Trends in Utilization of Services for Mental Health and Substance Use Disorders Before and After Bariatric Surgery

The objective of this study was to analyze changes in mental health services utilization and substance use treatment following bariatric surgery from a large commercial insurance claims database.

Mental health and substance use screenings are important components of evaluation prior to bariatric surgery. Long-term mental health services and substance use treatment utilization trends post-operatively have not been previously examined.

Using the Merative MarketScan database of commercial health insurance claims from 2011-2019, bariatric surgery patients were assessed for patterns of mental health and substance treatment utilization over 3 time points: pre-surgery (first MarketScan claim to 6 months before surgery), peri-surgery (6 months before-6 months after surgery), and post-surgery (>6 months after surgery). Rates of outpatient mental health visits, psychiatric medication prescription, inpatient psychiatric services, and substance use disorder treatment were extracted. We calculated standardized rates in person-months (pms) and ran generalized estimating equations with Poisson distribution to test for differences at each time interval.

There were modest increases in the incidence rate ratio from the pre- to-post-surgical period for inpatient psychiatric encounters (1.721 (1.481-2.00)), community mental health visits (1.325 (1.005-1.748)), outpatient psychiatrist visits (1.311 (1.255-1.37)), therapist visits (1.281(1.233-1.341)), antidepressant refills (1.154 (1.139-1.169)) and anxiolytic refills (1.418 (1.376-1.462)). However, there was a dramatic increase in encounters for substance use treatment (3.795 (3.289-4.378).

Health service utilization rates for substance use disorder treatment significantly increased postoperatively. Further investigation is needed to understand how to reduce risks and best to support these patients, particularly in the long-term post-operative period.