title: Psychological and personality factors in type 2 diabetes mellitus, presenting the rationale and exploratory results from The Maastricht Study, a population-based cohort study.
abstract: BACKGROUND
  Strong longitudinal evidence exists that psychological distress is associated with a high morbidity and mortality risk in type 2 diabetes. Little is known about the biological and behavioral mechanisms that may explain this association. Moreover, the role of personality traits in these associations is still unclear. In this paper, we first describe the design of the psychological part of The Maastricht Study that aims to elucidate these mechanisms. Next, we present exploratory results on the prevalence of depression, anxiety and personality traits in type 2 diabetes. Finally, we briefly discuss the importance of these findings for clinical research and practice.
  
  
  METHODS
  We measured psychological distress and depression using the MINI diagnostic interview, the PHQ-9 and GAD-7 questionnaires in the first 864 participants of The Maastricht Study, a large, population-based cohort study. Personality traits were measured by the DS14 and Big Five personality questionnaires. Type 2 diabetes was assessed by an oral glucose tolerance test. Logistic regression analyses were used to estimate the associations of depression, anxiety and personality with type 2 diabetes, adjusted for age, sex and education level.
  
  
  RESULTS
  Individuals with type 2 diabetes had higher levels of depressive and anxiety symptoms, odds ratios (95 % CI) were 3.15 (1.49; 6.67), 1.73 (0.83-3.60), 1.50 (0.72-3.12), for PHQ-9 ≥ 10, current depressive disorder and GAD-7 ≥ 10, respectively. Type D personality, social inhibition and negative affectivity were more prevalent in type 2 diabetes, odds ratios were 1.95 (1.23-3.10), 1.35 (0.93-1.94) and 1.70 (1.14-2.51), respectively. Individuals with type 2 diabetes were less extraverted, less conscientious, less agreeable and less emotionally stable, and similar in openness to individuals without type 2 diabetes, although effect sizes were small.
  
  
  CONCLUSIONS
  Individuals with type 2 diabetes experience more psychological distress and have different personality traits compared to individuals without type 2 diabetes. Future longitudinal analyses within The Maastricht Study will increase our understanding of biological and behavioral mechanisms that link psychological distress to morbidity and mortality in type 2 diabetes.
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG, Maastricht, The Netherlands. F.E.P.Dooren@uvt.nl.|Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands. F.E.P.Dooren@uvt.nl.|MHeNS - Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. F.E.P.Dooren@uvt.nl.
authors.forename: Fleur E P
authors.initials: FE
authors.lastname: van Dooren
authors.affiliation: Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands. J.Denollet@uvt.nl.
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.affiliation: MHeNS - Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. f.verhey@maastrichtuniversity.nl.
authors.forename: Frans R J
authors.initials: FR
authors.lastname: Verhey
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG, Maastricht, The Netherlands. cda.stehouwer@mumc.nl.|CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands. cda.stehouwer@mumc.nl.
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG, Maastricht, The Netherlands. s.sep@mumc.nl.|CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands. s.sep@mumc.nl.
authors.forename: Simone J S
authors.initials: SJ
authors.lastname: Sep
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG, Maastricht, The Netherlands. rma.henry@mumc.nl.|CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands. rma.henry@mumc.nl.
authors.forename: Ronald M A
authors.initials: RM
authors.lastname: Henry
authors.affiliation: Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands. s.kremers@maastrichtuniversity.nl.
authors.forename: Stef P J
authors.initials: SP
authors.lastname: Kremers
authors.affiliation: CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands. dagnelie@maastrichtuniversity.nl.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. dagnelie@maastrichtuniversity.nl.|Department of Epidemiology, Maastricht University, Maastricht, The Netherlands. dagnelie@maastrichtuniversity.nl.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Dagnelie
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG, Maastricht, The Netherlands. n.schaper@mumc.nl.|CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands. n.schaper@mumc.nl.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. n.schaper@mumc.nl.
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG, Maastricht, The Netherlands. c.vanderkallen@maastrichtuniversity.nl.|CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands. c.vanderkallen@maastrichtuniversity.nl.
authors.forename: Carla J H
authors.initials: CJ
authors.lastname: van der Kallen
authors.affiliation: Department of Social Medicine, Maastricht University, Maastricht, The Netherlands. a.koster@maastrichtuniversity.nl.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. a.koster@maastrichtuniversity.nl.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Koster
authors.affiliation: Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands. F.Pouwer@uvt.nl.
authors.forename: Frans
authors.initials: F
authors.lastname: Pouwer
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG, Maastricht, The Netherlands. m.schram@maastrichtuniversity.nl.|CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands. m.schram@maastrichtuniversity.nl.
authors.forename: Miranda T
authors.initials: MT
authors.lastname: Schram
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D016022:Case-Control Studies; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007266:Inhibition, Psychological; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010551:Personality
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