Clinical Scorecard: Integrating Trauma-Informed Care Principles in the Assessment and Treatment of Patients Undergoing Metabolic and Bariatric Surgery

At a Glance

Key Highlights

• High prevalence of psychosocial disorders (depression, anxiety, disordered eating, substance use history) among MBS candidates.
• Adverse childhood experiences (ACEs) significantly influence psychosocial functioning and obesity development, impacting MBS outcomes.
• Trauma-informed care principles are essential to avoid re-traumatization and improve comprehensive, patient-centered care in MBS.

Guideline-Based Recommendations

Diagnosis

• Conduct thorough preoperative psychosocial evaluations including assessment for depression, anxiety, eating disorders, and substance use history.
• Assess for history of adverse childhood experiences (ACEs) as part of psychosocial evaluation, recognizing their impact on obesity and mental health.

Management

• Apply trauma-informed care principles throughout the MBS care continuum to address psychosocial needs and prevent re-traumatization.
• Incorporate multidisciplinary approaches including mental health professionals to support psychosocial functioning pre- and post-surgery.

Monitoring & Follow-up

• Monitor for postoperative mental health issues including increased risk of alcohol use disorders, self-injurious behavior, and suicidality, especially beyond the first postoperative year.
• Regularly evaluate psychosocial status and quality of life improvements as well as emerging mental health concerns during follow-up.

Risks

• Be aware of increased risk of alcohol use disorders, self-injurious behaviors, and suicidality in MBS patients, particularly in the second postoperative year and beyond.
• Recognize that untreated psychosocial burden and unaddressed trauma history may negatively impact surgical outcomes and patient well-being.

Patient & Prescribing Data

Patients with severe obesity undergoing metabolic and bariatric surgery, many with significant psychosocial comorbidities and trauma histories.

Psychosocial improvements are common postoperatively, but a substantial minority experience worsening or new mental health issues; trauma-informed care can optimize treatment outcomes.

Clinical Best Practices

• Integrate trauma-informed care principles into all phases of MBS treatment to enhance patient-centered care.
• Ensure multidisciplinary collaboration including mental health expertise to address complex psychosocial needs.
• Systematically assess for ACEs and other trauma histories during preoperative evaluations.
• Educate all members of the MBS treatment team on trauma-informed approaches to avoid re-traumatization.
• Implement ongoing psychosocial monitoring postoperatively to identify and manage emerging mental health risks.

References

• Psychosocial burden in MBS patients
• Trauma-informed care principles
• Adverse childhood experiences and obesity