title: Association between current perceived stress and incident diabetes is dependent on occupational status: Evidence from the IPC cohort study.
abstract: OBJECTIVE
  The role of stress in the onset of type 2 diabetes is a widespread lay belief, yet observational studies have produced inconsistent results. This study aimed to test the hypothesis that the association between perceived stress and incident diabetes might depend on occupational status (OS).
  
  
  METHODS
  The four-item Perceived Stress Scale (PSS-4) was completed at baseline by 22,567 participants in the labour force (16,193 men, 6374 women; mean age: 44.5±9.8 years) who had undergone two health checkups subsidized by the French national healthcare system. All subjects were free from diabetes at baseline, defined as a fasting blood glycaemia≥7mmol/L or the use of antidiabetic drugs.
  
  
  RESULTS
  After a mean follow-up of 5.3±2.1 years, 527 participants (2.3%) had incident diabetes. After adjusting for sociodemographic, behavioural and biomedical risk factors as well as self-rated health, the association between baseline perceived stress and diabetes at follow-up was non-significant for the total study population. However, perceived stress was significantly associated with incident diabetes in participants of low OS [odds ratio (OR) for a five-point increment: 1.39; 95% confidence interval (CI): 1.02-1.90]. In contrast, there was a negative association between perceived stress and diabetes among those of high OS (OR: 0.60; 95% CI: 0.41-0.88) and no association within other occupational categories. The interaction between perceived stress and OS was significant (P<0.01).
  
  
  CONCLUSIONS
  This study suggests that the association between perceived stress and diabetes onset is dependent on OS. Furthermore, this association does not appear to be explained by the classical risk factors for diabetes.
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health, U1018, 94807 Villejuif, France; Université Versailles-Saint-Quentin, 78000 Versailles, France. Electronic address: emmanuel.wiernik@inserm.fr.
authors.forename: E
authors.initials: E
authors.lastname: Wiernik
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health, U1018, 94807 Villejuif, France; Université Versailles-Saint-Quentin, 78000 Versailles, France.
authors.forename: H
authors.initials: H
authors.lastname: Nabi
authors.affiliation: IPC Center, 75016 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Thomas
authors.affiliation: IPC Center, 75016 Paris, France; Hôpital Manhes, 91700 Fleury-Mérogis, France.
authors.forename: B
authors.initials: B
authors.lastname: Pannier
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75006 Paris, France; AP-HP, Hôpital Broca, Service de Gériatrie, 75013 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Hanon
authors.affiliation: Inserm, U-1148, 75018 Paris, France; Université Pierre-et-Marie-Curie (UPMC), 75006 Paris, France; AP-HP, Hôpital Saint-Antoine, 75012 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Simon
authors.affiliation: AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Service d'Oncologie Radiothérapique, 75013 Paris, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Simon
authors.affiliation: IPC Center, 75016 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75006 Paris, France; AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Cardiologie, 75015 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75006 Paris, France; Inserm U894, Centre Psychiatrie et Neurosciences, 75014 Paris, France; AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, 75015 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Limosin
authors.affiliation: Université Versailles-Saint-Quentin, 78000 Versailles, France; AP-HP, Hôpital Ambroise-Paré, Unité de Nutrition, 92104 Boulogne-Billancourt, France.
authors.forename: S
authors.initials: S
authors.lastname: Czernichow
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75006 Paris, France; Inserm U894, Centre Psychiatrie et Neurosciences, 75014 Paris, France; AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Lemogne
mesh_terms: D000328:Adult; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*
chemical_list: D001786:Blood Glucose
keywords: Diabetes mellitus; Longitudinal studies; Occupational status; Psychological stress; Risk factors