title: Trait anger but not anxiety predicts incident type 2 diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: OBJECTIVE
  Prior studies have shown a bidirectional association between depression and type 2 diabetes mellitus (T2DM); however, the prospective associations of anger and anxiety with T2DM have not been established. We hypothesized that trait anger and anxiety would predict incident T2DM, independently of depressive symptoms.
  
  
  METHODS
  In the Multi-ethnic Study of Atherosclerosis (MESA), we prospectively examined the association of trait anger and trait anxiety (assessed via the Spielberger Trait Anger and Anxiety Scales, respectively) with incident T2DM over 11.4 years in 5598 White, Black, Hispanic, and Chinese participants (53.2% women, mean age 61.6 years) at baseline without prevalent T2DM or cardiovascular disease. We used Cox proportional hazards models to calculate the hazard ratios (HR) of incident T2DM by previously defined anger category (low, moderate, high), and anxiety quartile, as there were no previously defined categories.
  
  
  RESULTS
  High total trait anger was associated with incident T2DM (HR 1.50; 95% CI 1.08-2.07) relative to low total trait anger. The association was attenuated following adjustment for waist circumference (HR 1.32; 95% CI 0.94-1.86). Higher anger reaction was also associated with incident T2DM (HR=1.07; 95% CI 1.03-1.11) that remained significant after adjusting for potential confounders/explanatory factors. In contrast, trait anxiety did not predict incident T2DM.
  
  
  CONCLUSIONS
  High total trait anger and anger reaction are potential modifiable risk factors for T2DM. Further research is needed to explore the mechanisms of the anger-diabetes relationship and to develop preventive interventions.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Sherley
authors.initials: S
authors.lastname: Abraham
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Nina G
authors.initials: NG
authors.lastname: Shah
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, MI, United States.
authors.forename: Ana
authors.initials: A
authors.lastname: Diez Roux
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States; Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Felicia
authors.initials: F
authors.lastname: Hill-Briggs
authors.affiliation: University of California, Los Angeles, CA, United States.
authors.forename: Teresa
authors.initials: T
authors.lastname: Seeman
authors.affiliation: Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.affiliation: University of Minnesota School of Public Health, Minneapolis, MN, United States.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schreiner
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States; Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: sahill@jhmi.edu.
authors.forename: Sherita Hill
authors.initials: SH
authors.lastname: Golden
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000786:Anger; D001007:Anxiety / Q000453:epidemiology; D001213:Asian / Q000706:statistics & numerical data; D050197:Atherosclerosis / Q000453:epidemiology* / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D044465:White People / Q000706:statistics & numerical data
keywords: Anger; Anxiety; Diabetes