Depressive symptoms at short-, medium-, and long-term follow-up after bariatric surgical procedures: A systematic review and meta-analysis.

Importance: Patients experience both positive and negative changes in mood following bariatric surgery and mental health outcomes have been reported to differ between procedure types. Understanding changes in symptoms over time and between surgical procedures is vital to providing meaningful, long-term, patient-centered care.

Objective: To examine the nature and time course of changes in depressive symptoms after different bariatric procedures.

Evidence review: Medline, Embase, Emcare, PsycINFO, CINAHL, and CENTRAL databases were systematically searched from inception to January 18, 2024. Ninety publications describing patient-reported depressive symptoms in 13,146 individuals undergoing bariatric procedures were included.

Findings: Qualitative analysis indicated a reduction of depressive symptoms at all time points following all bariatric procedure types. However, a subset of patients experienced worsening symptoms post-surgery. Meta-analyses indicated depressive symptoms improve following bariatric surgery by an SMD of -0.6 (95% CI: -0.8, -0.4) in the short term (0-4 months post-surgery), -0.9 (95% CI: -1.0, -0.8) in the medium term (5-12 months), and -0.7 (95% CI: -0.9, -0.5) in the long term (> 12 months). There was no evidence that surgery type was associated with the change in depressive symptoms at any time point post-surgery.

Conclusions and relevance: Patient-reported depressive symptoms improve following bariatric surgery with improvements peaking in the medium term and diminishing over time. Significant heterogeneity in the results cannot be explained by surgery type, baseline depression, or depression instrument used across studies. Long-term management of post-bariatric surgery patients must consider the potential for adverse psychological effects of surgery.