Evaluation of General Psychopathology,Subjective Sleep Quality,and Health-Related Quality of Life in Patients with Obesity

Abstract

Objective:

Recently, the increasing rate of obesity has been elucidated as a major public health problem. The aim of this study was to examine the psychological distress, subjective sleep quality, and health-related quality of life (HRQOL) in a group of patients diagnosed with obesity.

Methods:

A total of 124 obese patients (32 of them Class I obesity (BMI: 30–34.9 kg/m2), 92 Class II obesity (BMI: ≥ 35kg/m2)) and 106 healthy control subjects were involved in the study. Subjects were evaluated with self-administered questionnaires including the Symptoms Checklist-90-Revised (SCL-90-R), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Short Form 36 (SF-36). Several clinical and socio-demographic data were also recorded.

Results:

Class II obesity group had a significantly worse psychological status, quality of life, and sleep quality than control group. Although Class I obesity group did not differ from Class II and control groups according to sleep quality and psychological status, they had worse HRQOL than the control group. BMI scores positively correlated with the majority of subscales of psychological distress (SCL-90-R) and sleep quality (PSQI, ESS) and negatively correlated with all dimensions of HRQOL (SF-36).

Conclusions:

Obesity is associated with psychological distress, poor sleep quality, and reduced quality of life. Thus, obesity should be evaluated in a biopsychosocial manner, including management of patients' psychopathology.

Keywords

obesity psychological distress sleep quality daytime sleepiness quality of life

Get full access to this article

View all access options for this article.

References

Flegal

Carroll

Ogden

Johnson

. Prevalence and trends in obesity among US adults: 1999–2000. Journal of the American Medical Association 2002; 288: 1723–1727.

Olshansky

Passaro

Hershow

Layden

Carnes

Bordy

. A potential decline in life expectancy in the United States in the 21st century. New England Journal of Medicine 2005; 352: 1138–1145.

Krassas

Kelestimur

Micic

Tzotzas

Konstandinidis

Bougoulia

. Balkan Group for the Study of Obesity. Self-reported prevalence of obesity among 20,329 adults from large territories of Greece, Serbia and Turkey. Hormones 2003; 2: 49–54.

Dalle

Calugi

Molinari

Petroni

Bondi

Compare

. Weight loss expectations in obese patients and treatment attrition: An observational multi-center study. Obesity Research 2005; 13: 1961–1969.

Simon

Von Korff

Saunders

Miglioretti

Crane

van Belle

. Association between obesity and psychiatric disorders in the US adult population. Archives of General Psychiatry 2006; 63: 824–830.

Baumeister

Härter

. Mental disorders in patients with obesity in comparison with healthy probands. International Journal of Obesity 2007; 31: 1155–1165.

Onyike

Crum

Lee

Lyketsos

Eaton

. Is obesity associated with major depression: Results from the Third National Health and Nutrition Examination Survey. American Journal of Epidemiology 2003; 158: 1139–1147.

Heo

Pietrobelli

Fontaine

Sirey

Faity

. Depressive mood and obesity in US adults: Comparison and moderation by sex, age, and race. International Journal of Obesity 2006; 30: 513–519.

Dong

Sanchez

Price

. Relationship of obesity to depression: A family-based study. International Journal of Obesity and Related Metabolic Disorders 2004; 28: 790–795.

10.

Roberts

Strawbridge

Deleger

Kaplan

. Are the fat more jolly? Annals of Behavioral Medicine 2002; 24: 169–180.

11.

Hasler

Pine

Gamma

Milos

Ajdacic

Eich

. The associations between psychopathology and being overweight: A 20-year prospective study. Psychology and Medicine 2004; 34: 1047–1057.

12.

Goodman

Whitaker

. A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics 2002; 110: 497–504.

13.

Roberts

Deleger

Strawbridge

Kaplan

. Prospective association between obesity and depression: Evidence from the Alameda County Study. International Journal of Obesity and Related Metabolic Disorders 2003; 27: 514–521.

