Psychological distress and incidence of type 2 diabetes in high-risk and low-risk populations: the Whitehall II Cohort Study.
OBJECTIVE
We examined whether psychological distress predicts incident type 2 diabetes and if the association differs between populations at higher or lower risk of type 2 diabetes.


METHODS
This was a prospective cohort of 5,932 diabetes-free adults (4,189 men and 1,743 women, mean age 54.6 years) with three 5-year data cycles (1991-2009): a total of 13,207 person-observations. Participants were classified into four groups according to their prediabetes status and Framingham Offspring Type 2 Diabetes Risk Score: normoglycemia with a risk score of 0-9, normoglycemia with a risk score of 10-19, prediabetes with a risk score of 10-19, and prediabetes with a risk score of >19. Psychological distress was assessed by the General Health Questionnaire. Incident type 2 diabetes was ascertained by 2-h oral glucose tolerance test, doctor diagnosis, or use of antihyperglycemic medication at the 5-year follow-up for each data cycle. Adjustments were made for age, sex, ethnicity, socioeconomic status, antidepressant use, smoking, and physical activity.


RESULTS
Among participants with normoglycemia and among those with prediabetes combined with a low risk score, psychological distress did not predict type 2 diabetes. Diabetes incidence in these groups varied between 1.6 and 15.6%. Among participants with prediabetes and a high risk score, 40.9% of those with psychological distress compared with 28.5% of those without distress developed diabetes during the follow-up. The corresponding adjusted odds ratio for psychological distress was 2.07 (95% CI 1.19-3.62).


CONCLUSIONS
These data suggest that psychological distress is associated with an accelerated progression to manifest diabetes in a subpopulation with advanced prediabetes.
Finnish Institute of Occupational Health, Helsinki, Finland marianna.virtanen@ttl.fi.
Marianna
M
Virtanen
Department of Epidemiology and Public Health, University College, London, U.K.School of Community and Social Medicine, University of Bristol, Bristol, U.K.
Jane E
JE
Ferrie
Department of Epidemiology and Public Health, University College, London, U.K.1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
Adam G
AG
Tabak
Institut National de la Santé et de la Recherche Médicale, U1061, Montpellier, France.
Tasnime N
TN
Akbaraly
Finnish Institute of Occupational Health, Helsinki, FinlandUniversity of Turku and Turku University Hospital, Turku, Finland.
Jussi
J
Vahtera
Department of Epidemiology and Public Health, University College, London, U.K.Institut National de la Santé et de la Recherche Médicale, U1018, Paris, France.
Archana
A
Singh-Manoux
Department of Epidemiology and Public Health, University College, London, U.K.
Mika
M
Kivimäki
D000328:Adult; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000453:epidemiology / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology