title: Stress resilience and subsequent risk of type 2 diabetes in 1.5 million young men.
abstract: OBJECTIVE
  Psychosocial stress in adulthood is associated with a higher risk of type 2 diabetes, possibly mediated by behavioural and physiological factors. However, it is unknown whether low stress resilience earlier in life is related to subsequent development of type 2 diabetes. We examined whether low stress resilience in late adolescence is associated with an increased risk of type 2 diabetes in adulthood.
  
  
  METHODS
  We conducted a national cohort study of all 1,534,425 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old men nationwide each year) without prior diagnosis of diabetes, who underwent standardised psychological assessment for stress resilience (on a scale of 1-9) and were followed up for type 2 diabetes identified from outpatient and inpatient diagnoses during 1987-2012 (maximum attained age 62 years).
  
  
  RESULTS
  There were 34,008 men diagnosed with type 2 diabetes in 39.4 million person-years of follow-up. Low stress resilience was associated with an increased risk of developing type 2 diabetes after adjusting for BMI, family history of diabetes, and individual and neighbourhood socioeconomic factors (HR for lowest vs highest quintile: 1.51; 95% CI 1.46, 1.57; p < 0.0001), including a strong linear trend across the full range of stress resilience (p trend < 0.0001). This association did not vary by BMI level, family history of diabetes or socioeconomic factors.
  
  
  CONCLUSIONS
  These findings suggest that low stress resilience may play an important long-term role in aetiological pathways for type 2 diabetes. Further elucidation of the underlying causal factors may help inform more effective preventive interventions across the lifespan.
authors.affiliation: Department of Medicine, Stanford University, 1265 Welch Road, MSOB X212, Stanford, CA, 94305-5411, USA. kccrump@stanford.edu.
authors.forename: Casey
authors.initials: C
authors.lastname: Crump
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.affiliation: Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Winkleby
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology
keywords: Psychological resilience; Psychological stress; Type 2 diabetes mellitus