Psychometric Properties of NIH PROMIS® Instruments in Bariatric Surgery Candidates

Objective: Ascertain the psychometric properties of the Patient-Reported Outcomes Measurement Information System (R) (PROMIS (R)) Depression (PROMIS-D (R)) and Anxiety (PROMIS-A (R)) Short Forms in a sample of presurgical bariatric patients. Method: This retrospective chart review included 259 patients who completed a presurgical psychological evaluation comprising a semistructured interview and self-report measures. Other data used included demographics, psychiatric diagnoses, and initial psychological clearance for surgery (yes/no). Reliability of the PROMIS-D (R) and PROMIS-A (R) instruments was assessed using Cronbach's alpha, interitem correlations, and item-total correlations. Convergent, predictive, and concurrent validity were assessed using various methods (correlations, logistic regressions, and generalized linear models) to determine whether PROMIS (R) instruments were correlated with similar measures, predicted surgical clearance and psychiatric diagnosis, and whether psychiatric diagnosis status was associated with significantly different PROMIS (R) scores. Categorical confirmatory factor analyses assessed the factor structure, and multiple-indicator multiple cause models assessed invariance. Results: Patients were predominantly female (78%), white (97%) and middle-aged (M = 43.49, SD = 11.26). Rates of diagnosed anxiety and depression-related disorders were high (17% and 23%). At least 65% of respondents reported "never" or "rarely" experiencing symptoms across both measures, and the mean T scores for the PROMIS-A (R) and PROMIS-D (R) were 48.31 (SD = 8.99) and 48.64 (SD = 9.49), respectively. Both measures demonstrated good psychometric properties and were essentially unidimensional. Conclusions: Analyses supported using both PROMIS (R) measures. Additionally, two subgroups were identified: those who reported virtually no symptoms of anxiety or depression, likely because they want surgical approval, and those not receiving initial psychological clearance for surgery based on PROMIS (R) self-reported scores indicating distress and clinician-diagnosed psychopathology.