SURGERY IN LOW AND MIDDLE INCOME COUNTRIES

Self-Efﬁcacy, Happiness and Psychological Well-Being After

Sleeve Gastrectomy

Zahra Sobhani

•

Masood Amini

•

Seyed Vahid Hosseini

•

Samaneh Khazraei

•

Hajar Khazraei

Accepted: 16 August 2020

Ó Socie

Internationale de Chirurgie 2020

Abstract

Purpose Sleeve gastrectomy (SG) is an effective treatment for patients with severe obesity and it leads to signiﬁcant

weight loss and promotes the quality of life. The aim of this study was evaluating the relationship between self-

efﬁcacy, happiness and psychological well-being after sleeve gastrectomy.

Methods One hundred patients that underwent SG were participated in this study. They were asked to ﬁll ques-

tionnaires 12 months after surgery. To assess self-efﬁcacy, Sherer and et al. scale, for happiness, oxford happiness

scale and for psychological well-being, Ryff scale were used. Regression analysis was used on psychological well-

being and happiness for evaluating the prediction of self-efﬁcacy.

Results The results showed that 44% of happiness and 4% of psychological well-being were determined by self-

efﬁcacy after surgery.

Conclusion Based on these ﬁndings, self-efﬁcacy is a signiﬁcant predictor of psychological well-being and

happiness.

Introduction

Obesity is an epidemic disease that is a major problem in

public health. It affects over 1.5 billion people globally;

sleeve gastrectomy (SG) is an effective invasive treatment

for patients with severe obesity as it leads to signiﬁcant

weight loss and promotes the quality of life [1–3]. The

psychological and clinical postoperative evaluation is very

important due to increases surgery and the realization

elapsed time if symptoms are changing as a result of weight

loss [4]. Improvements in eating self-efﬁcacy are pre-

dictably associated with greater weight loss. Moreover,

self-efﬁcacy is an important predictor of the initiation and

performance of weight control behaviors such as adherence

to an eating plan and calorie monitoring [5]. With regard to

long-term change, self-efﬁcacy is a predictor of mainte-

nance of lost weight years after treatment with very low

calorie diets and weight loss surgery [6], and self-efﬁcacy

has an important role in weight control and physical

activity [7].

Happiness is believed to be a stable position that person

ﬁnds between desire and satisfaction. Also, happiness is

used in emotional or mental behavior including positive

and pleasant emotions. Happiness has been used in well-

being and life satisfaction as well and enhances psycho-

logical well-being and body image satisfaction [8]. Hap-

piness, positive affect and optimism, can have beneﬁcial

effects on cardiovascular and immune systems, inﬂuence

hormones and inﬂammation, and maintaining good

& Hajar Khazraei

[email protected]

Laparoscopy Research Center, Shiraz University of Medical

Sciences, Shiraz, Iran

Colorectal Research Center, Shiraz University of Medical

Sciences, Shiraz, Iran

Department of Psychiatry, Shiraz University of Medical

Sciences, Shiraz, Iran

123

World J Surg

https://doi.org/10.1007/s00268-020-05761-2

nutrition may be important for happiness and psychological

health in people [9, 10].

Well-being is an attempt to promote the manifest for

realization of the one’s talents and abilities [11]. Psycho-

logical well-being is very important to correlate well-being

with excess weight in people and individual with obesity is

often associated with impairing of psychological well-be-

ing [12]. These ﬁndings suggest that self-efﬁcacy, happi-

ness and psychological well-being are important predictors

of the adoption and maintenance of weight control

behaviors during treatment and greater conﬁdence in abil-

ity to control eating behavior is associated with long-term

maintenance of lost weight after SG. So far, no research

has investigated these variables simultaneously; thus, the

purpose of this study was to evaluate the relationship

between self-efﬁcacy, happiness and psychological well-

being after SG.

