Psychological Assessment and Psychosocial Outcomes in Bariatric Surgery Candidates: A Retrospective Study

<b>Background/Objectives:</b> Psychological vulnerability in individuals with obesity represents a significant concern in the context of bariatric surgery. This study aimed to assess psychosocial functioning and identify the psychological, clinical, and sociodemographic predictors of impairment among patients undergoing preoperative evaluation. <b>Methods</b>: A retrospective observational study was conducted on patients referred for bariatric surgery at a single academic medical center. Data were collected through clinical interviews and validated psychometric tools: the Clinical Impairment Assessment (CIA), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). Robust multiple regression analysis determined associations between CIA scores and psychological and demographic factors. <b>Results</b>: A total of 688 patients were evaluated (median age: 46 years; 70.3% female). Most had a high school education (56.9%) and were employed (69%). Elevated scores on the Clinical Impairment Assessment (CIA) were significantly associated with female gender (β = 1.075, <i>p</i> = 0.029), moderate anxiety (GAD-7 ≥ 10; β = 3.85, <i>p</i> < 0.001), and severe depressive symptoms (PHQ-9 ≥ 15; β = 16.67, <i>p</i> < 0.001). Other significant predictors included prior psychotherapy (β = 1.18, <i>p</i> = 0.044), aesthetic motivation for surgery (β = 0.92, <i>p</i> = 0.120), and expectations that weight loss would improve self-esteem (β = 2.11, <i>p</i> = 0.001) or social relationships (β = 1.98, <i>p</i> = 0.002). Conversely, physical activity was associated with lower CIA scores (β = -1.23, <i>p</i> = 0.050). The regression model showed strong explanatory power (McFadden R² = 0.529). <b>Conclusions</b>: This study highlights key predictors of psychosocial distress in bariatric candidates, underscoring the importance of comprehensive psychological assessment before surgery. The CIA appears to be a valuable screening and monitoring tool. Future research should explore the longitudinal evolution of psychosocial functioning and support the integration of psychological care into multidisciplinary bariatric programs.