{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T08:13:56Z","timestamp":1769588036884,"version":"3.49.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009228","name":"Region \u00c3\u2013rebro l\u00c3\u00a4n","doi-asserted-by":"publisher","award":["OLL-939106"],"award-info":[{"award-number":["OLL-939106"]}],"id":[{"id":"10.13039\/501100009228","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007435","name":"\u00c3\u2026ke Wiberg Stiftelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007435","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011727","name":"Stockholm l\u00c3\u00a4ns landsting","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011727","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Social anxiety disorder is common among patients considered for metabolic and bariatric surgery (MBS). The combination of social anxiety with obesity may, however, be associated with a higher risk for adverse outcomes after surgery. In this nationwide, registry-based, matched cohort study, all patients who underwent primary MBS in Sweden from 2007 until 2019 and who had a diagnosis of moderate to severe social anxiety disorder (n\u2009=\u2009586) were matched using a Propensity score to controls who underwent the same treatment but who did not have social anxiety disorder (n\u2009=\u20095791) with a mean follow-up time of 6.9 years. Patients with social anxiety disorder experienced an increased risk for non-serious postoperative complications (OR 1.59; 95%CI 1.21\u20132.09), self-harm (HR 2.44 CI 95% 1.84\u20133.25 p\u2009&lt;\u20090.001) and alcohol or substance abuse (HR 2.41, 95%CI 1.96\u20132.96, p\u2009&lt;\u20090.001), and reported lower psychosocial health-related quality of life before and after surgery. However, patients with social anxiety disorder significantly improved in health-related quality of life compared to baseline, and experienced similar effects on weight reduction at 2 years after surgery (total weight loss: 32.8\u2009\u00b1\u200910.3% compared to 32.6\u2009\u00b1\u20099.7%) and risks for cardiovascular events compared to the matched control group. MBS appears to be a safe and effective treatment for severe obesity in patients with social anxiety disorder, but an individualized and increased peri- and postoperative support should be considered for patients with moderate to severe social anxiety disorder and severe obesity.<\/jats:p>","DOI":"10.1371\/journal.pone.0341175","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T18:26:56Z","timestamp":1769538416000},"page":"e0341175","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolic and bariatric surgery among patients with social anxiety disorder, a matched cohort study"],"prefix":"10.1371","volume":"21","author":[{"given":"Jesper","family":"Christiansen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"N\u00e4slund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrik","family":"Larsson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9189-0093","authenticated-orcid":true,"given":"Erik","family":"Stenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"issue":"10456","key":"pone.0341175.ref001","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1016\/S0140-6736(24)01210-8","article-title":"Obesity in adults","volume":"404","author":"I Lingvay","year":"2024","journal-title":"Lancet"},{"issue":"3","key":"pone.0341175.ref002","doi-asserted-by":"crossref","first-page":"182","DOI":"10.4103\/jpgm.JPGM_712_16","article-title":"Psychiatric disorders and obesity: A review of association studies","volume":"63","author":"TM Rajan","year":"2017","journal-title":"J Postgrad Med"},{"key":"pone.0341175.ref003","volume-title":"Social Anxiety Disorder","author":"GM Rose","year":"2025"},{"issue":"5","key":"pone.0341175.ref004","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1381\/0960892053923815","article-title":"Psychiatric symptoms among prospective bariatric surgery patients: rates of prevalence and their relation to social desirability, pursuit of surgery, and follow-up attendance","volume":"15","author":"CH Rosik","year":"2005","journal-title":"Obes Surg"},{"issue":"7","key":"pone.0341175.ref005","doi-asserted-by":"crossref","first-page":"2438","DOI":"10.1007\/s11695-024-07246-w","article-title":"Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery","volume":"34","author":"S Wnuk","year":"2024","journal-title":"Obes Surg"},{"issue":"4","key":"pone.0341175.ref006","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1007\/s11695-014-1423-7","article-title":"Attachment anxiety predicts poor adherence to dietary recommendations: an indirect effect on weight change 1 year after gastric bypass surgery","volume":"25","author":"F Aarts","year":"2015","journal-title":"Obes Surg"},{"issue":"6","key":"pone.0341175.ref007","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1097\/SLA.0000000000001920","article-title":"Substantial Decrease in Comorbidity 5 Years After Gastric Bypass: A Population-based Study From the Scandinavian Obesity Surgery Registry","volume":"265","author":"M Sundbom","year":"2017","journal-title":"Ann Surg"},{"issue":"2","key":"pone.0341175.ref008","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.soard.2014.10.027","article-title":"Health-related quality of life after