title: Increased risk of diabetes mellitus among persons with psychotic symptoms: results from the WHO World Health Survey.
abstract: OBJECTIVE
  To analyze with a symptom-based approach the relationship between psychosis and diabetes mellitus in the general population.
  
  
  METHODS
  Nationally representative samples from the World Health Organization (WHO) World Health Survey, totaling 224,743 randomly selected adults 18 years and older from 52 countries worldwide, were interviewed to establish the presence of psychotic symptoms and diabetes mellitus. Presence of psychotic symptoms was established using questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Presence of diabetes was established with a response of "yes" to the question, "Have you ever been diagnosed with diabetes (high blood sugar)?" The World Health Survey was conducted between 2002 and 2004.
  
  
  RESULTS
  An increasing number of psychotic symptoms was related to increasing likelihood of diabetes mellitus (OR = 1.27; 95% CI, 1.24-1.30). As compared to no symptoms, at least 1 psychotic symptom substantially elevated the risk (OR = 1.71; 95% CI, 1.61-1.81). In people with a lifetime diagnosis of schizophrenia or psychosis, the prevalence of diabetes was higher in those with current psychotic symptoms (7.3% vs 5.2%; OR = 1.65; 95% CI, 1.21-2.26), suggesting that the persistence of symptoms over time could play a central role. After controlling for different potential confounders, there was a clear increase in the probability of having diabetes as the number of psychotic symptoms increased. The relationship between psychotic symptoms and diabetes was tested with multiple mediation models and path analyses for categorical outcomes. Only body mass index appeared as a relevant mediator in a model with a good fit (ie, χ21 = 3.2, P = .0742; comparative fit index = 0.999).
  
  
  CONCLUSIONS
  Psychotic symptoms are related to increased rates of diabetes mellitus in nonclinical samples, independent of several potential confounders-including a clinical diagnosis of psychosis or schizophrenia, previous antipsychotic treatment, depression, lifestyle, and individual or country socioeconomic status. The findings highlight the worldwide relevance of the problem and the importance of identifying the specific paths of this association.
authors.affiliation: Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Nuevo
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
authors.forename: David
authors.initials: D
authors.lastname: Fraguas
authors.forename: Emese
authors.initials: E
authors.lastname: Verdes
authors.forename: Nirmala
authors.initials: N
authors.lastname: Naidoo
authors.forename: Celso
authors.initials: C
authors.lastname: Arango
authors.forename: José Luis
authors.initials: JL
authors.lastname: Ayuso-Mateos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology*; D012306:Risk; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D014944:World Health Organization; D055815:Young Adult