Materials and methods

Participants

One hundred patients that underwent bariatric surgery for

their morbid obesity from 2017 to 2019 were asked to

participate in this study. The patients’ mean age was

37.65 years (SD = 10.59). In our study, 15.4% of partici-

pants were men and 84.6% were women. They were asked

to ﬁll questionnaires 12 months after SG. The average time

for the ﬁlling out research questionnaires was about

30 min. Data were analyzed by Pearson correlation coef-

ﬁcient and regression tests using SPSS (ver. 16) software.

Descriptive data were also reviewed with mean and stan-

dard deviations.

Measurements.

General self-efﬁcacy questionnaire

To assess the general self-efﬁcacy, we used ten-item scale

developed and validated by Sherer and Maddux [13] that

measured three aspects of behavior: desire to initiate

behavior, desire to expand efforts to complete the task and

resistance in dealing with obstacles. Respondents were

asked to report on the extent to which they had experienced

general self-efﬁcacy. Responses were made on a four-point

Likert-type scale ranging from 1 = ‘‘absolutely untrue’’ to

4 = ‘‘absolutely true.’’ All items had factor loadings

ranging from 10 to 40. In Shere et al. study, the Cronbach’s

alpha was 0.85 and its validity was 0.86 for this scale [13].

High reliability, stability and construct validity of the

GSES scale are conﬁrmed in earlier studies [14, 15]. In our

study, Cronbach’s alpha was 0.87.

Happiness questionnaire

To assess happiness, we used Oxford happiness scale (29

items) developed by Argyle and Lou [16]. Responses were

made on a four-point Likert-scale ranging from

0 = ‘‘completely opposed,’’ 1 = ‘‘opposed,’’ 2 = ‘‘agree’’

and 3 = ‘‘completely agree.’’ According to Oxford happi-

ness scale, the highest grade is 87 and lowest is 0 that

denotes the lack of happiness of patients. Alpha coefﬁcient

was 0.90 [16, 17]. The Cronbach’s alpha index for this

measure was 91%, according to previous speciﬁc validity

studies in Iran [18]. Cronbach’s alpha in this study was

0.95.

Psychological well-being questionnaire

To assess psychological well-being, we used 18-item scale

of the Ryff psychological well-being scale that was

and the retest method for the whole scale was 0.82.

Responses were based on a six-point Likert-type scale

ranging from 1 = ‘‘completely opposed,’’ 2 = ‘‘somewhat

disagree,’’ 3 = ‘‘opposed,’’ 4 = ‘‘agree,’’ 5 = ‘‘somewhat

agree’’ and 6 = ‘‘completely agree.’’ The correlation

between the short version of the psychological well-being

scale and the Ryff scale was ﬂuctuating from 0.7 to 0.89

[20]. Bayani et al. [21] reported the reliability coefﬁcient

by using the retest of psychological well-being scale (0.82),

and the subscales of self-acceptance, positive relationships

with others, autonomy; environmental dominance, targeted

life and personal growth were 0.71, 0.78, 0.70, 0.77, 0.78

and 0.77, respectively. Cronbach’s alpha in our study was

0.68.

Results

In order to evaluate the prediction of self-efﬁcacy after SG,

regression analysis was used on happiness and psycho-

logical well-being. The age range was between 18 and

66 years old. The patients mean weight was reduced after

surgery from 121.41 to 90.24 kg. (Mean of BMI decreased

from 43.22 to 33.16.) The results of happiness, self-efﬁcacy

and psychological well-being 12 months after surgery are

shown in Table 1. The regression analysis results of self-

Table 1 Mean and standard deviation of psychological well-being,

happiness and self-efﬁcacy after SG

Psychological well-being Happiness Self-efﬁcacy

70.91 ± 11.49 55.21 ± 15.11 31.03 ± 4.44

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efﬁcacy and psychological well-being on happiness are

shown in Table 2.

The results showed that 4% of psychological well-being

and 44% of happiness variances after surgery were deter-

mined by self-efﬁcacy. Therefore, self-efﬁcacy is a sig-

niﬁcant predictor of psychological well-being (P = 0.02,

F = 4.95) and happiness (P \ 0.0001, F = 88.54).