bariatric surgery: a systematic review of prospective long-term studies","volume":"11","author":"JR Andersen","year":"2015","journal-title":"Surg Obes Relat Dis"},{"issue":"10","key":"pone.0341175.ref009","first-page":"1447","article-title":"Fifteen-year changes in health-related quality of life after bariatric surgery and non-surgical obesity treatment","volume":"48","author":"H Konttinen","year":"2024","journal-title":"Int J Obes (Lond)"},{"issue":"2","key":"pone.0341175.ref010","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/SLA.0000000000001884","article-title":"Suicide, Self-harm, and Depression After Gastric Bypass Surgery: A Nationwide Cohort Study","volume":"265","author":"YT Lagerros","year":"2017","journal-title":"Ann Surg"},{"issue":"2","key":"pone.0341175.ref011","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.soard.2022.10.028","article-title":"Association between attention deficit hyperactivity disorder and outcomes after metabolic and bariatric surgery: a nationwide propensity-matched cohort study","volume":"19","author":"E Stenberg","year":"2023","journal-title":"Surg Obes Relat Dis"},{"issue":"3","key":"pone.0341175.ref012","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.soard.2020.10.017","article-title":"High acquisition rate and internal validity in the Scandinavian Obesity Surgery Registry","volume":"17","author":"M Sundbom","year":"2021","journal-title":"Surgery for Obesity and Related Diseases"},{"issue":"1","key":"pone.0341175.ref013","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","author":"JF Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0341175.ref014","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s10654-016-0117-y","article-title":"Registers of the Swedish total population and their use in medical research","volume":"31","author":"JF Ludvigsson","year":"2016","journal-title":"Eur J Epidemiol"},{"issue":"4","key":"pone.0341175.ref015","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s10654-019-00511-8","article-title":"The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research","volume":"34","author":"JF Ludvigsson","year":"2019","journal-title":"Eur J Epidemiol"},{"issue":"1","key":"pone.0341175.ref016","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11695-022-06332-1","article-title":"2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery","volume":"33","author":"D Eisenberg","year":"2023","journal-title":"Obes Surg"},{"issue":"1","key":"pone.0341175.ref017","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-020-02644-7","article-title":"Validity and reliability of social anxiety disorder diagnoses in the Swedish National Patient Register","volume":"20","author":"A Vilaplana-P\u00e9rez","year":"2020","journal-title":"BMC Psychiatry"},{"issue":"11","key":"pone.0341175.ref018","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.1038\/s41366-020-0637-0","article-title":"The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery","volume":"44","author":"E Stenberg","year":"2020","journal-title":"Int J Obes (Lond)"},{"issue":"3","key":"pone.0341175.ref019","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1381\/096089203765887679","article-title":"Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome","volume":"13","author":"T Olbers","year":"2003","journal-title":"Obes Surg"},{"issue":"8","key":"pone.0341175.ref020","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1001\/jama.2019.0131","article-title":"Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Disease: A Review","volume":"321","author":"CM Riley","year":"2019","journal-title":"JAMA"},{"issue":"2","key":"pone.0341175.ref021","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"PA Clavien","year":"2009","journal-title":"Ann Surg"},{"issue":"5","key":"pone.0341175.ref022","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1038\/sj.ijo.0802272","article-title":"Psychosocial functioning in the obese before and after weight reduction: construct validity and responsiveness of the Obesity-related Problems scale","volume":"27","author":"J Karlsson","year":"2003","journal-title":"Int J Obes Relat Metab Disord"},{"key":"pone.0341175.ref023","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.jad.2016.06.045","article-title":"Experimentally increasing sedentary behavior results in increased anxiety in an active young adult population","volume":"204","author":"MK Edwards","year":"2016","journal-title":"J Affect Disord"},{"issue":"1","key":"pone.0341175.ref024","doi-asserted-by":"crossref","first-page":"5247","DOI":"10.1038\/s41598-024-55898-6","article-title":"Association between long-term sedentary behavior and depressive symptoms in U.S. adults","volume":"14","author":"Y Guo","year":"2024","journal-title":"Sci Rep"},{"issue":"2","key":"pone.0341175.ref025","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1002\/osp4.558","article-title":"Associations of physical activity and sedentary behavior with appetite sensations and eating regulation behaviors before and during the initial year following bariatric surgery","volume":"8","author":"DS Bond","year":"2021","journal-title":"Obes Sci Pract"},{"issue":"2","key":"pone.0341175.ref026","doi-asserted-by":"crossref","first-page":"59","DOI":"10.17756\/jocd.2020-039","article-title":"Psychosocial