title: Psychological distress and type 2 diabetes mellitus: a 4-year policemen cohort study in China.
abstract: This study investigated whether psychological distress predicts the development of type 2 diabetes mellitus (T2DM) and if the association differs between populations at a high or low diabetes risk level among Chinese police officers.
  
  
  
  Prospective cohort study.
  
  
  
  Single centre.
  
  
  
  6559 participants underwent clinical measurements at the hospital in April 2007. 5811 police officers participated in the follow-up consisting of new-onset diabetes (NOD) events occurring annually between 2008 and 2011.
  
  
  
  Baseline data were collected from policemen who completed the Symptom Checklist 90-Revised (SCL-90-R) questionnaire and a self-designed questionnaire. Psychological distress was measured by the SCL-90-R questionnaire. Hong Kong Chinese Diabetes Risk Score (HKCDRS) was used to evaluate the risk of T2DM, and the participants were divided into low-risk group and high-risk group based on the HKCDRS. Cox proportional hazards regression was used to calculate the HRs of the incidence of T2DM related to psychological distress and further stratified the analysis based on HKCDRS.
  
  
  
  Among 5811 participants, 179 subjects developed NOD during the 4-year follow-up. 54 subjects (1.63%) with a HKCDRS 0-7 vs 125 subjects (4.98%) with a HKCDRS>7 developed NOD (p<0.05). There was a significant association between psychological distress and T2DM (HR=1.46; 95% CI 1.05 to 2.02). Among the participants with a high-risk score (HKCDRS>7), 7.07% of those with psychological distress developed T2DM compared with 4.43% of participants without psychological distress (p<0.05). The corresponding adjusted HR for psychological distress was 1.61 (95% CI 1.10 to 2.37).
  
  
  
  Psychological distress is an independent risk factor for T2DM in this prospective cohort study. Stratification analysis indicated that psychological distress was associated with T2DM in a high-risk level population.
authors.affiliation: Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China.
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.affiliation: Tongling University, Tongling, Anhui, China.
authors.forename: J C
authors.initials: JC
authors.lastname: Liu
authors.affiliation: Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China.|Department of Cardiology, Tianjin 4 Center Hospital, The 4 Center Hospital of Tianjin Medical University, Tianjin, China.|Tianjin Emergency Medical Center, Tianjin, China.
authors.forename: X
authors.initials: X
authors.lastname: Xiao
authors.affiliation: Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China.
authors.forename: X
authors.initials: X
authors.lastname: Chen
authors.affiliation: Medical Center of Police Hospital, Tianjin, China.
authors.forename: S
authors.initials: S
authors.lastname: Yue
authors.affiliation: Tianjin Centers for Disease Control and Prevention, Tianjin, China.
authors.forename: H
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Cardiology, Tianjin 4 Center Hospital, The 4 Center Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: F S
authors.initials: FS
authors.lastname: Tian
authors.affiliation: Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China.
authors.forename: N J
authors.identifier: 0000-0002-1177-252X
authors.initials: NJ
authors.lastname: Tang
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016495:Police / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: prospective cohort studies; psychological distress; type 2 diabetes mellitus