiegelhalder K, Johann A, et al. Insomnia as a predictor of mental disorders: a systematic review and meta-analysis. Sleep Med Rev. 2019;43:96-105.

   [Crossref] [Google Scholor] [PubMed]

5. Neckelmann D, Mykletun A, Dahl AA. Chronic insomnia as a risk factor for developing anxiety and depression. Sleep. 2007;30(7):873-80.

   [Crossref] [Google Scholor] [PubMed]

6. Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in US adults. Br J Dermatol. 2019;181(3):554-565.

   [Crossref] [Google Scholor] [PubMed]

7. Beikert FC, Langenbruch AK, Radtke MA, Kornek T, Purwins S, Augustin M. Willingness to pay and quality of life in patients with atopic dermatitis. Arch Dermatol Res;306:279-286.

   [Crossref] [Google Scholor] [PubMed]

8. Yu SH, Attarian H, Zee P, Silverberg JI. Burden of sleep and fatigue in US adults with atopic dermatitis. Dermatitis. 2016;27(2):50-58.

   [Crossref] [Google Scholor] [PubMed]

9. Alqahtani JM. Atopy and allergic diseases among Saudi young adults: A cross-sectional study. J Int Med Res. 2020;48(1):0300060519899760.

   [Crossref] [Google Scholor] [PubMed]

10. Makiko KN, Nakahara T, Yasukochi Y, Ulzii D, Furue M. Patient-oriented eczema measure score: A useful tool for web-based surveys in patients with atopic dermatitis. Acta Derm Venereol. 2020;100(10).

    [Crossref] [Google Scholor] [PubMed]

11. Saeki H, Ohya Y, Nawata H, Arima K, Inukai M, Rossi AB, et al. Impact of the Family and Household Environment on Pediatric Atopic Dermatitis in Japan. J Clin Med. 2023;12(8):2988.

    [Crossref] [Google Scholor] [PubMed]