The Significance of Attachment Representations for Quality of Life One Year Following Gastric Bypass Surgery: A Longitudinal Analysis

Abstract

Background: Quality of life after bariatric surgery may, among other things, depend on patients' attachment representations such as anxiety about rejection and abandonment (attachment anxiety) and avoidance of intimacy and interdependence (attachment avoidance). The aim of this study was to examine whether attachment representations, independent of body mass index (BMI), are associated with the level and course of physical functioning and mental well-being after gastric bypass surgery. Method: A total of 131 patients applying for a Roux-en-Y gastric bypass operation agreed to participate in this longitudinal study. Patients' attachment representations (ECR-R) were measured before surgery, and quality of life dimensions (physical functioning and mental well-being, SF-36) were measured before surgery and 1, 3, 6, and 12 months following surgery. Linear mixed effect models were used in analyses. Results: Physical functioning (p<0.001) improved, and mental well-being worsened (p=0.002) in the postoperative interval. Both attachment anxiety (p=0.005) and attachment avoidance (p<0.001) were associated with a lower level of mental well-being, but not with the postoperative course of quality of life. Conclusions: Our study suggests that bariatric surgery leads to improvement in physical functioning but not mental well-being. Results highlight that patients with insecure attachment representations should be protected against unrealistic expectations regarding improvement of mental well-being after surgery.