"Am I doing everything right enough?": a mixed methods evaluation of the early post-bariatric surgery period

The post-bariatric surgery period is a multidimensional experience encompassing individuals' physical, psychological, and social adjustment processes. During this period, personality functioning and emotion regulation abilities may significantly influence postoperative adjustment and quality of life. Therefore, it is important to address the issue from a holistic perspective. This study aimed to examine the relationship between personality functioning, emotion regulation difficulties, and quality of life after bariatric surgery, and to explore patients' postoperative experiences using a mixed-methods approach.

This study was conducted using a concurrent parallel mixed-method design. Quantitative and qualitative data were collected from individuals within the first year after bariatric surgery. In the quantitative phase, 95 participants completed the Inventory of Personality Organization (IPO-TR), the Difficulties in Emotion Regulation Scale-Short Form (DERS-16), and the Post-Bariatric Surgery Quality of Life Scale (PBSQLS). Regression analyses were conducted to examine the relationships among variables. From among the quantitative participants, 18 patients were selected through purposive sampling based on different follow-up months and gender, and participated in semi-structured interviews. Qualitative data were analyzed using Braun and Clarke's thematic analysis. Quantitative and qualitative data were analyzed separately and then integrated through a joint display approach.

Quantitative analyses indicated that IPO-TR scores strongly and positively predicted PBSQLS-Complications scores and negatively predicted PBSQLS-Biopsychosocial Area scores. When DERS-16 was added to the model including IPO-TR, DERS-16 was not independently associated with PBSQLS-Complications subscale scores and showed a marginally significant association with the PBSQLS-Biopsychosocial Area subscale. Female sex and earlier postoperative follow-up periods (1, 3, and 6 months) were associated with higher scores on the PBSQLS-Complications subscale. Qualitative themes revealed psychological distress and functional difficulties during the 1st-3rd postoperative months; increased body satisfaction and self-confidence during the 6th-12th months; support as well as jealousy/tension in interpersonal relationships; and patterns of externalization, self-criticism, and suspiciousness in the adjustment process. Integration findings indicated that the statistical associations between IPO-TR and the PBSQLS subscale scores were contextualized by the qualitative findings. Quantitative findings related to emotion regulation were further informed by the contextual insights obtained from the qualitative data.

Quality of life after bariatric surgery appears to be associated not only with physical recovery but also with personality functioning and psychosocial processes. The findings highlight the importance of considering psychological vulnerability and adjustment difficulties in early postoperative clinical follow-up. Given the cross-sectional design and the reliance on self-report measures, the findings should not be interpreted as indicating causal relationships. Future studies with larger samples, more comprehensive clinical variables, and longitudinal designs are needed to validate these findings.