title: Psychosocial stress at work doubles the risk of type 2 diabetes in middle-aged women: evidence from the Whitehall II study.
abstract: OBJECTIVE
  To investigate the effect of psychosocial stress at work on risk of type 2 diabetes, adjusting for conventional risk factors, among a sample of British, white-collar, middle-aged men and women.
  
  
  METHODS
  This was a prospective analysis (1991-2004) from the Whitehall II cohort study. The current sample consists of 5,895 Caucasian middle-aged civil servants free from diabetes at baseline. Type 2 diabetes was ascertained by an oral glucose tolerance test supplemented by self-reports at baseline and four consecutive waves of data collection including two screening phases. The job strain and iso-strain models were used to assess psychosocial work stress.
  
  
  RESULTS
  Iso-strain in the workplace was associated with a twofold higher risk of type 2 diabetes in age-adjusted analysis in women but not in men (hazard ratio 1.94 [95% CI 1.17-3.21). This effect remained robust to adjustment for socioeconomic position and outside work stressors and was only attenuated by 20% after adjustment for health behaviors, obesity, and other type 2 diabetes risk factors.
  
  
  CONCLUSIONS
  Psychosocial work stress was an independent predictor of type 2 diabetes among women after a 15-year follow-up. This association was not explained by potential confounding and mediating factors. More evidence from prospective studies using the same work stress models is needed to support the current findings and provide further information on sex differences.
authors.affiliation: Department of Epidemiology and Public Health, Royal Free and University College London Medical School, London, UK. a.heraclides@ucl.ac.uk
authors.forename: Alexandros
authors.initials: A
authors.lastname: Heraclides
authors.forename: Tarani
authors.initials: T
authors.lastname: Chandola
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Witte
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Brunner
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D015986:Confounding Factors, Epidemiologic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D004032:Diet; D004651:Employment / Q000523:psychology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014280:Triglycerides / Q000097:blood; D006113:United Kingdom / Q000453:epidemiology; D044465:White People; D014930:Women / Q000523:psychology*
chemical_list: D014280:Triglycerides; D002097:C-Reactive Protein