Quality of Life of Substance Abuse Treatment Patients:
Post-Bariatric Surgery Cases Versus Controls
Karen K. Saules, Ashley Wiedemann, Valentina Ivezaj, Summar Reslan, Daniel Wood & Lauren Skilton
Eastern Michigan University, Department of Psychology
Introduction
Results
Quality of life (QOL) among post-bariatric surgery patients is
high, approximating that of healthy controls by one year postsurgery (Andami et al., 2005). Evidence from our laboratory,
however, suggests that post-bariatric patients are overrepresented in substance abuse treatment programs (Saules et
al., 2011). We hypothesized that QOL of post-bariatric surgery
patients admitted to substance abuse treatment would be
relatively poor, overall, and significantly worse than that of other
substance abuse treatment patients.
Relative to controls, and consistent with the bariatric treatment
population in general, bariatric patients were more likely to be female
(74% vs. 38%, Chi-Square (1) = 13.3, p < .001). Bariatric patients’
weight loss approximated that reported in the literature for bariatric
patients in general, with a maximum pre-surgical BMI of 53.1 ± 11.2
and a mean current BMI of 32.0 ± 7.6. Bariatric patients and controls
differed on BMI, with non-bariatric patients having a mean BMI of 25.3
± 4.5, t (103) = −5.6, p <.001. BMI, however, was not significantly
associated with any of the assessed dimensions of QOL.
Method
Post-bariatric substance abuse patients had significantly lower
psychological QOL compared to non-bariatric controls, t (96) = −2.5, p
<.05. As noted, bariatric patients were disproportionately female, but
a linear regression model that included both gender and bariatric
status indicated that it was bariatric status, and not gender, that
accounted for significant variance in the prediction of Psychological
QOL. Bariatric cases and controls did not differ on anxiety or
depression scores, but bariatric patients were much more likely to
have histories of physical (65% vs. 32%, p < .01), emotional (70% vs.
38%, p < .05), and sexual abuse (61% vs. 25%, p < .01). Abuse history,
however, was not significantly related to Psychological QOL.
PARTICIPANTS/PROCEDURES: The sample included 42 postbariatric patients and 56 controls, all recruited from an inpatient
substance abuse treatment program. Bariatric patients were
identified during the admission history and physical. All nonbariatric patients were eligible to serve as controls, and those
who volunteered are included here. Overall, the sample had a
mean age of 43.4 ± 11.9 years and a mean education level of
14.1 ± 2.2 years, neither of which differed as a function of
bariatric status.
MEASURES:
The WHOQOL-BREF (Murphy, Herrman, Hawthorne, Pinzone,
Evert, 2000) is a 26-item measure developed by the
World Health Organization (1996) to assess quality of life
(QOL) in four domains: (1) Physical, (2) Psychological, (3)
Social, and (4) Environmental. In addition, the first two
WHOQOL-BREF are examined separately: Item 1 asks about
the individual’s overall perception of QOL, and Item 2 asks
about the individual’s overall perception of his/her health.
 The Patient Health Questionnaire (PHQ) was used to assess
depression and anxiety (Spitzer, Kroenke, & Williams, 1999)
 Body Mass Index (BMI) was obtained from the medical
record for all patients, although pre-surgical BMI for the
bariatric patients was obtained from self-report.
5
Quality of Life for Substance Abuse Treatment Patients:
Post-Bariatric Cases vs. Controls
20
*
15
14.1
12.9
13.9
13.3
12.2
12.1
Bariatric
Control
11.3
10.5
10
5
0
Physical
Psychological
Social
Environmental
Presented at the 2011 Annual Meeting of the Society of Behavioral Medicine
Psychological Quality of Life for Substance Abuse
Treatment Patients: Meant Item Scores for
Post-Bariatric Cases vs. Controls
Bariatric
4
*
*
3.3
3.2
3
2.8
Control
3.1
2.8
2.9
2.9
*
*
2.8
2.8
2.3
2.7
2.3
2
1
0
Enjoy Life
Meaningful
Able to
Appearance Satisfied with
Life
Concentrate Acceptance
Self
Positive
Mood
The mean score for each item that comprises the Psychological QOL
scale is shown above, as a function of bariatric status.
Discussion
Results suggest that bariatric patients who experience post-surgical
substance use disorders of the magnitude warranting inpatient
treatment have low overall QOL. Hawthorne et al. (2006) present
WHOQOL-BREF community norms that, when transformed for the 420 scoring metric used in this report, correspond to norms of 15.5 for
Physical, 15 for Psychological, 15 for Social, and 31.5 for
Environmental QOL, all of which are high by comparison to the
present sample. In the Psychological domain, however, bariatric
patients’ QOL was significantly lower than the already low scores
observed for control substance abuse cases. Furthermore, the low
QOL is not simply a function of dissatisfaction over bodily
appearance.
While not directly related to QOL, bariatric patients had strong
histories of physical, emotional, and sexual abuse. Future research
should evaluate whether a history of physical, emotional, and/or
sexual abuse elevates risk for development of substance use
disorders after bariatric surgery.
Quality of Life of Substance Abuse Treatment Patients:
Post-Bariatric Surgery Cases Versus Controls
Karen K. Saules, Ashley Wiedemann, Valentina Ivezaj, Summar Reslan, Daniel Wood & Lauren Skilton
Eastern Michigan University, Department of Psychology
References
Adami, G.F., Ramberti, G., Weiss, A., Carlini, F., Murelli, F., & Scopinaro, N. (2005). Quality of life in obese subjects following
biliopancreatic diversion. Behav Med. 31(2), 53-60.
Hawthorne, G., Herrman, H., & Murphy, B. (2000). Interpreting the WHOQOL-BREF: Preliminary population norms and effect sizes.
Social Indicators Research, 77, 37-59.
Murphy, B., Herrman, H., Hawthorne, G., Pinzone, T., Evert, H. (2000). Australian WHOQoL instruments: User’s manual and
interpretation guide. Australian WHOQoL Field Study Centre, Melbourne, Australia.
Spitzer, R.L., Kroenke, K., & Williams, J.B.W. (1999). Validation and utility of a self-report version of PRIME-MD; The PHQ Primary Care
Study. Journal of the American Medical Association, 282, 1737-1744.
Contact: ksaules@emich.edu