Discussion

Sleeve gastrectomy is an effective treatment for severe

obesity in terms of improving weight comorbidities and

weight loss [1]. In our study, we evaluated the self-efﬁcacy,

happiness and psychological well-being after SG. The

results of our study showed that self-efﬁcacy is a signiﬁ-

cant predictor of psychological well-being and happiness

and these criteria’s were increased after SG.

Various studies have shown that there is a two-way

relationship between happiness and mental health.

Increasing happiness in people can activate the immune

system and affect the various dimensions of health in a

positive manner under the inﬂuence of cognitive processes

[9]. Batsis et al. measured eating self-efﬁcacy in morbidly

obese patients who were previously evaluated for weight-

loss surgery. After four years, the operative group, when

compared to the non-operative group, lost 31% of initial

body weight approximately and had higher ratings of self-

efﬁcacy signiﬁcantly [6]. A study suggests that an inter-

vention of self-efﬁcacy is effective for increasing exercise

in inactive obese women [7]. In clinical practice, measur-

ing self-efﬁcacy may help identify patients who lack con-

ﬁdence for controlling eating behavior and target those

problem areas during obesity treatment and increasing self-

efﬁcacy in peoples with overweight will increase their

happiness.

SG affects in massive weight loss, improvement in

health and mental well-being, happiness and self-efﬁcacy

for morbid obesity. Psychological well-being can affect the

people’s mental and physical health. Happiness is one of

the most important goals of mankind. On the other hand,

happiness helps the achievement of other goals and desir-

able behaviors and their outcomes. Happiness and suc-

cessful in many areas of live in people are directly related

to each other [9, 10]. After SG, since the eating process is

limited, the weight loss occurs and the positive physical

image is given to the individual, which results in an

increase in happiness and ultimately in the psychological

well-being of the individual [2, 8].

The assessment appearance of patients was related to

their assessment of health; the more they believe in their

attractiveness and appearance, the more they will appre-

ciate their health and will have a higher psychological

well-being; obesity surgery improves the uncomfort-

able feeling in women when they feel to have low self-

efﬁcacy and are not satisﬁed from their body shape [22].

SG seems to be able to capture the person’s mental image

of the obese person because weight loss brings them closer

to the dominant and accepted ideal mental image of the

community.

One of the strengths of this study was that this study was

conducted at an advanced obesity clinic in Iran and the

Middle East, which provided substantially good services to

all patients referred to this center, including participants in

this study. So, it has made it possible for all the patients to

follow their post-treatment follow-up completely and

spontaneously. Due to this fact, only nine of these patients,

who lived in the southern cities of Iran and were unable to

receive regular follow-up appointments, missed the study

requirement and excluded from the study. Since only the

questionnaire was used in this study, it is suggested that

psychological interventions are used in future research to

improve self-management behaviors.

Conclusion

The study showed that self-efﬁcacy is a signiﬁcant pre-

dictor of psychological well-being and happiness. There-

fore, self-efﬁcacy, happiness and psychological well-being

increased after SG.

Acknowledgements The authors thank the staff of the Mother and

Child Hospital, who helped and assisted this research, and all the

participants involved in this research study for their sincere cooper-

ation. This study was approved by Shiraz University of Medical

Sciences by no. 97-01-69-17697.

Compliance with ethical standards

Conﬂict of interest The authors declare that they have no conﬂict of

interest.

Table 2 Regression analysis of self-efﬁcacy on happiness and psychological well-being after SG

Variables BTF RR

P value

Psychological well-being .20 2.22 4.95 0.20 0.04 .02

Happiness 0.67 9.41 88.54 0.67 0.44 .0001

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Ethical approval This study was approved by the research ethics

committee of University of Medical Sciences

(no.IR.SUMS.REC.1398.075).