14.

Dixon

Schachter

O'Brien

. Predicting sleep apnea and excessive day sleepiness in the severely obese: Indicators for polysomnography. Chest 2003; 123: 1134–1141.

15.

Dixon

Schachter

O'Brien

. Sleep disturbance and obesity: Changes following surgically induced weight loss. Archives of Internal Medicine 2001; 161: 102–106.

16.

Serafini

Anderson

Rosemurgy

Strait

Murr

. Clinical predictors of sleep apnea in patients undergoing bariatric surgery. Obesity Surgery 2001; 11: 28–31.

17.

Vgontzas

Bixler

Tan

Kantner

Martin

Kales

. Obesity without sleep apnea is associated with daytime sleepiness. Archives of Internal Medicine 1998; 158: 1333–1337.

18.

Melamed

Oksenberg

. Excessive daytime sleepiness and risk of occupational injuries in non-shift daytime workers. Sleep 2002; 25: 315–322.

19.

Johns

. Rethinking the assessment of sleepiness. Sleep Medical Review 1998; 2: 3–15.

20.

Higgs

Wade

Cescato

Atchison

Slvotinek

Higgins

. Differences between treatment seekers in an obese population: Medical intervention vs. dietary restriction. Journal of Behavioral Medicine 1997; 20: 391–405.

21.

Bjorntorp

. Obesity: A chorinic disease with alarming prevalence and consequences. Journal of Internal Medicine 1998; 244: 267–269.

22.

World Health Organization. Physical status: The use and interpretation of anthropometry report of a WHO expert committee. World Health Organization Technical Report Series 1995; 854: 312–344.

23.

Agargun

Cilli

Kara

Bilici

Telcioglu

Semiz

. Validity and reliability of the Epworth Sleepiness Scale in Turkish sample. Turk Psikiyatri Derg 1999; 10: 261–267.

24.

Johns

. A new method of measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991; 14: 540–545.

25.

Agargun

Kara

Anlar

. Validity and Reliability of the Pittsburgh Sleep Quality Index in Turkish Sample. Turk Psikiyatri Derg 1996; 7: 107–111.

26.

Buysse

Reynolds

Monk

Berman

Kupfer

. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research 1989; 28: 193–213.

27.

Kocyigit

Aydemir

Fisek

Olmez

Memis

. Validity and reliability of the SF-36 in Turkish sample. Ege Fizik Tedavi ve Rehabilitasyon Dergisi 1999.

28.

Ware

Snow

Kosinski

Gandek

. SF-36 Health Survey: Manual and interpretation guide. Boston, MA: The Health Institute of New England Medical Center, 1993.

29.

Dag

. Validity and reliability of the symptoms checklist-90-revised in college students. Turkish Psikiyatri Dergisi 2001; 2: 5–12.

30.

Derogatis

Rickels

Rock

. The SCL-90 and the MMPI: A step in the validation of a new self-report scale. British Journal of Psychiatry 1976; 128: 280–289.

31.

Carpenter

Hasin

Allison

Faith

. Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: Results from a general population study. American Journal of Public Health 2000; 90: 251–257.

32.

Fontaine

Barofsky

. Obesity and health-related quality of life. Obesity Review 2001; 2: 173–182.

33.

Kolotkin

Crosby

. Psychometric evaluation of the impact of weight on quality of life questionnaire (IWQOL-Lite) in a community sample. Quality of Life Research 2002; 11: 157–171.

34.

Jia

Lubetkin

. The impact of obesity on health-related quality-of-life in the general adult US population. Journal of Public Health 2005; 27: 156–164.

35.

Richards

Adams

Hunt

. Functional status and emotional well-being, dietary intake, and physical activity of severely obese subjects. Journal of the American Dietetic Association 2000; 100: 67–75.

36.

