title: Depressive symptoms and the risk of type 2 diabetes: the Atherosclerosis Risk in Communities study.
abstract: OBJECTIVE
  The goal of this study was to determine whether depressive symptoms predict type 2 diabetes.
  
  
  METHODS
  We analyzed data on depressive symptoms (including recent fatigue, sleep disturbance, feelings of hopelessness, loss of libido, and increased irritability) in a longitudinal, biracial cohort study of 11,615 initially nondiabetic adults aged 48-67 years, who were subsequently followed for 6 years for the development of type 2 diabetes.
  
  
  RESULTS
  At baseline, depressive symptoms were positively associated with BMI, fasting insulin, systolic blood pressure, caloric intake, physical inactivity, and current smoking (all P < 0.05). In prospective analyses, after adjusting for age, race, sex, and education, individuals in the highest quartile of depressive symptoms had a 63% increased risk of developing diabetes compared with those in the lowest quartile (relative hazard [RH] 1.63, 95% CI 1.31-2.02). This relation persisted after adjustment for stress-associated lifestyle factors (smoking, physical activity, caloric intake, and adiposity) (1.28, 1.02-1.60) and metabolic covariates (fasting insulin and glucose, lipids, blood pressure, and adiposity) (1.38, 1.10-1.73).
  
  
  CONCLUSIONS
  In this cohort, depressive symptoms predicted incident type 2 diabetes. This relation is only partially explained by demographic, metabolic, and lifestyle factors. Possible neuroendocrine mediators of the stress-obesity-diabetes relationship require further evaluation in prospective cohort studies that use an established tool to assess depression and incorporate neurohormonal measurements.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA. sgolden1@jhem.jhmi.edu
authors.forename: Sherita Hill
authors.initials: SH
authors.lastname: Golden
authors.forename: Janice E
authors.initials: JE
authors.lastname: Williams
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Catherine
authors.initials: C
authors.lastname: Paton Sanford
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Nieto
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
mesh_terms: D001161:Arteriosclerosis / Q000453:epidemiology; D001774:Blood Chemical Analysis; D015992:Body Mass Index; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012307:Risk Factors; D014481:United States / Q000453:epidemiology