Informed consent Informed consent was obtained from all individ-

ual participants included in the study.

References

1. Mingrone G et al (2015) Bariatric–metabolic surgery versus

conventional medical treatment in obese patients with type 2

diabetes: 5 year follow-up of an open-label, single-centre, ran-

domised controlled trial. Lancet 386(9997):964–973

2. Jime

nez-Loaisa A et al (2020) Changes in bariatric patients’

physical activity levels and health-related quality of life follow-

ing a postoperative motivational physical activity intervention.

Obes Surg 30:2302–2312

3. Major P et al (2020) Quality of life 10 years after bariatric sur-

gery. Obes Surg. https://doi.org/10.1007/s11695-020-04726-7

4. Adams TD et al (2012) Health beneﬁts of gastric bypass surgery

after 6 years. JAMA 308(11):1122–1131

5. Linde JA et al (2006) The impact of self-efﬁcacy on behavior

change and weight change among overweight participants in a

weight loss trial. Health Psychol 25(3):282

6. Batsis JA et al (2009) Self-efﬁcacy after bariatric surgery for

obesity. A Populat-Based Cohort Study Appetite 52(3):637–645

7. Robertson MC et al (2020) Self-efﬁcacy and physical activity in

overweight and obese adults participating in a worksite weight

loss intervention: multistate modeling of wearable device data.

Cancer Epidemiol Biomarkers Prev 29(4):769–776

8. Yazdani N et al (2018) Relationship between body image and

psychological well-being in patients with morbid obesity. In J

Commun Based Nurs Midwifery 6(2):175

9. Ironson G et al (2018) Positive emotional well-being, health

behaviors, and inﬂammation measured by C-reactive protein. Soc

Sci Med 197:235–243

10. Jyva

korpi SK et al (2018) Happiness of the oldest-old men is

associated with fruit and vegetable intakes. Eur Geriatr Med

9(5):687–690

11. Sabatini F (2014) The relationship between happiness and health:

Evidence from Italy. Soc Sci Med 114:178–187

12. Giuli C et al (2012) Social isolation risk factors in older hospi-

talized individuals. Arch Gerontol Geriatr 55(3):580–585

13. Sherer M et al (1982) The self-efﬁcacy scale: construction and

validation. Psychol Rep 51(2):663–671

14. Koskinen-Hagman, M., R. Schwarzer, and M. Jerusalem, Swed-

ish version of the general self-efﬁcacy scale; 1999. https://www.

userpage.fu-berlin.de/health/swedish.htm.[accessed 2016-02-

01][WebCite Cache ID 6ey3E7yR4], 1999.

15. Asgharnejad T, Ahmadi DM, Valielah F, Khodapanahi MK

(2006) Psychometric properties of Sherer’s general self-efﬁcacy

scale. J Psychol 10:262–274

16. Argyle M, Lu L (1990) The happiness of extraverts. Personal

Individ Differ 11(10):1011–1017

17. Hills P, Argyle M (2002) The oxford happiness questionnaire: a

compact scale for the measurement of psychological well-being.

Personal Individ Differ 33(7):1073–1082

18. Alipour A, A.M, (2007) Reliability and validity of the Oxford

Happiness Inventory among Iranians. J Iran Psychol

12(3):287–298

19. Ryff CD (1989) Happiness is everything, or is it? Explorations on

the meaning of psychological well-being. J Pers Soc Psychol

57(6):1069

20. Ryff CD (2014) Psychological well-being revisited: advances in

the science and practice of eudaimonia. Psychother Psychosom

83(1):10–28

21. Bayani AA, Mohammad Koochekya A, Bayani A (2008) Relia-

bility and validity of Ryff’s psychological well-being scales. Iran

J Psychiat Clin Psychol 14(2):146–151

22. Emdadi S et al (2017) Relationship between body image and self-

efﬁcacy in female students of Hamadan University of Medical

Sciences. Dermatol Cosmetic 8(2):90–99

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