Predictors of Weight Loss and Quality of Life at 1 Year Post-Bariatric Surgery: A Cohort Study","volume":"4","author":"C-HD Hsu","year":"2020","journal-title":"J Obes Chronic Dis"},{"key":"pone.0341175.ref027","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.genhosppsych.2017.04.005","article-title":"Psychosocial predictors of quality of life and weight loss two years after bariatric surgery: Results from the Toronto Bari-PSYCH study","volume":"47","author":"S Sockalingam","year":"2017","journal-title":"Gen Hosp Psychiatry"},{"issue":"6","key":"pone.0341175.ref028","first-page":"695","article-title":"Serotonergic antidepressants and perioperative bleeding risk: a systematic review","volume":"13","author":"AA Mahdanian","year":"2014","journal-title":"Expert Opin Drug Saf"},{"issue":"3","key":"pone.0341175.ref029","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.3208","article-title":"Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding","volume":"7","author":"AA Rahman","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"2","key":"pone.0341175.ref030","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s00018-004-4262-1","article-title":"Serotonin reuptake inhibitors and cardiovascular diseases: a platelet connection","volume":"62","author":"E Maurer-Spurej","year":"2005","journal-title":"Cell Mol Life Sci"},{"issue":"6","key":"pone.0341175.ref031","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1182\/blood-2012-06-437392","article-title":"Platelet serotonin promotes the recruitment of neutrophils to sites of acute inflammation in mice","volume":"121","author":"D Duerschmied","year":"2013","journal-title":"Blood"},{"issue":"5","key":"pone.0341175.ref032","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.soard.2019.12.018","article-title":"Associations between perceived somatic symptoms and mental health after Roux-en-Y gastric bypass: a 3-year prospective cohort study","volume":"16","author":"IL Kvalem","year":"2020","journal-title":"Surg Obes Relat Dis"},{"key":"pone.0341175.ref033","doi-asserted-by":"crossref","first-page":"101894","DOI":"10.1016\/j.cpr.2020.101894","article-title":"Anxiety disorders and healthcare utilization: A systematic review","volume":"81","author":"A Horenstein","year":"2020","journal-title":"Clin Psychol Rev"},{"issue":"10","key":"pone.0341175.ref034","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1002\/ejp.886","article-title":"Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis","volume":"20","author":"M Sobol-Kwapinska","year":"2016","journal-title":"European Journal of Pain"},{"key":"pone.0341175.ref035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.physbeh.2016.04.032","article-title":"Factors affecting acute pain perception and analgesics consumption in patients undergoing bariatric surgery","volume":"163","author":"P Aceto","year":"2016","journal-title":"Physiol Behav"},{"issue":"1","key":"pone.0341175.ref036","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3390\/jcm10010053","article-title":"Anxiety and Depression Affect Early Postoperative Pain Dimensions after Bariatric Surgery","volume":"10","author":"S Gravani","year":"2020","journal-title":"J Clin Med"},{"issue":"7","key":"pone.0341175.ref037","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1097\/j.pain.0000000000002521","article-title":"Can perioperative psychological interventions decrease the risk of postsurgical pain and disability? A systematic review and meta-analysis of randomized controlled trials","volume":"163","author":"PG Nadinda","year":"2022","journal-title":"Pain"},{"issue":"1","key":"pone.0341175.ref038","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s13679-023-00495-3","article-title":"Obesity Stigma: Causes, Consequences, and Potential Solutions","volume":"12","author":"S Westbury","year":"2023","journal-title":"Curr Obes Rep"},{"key":"pone.0341175.ref039","doi-asserted-by":"crossref","first-page":"111590","DOI":"10.1016\/j.jpsychores.2024.111590","article-title":"Longitudinal trajectories and psychological predictors of weight loss and quality of life until 3 years after metabolic and bariatric surgery","volume":"178","author":"IAL Slurink","year":"2024","journal-title":"J Psychosom Res"},{"issue":"11","key":"pone.0341175.ref040","doi-asserted-by":"crossref","first-page":"4115","DOI":"10.3390\/ijerph17114115","article-title":"Determinants of Suicidality in the European General Population: A Systematic Review and Meta-Analysis","volume":"17","author":"MT Carrasco-Barrios","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0341175.ref041","doi-asserted-by":"crossref","first-page":"109945","DOI":"10.1016\/j.drugalcdep.2023.109945","article-title":"Social anxiety disorder is a risk factor for alcohol use problems in the National Comorbidity Surveys","volume":"249","author":"TH Rosenstr\u00f6m","year":"2023","journal-title":"Drug Alcohol Depend"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341175","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T18:27:02Z","timestamp":1769538422000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341175"}},"subtitle":[],"editor":[{"given":"M Saad","family":"Saumtally","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0341175","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]}}}