Objective:

To characterize psychosomatic burden and disability in patients undergoing preoperative evaluation for metabolic and bariatric surgery using a structured multidimensional assessment approach.

Approach:

• Study Design: Cross-sectional study evaluating a structured assessment combining detailed interviews, psychometric questionnaires, and measures of psychosocial functioning and disability.
• Participants: 220 adults with severe obesity undergoing preoperative psychosomatic assessment at Saarland University Medical Center from 2019 to 2022.
• Assessment Tools: Patient-reported outcomes were obtained using PHQ-D, GAD-7, WHODAS 2.0, AUDIT, OPD-SQS, and EDE-Q; therapist-administered ratings included GAF and GARF.

Key Findings:

• 69.1% of participants were female; mean age was 41.8 years with a mean BMI of 51.8 kg/m².
• 37.7% reported a prior history of mental illness; over 60% met DSM-IV Axis I criteria for current psychopathology.
• The most common psychopathologies were affective disorders (54.5%), anxiety disorders (24.5%), and eating disorders (19%).
• 76.7% of participants showed clinically significant disability (WHODAS score ≥25%).
• The mean WHODAS score was 20.3, with significant correlations observed between WHODAS scores and PHQ-9 (r =.57, p <.001) and PHQ-15 (r =.58, p <.001).
• Moderate-to-severe depressive symptoms were observed in 47.1% of participants.

Interpretation:

Disability was more strongly associated with depressive symptoms, somatic distress, and psychosocial functioning than with BMI, as indicated by the study findings.

Limitations:

• The study is cross-sectional, limiting causal inferences.
• Findings may not be generalizable beyond the study population.

Conclusion:

The findings highlight the importance of structured psychosomatic assessment in preoperative bariatric evaluation and the need for individualized perioperative mental health care.