Houston

Stevens

Cai

Morey

. Role of weight history on functional limitations and disability in late adulthood: The ARIC study. Obesity Research 2005; 13: 1793–1802.

37.

Morris

. The impact of obesity on employment. Labor Economics 2007; 14: 413–433.

38.

Resta

Barbaro

Foschino MP

Bonfitto

Giliberti

Depalo

Pannacciulli

. Low sleep quality and daytime sleepiness in obese patients without obstructive sleep apnoea syndrome. Journal of Internal Medicine 2003; 253: 536–543.

39.

Broussolle

Piperno

Gormand

Cambursano

Berthier

Perrin-Fayolle

. J. Sleep apnea syndrome in obese patients: Are there any predictive factors? Rev Med Interne 1994; 15: 161–165.

40.

Vgontzas

Tan

Bixler

Martin

Shubert

Kales

. Sleep apnea and sleep disruption in obese patients. Archives of Internal Medicine 1994; 154: 1705–1711.

41.

Richman

Elliott

Burns

Bearpark

Steinbeck

Caterson

. The prevalence of obstructive sleep apnea in an obese female population. International Journal of Obesity and Related Metabolic Disorders 1994; 18: 173–177.

42.

McNamara

Grunstein

Sullivan

. Obstructive sleep apnoea. Thorax 1993; 48: 754–764.

43.

Bixler

Vgontzas

Lin

Calhoun

Vela-Bueno

Kales

. Excessive daytime sleepiness in a general population sample: The role of sleep apnea, age, obesity, diabetes, and depression. Journal of Clinical Endocrinology and Metabolism 2005; 90: 4510–4515.

44.

Liu

Uchiyama

Kim

Okawa

Shibui

Kudo

. Sleep loss and daytime sleepiness in the general adult population of Japan. Psychiatric Research 2000; 93: 1–11.

45.

Gottlieb

Yao

Redline

Ali

Mahowald

. Does snoring predict sleepiness independently of apnea and hypopnea frequency? American Journal of Respiratory Critical Care Medicine 2000; 162: 1512–1517.

46.

Klink

Dodge

Quan

. The relation of sleep complaints to respiratory symptoms in a general population. Chest 1994; 105: 151–154.

47.

Gopta

Mueller

Chan

Menninger

. Obesity associated with poor sleep quality in adolescents? American Journal of Human Biology 2002; 14: 762–768.

48.

Vorona

Winn

Babineau

Eng

Feldman

Ware

. Overweight and obese patients in primary care population report less sleep than patients with a normal body mass index. Archives of Internal Medicine 2005; 165: 25–30.

49.

Punjabi

O'Hearn

Neubauer

Nieto

Schwartz

Smith

. Modeling hypersomnia in sleep-disordered breathing. American Journal of Respiratory Critical Care Medicine 1999; 159: 1703–1709.

50.

Vgontzas

Papanicolaou

Bixler

Kales

Tyson

Chrousos

. Elevation of plasma cytokines in disorders of excessive daytime sleepiness: Role of sleep disturbance and obesity. Clinical Endocrinology and Metabolism 1997; 82: 1313–1316.

51.

Guilleminault

Stoohs

Duncan

Snoring

. Daytime sleepiness in regular heavy snorers. Chest 1991; 99: 40–48.

52.

Hoffstein

Mateika

. Snoring and sleep architecture. American Review of Respiratory Diseases 1991; 143: 92–96.

53.

Andrews

Oei

. The roles of depression and anxiety in the understanding and treatment of Obstructive Sleep Apnea Syndrome. Clinical Psychology Review 2004; 24: 1031–1049.

54.

Harvey

Jones

Schmidt

. Sleep and posttraumatic stress disorder: A review. Clinical Psychological Review 2003; 23: 377–407.

55.

Lindberg

Tani

Appelberg

Stenberg

Naukkarinen

Rimón

. Sleep among habitually violent offenders with antisocial personality disorder. Neuropsychobiology 2003; 47: 198–205.