SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
Self-Efficacy, Happiness and Psychological Well-Being After
Sleeve Gastrectomy
Zahra Sobhani
1
Masood Amini
1
Seyed Vahid Hosseini
2
Samaneh Khazraei
3
Hajar Khazraei
2
Accepted: 16 August 2020
Ó Socie
´
te
´
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 [13]. 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
1
Laparoscopy Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran
2
Colorectal Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran
3
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
designed by Ryff [19]. Reliability coefficient was assessed,
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
2
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.
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