Trait anger but not anxiety predicts incident type 2 diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA)
Open accessAbstract
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. Research design and 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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the MESA cohort (n=5,598; 11.4-year follow-up), anxiety measured by the Spielberger trait anxiety scale was not associated with incident diabetes mellitus (HR 1.16, 95% CI 0.87-1.54).
“MESA cohort ( n = 5,598; 11.4 year follow-up) | Anxiety using the Spielberger trait anxiety scale | § HR 1.16 (95% CI 0.87-1.54).”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as Abraham (2015) 64
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn the MESA cohort (n=5,598; 11.4-year mean follow-up), anger using the Spielberger trait anger scale was associated with incident diabetes mellitus (trait anger HR 1.48, 95% CI 1.04-.12), attenuated after adjustment for waist circumference.
“MESA cohort ( n = 5,598; 11.4 year mean follow-up) | Anger using the Spielberger trait anger scale | *The trait anger HR 1.48 (95% CI 1.04-.12). Attenuated after adjustment for waist circumference.”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as Abraham (2015) 64
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredReported links between anxiety and new onset diabetes mellitus are equivocal.
“Anxiety is not as well researched as depression, and reported links with new onset diabetes mellitus have been equivocal 69-74”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [70]
In a later study of 5,598 individuals, trait anger significantly increased T2DM risk, but statistical adjustment for waist circumference attenuated the association.
“A later study of 5,598 individuals also found that this characteristic significantly increased T2DM risk; however, statistical adjustment for waist circumference attenuated the association 70”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [70]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnosis and Classification of Diabetes Mellitus
American Diabetes Association (2006) · Diabetes Care · doi:10.2337/diacare.29.s1.06.s43 · Cited by 924 · see citing works
Suls, J., & Bunde, J. (2005) · Psychological Bulletin · doi:10.1037/0033-2909.131.2.260 · Cited by 878 · see citing works
Prevalence of anxiety in adults with diabetes
Grigsby, A. B., Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(02)00417-8 · Cited by 609 · see citing works
Anxiety and depression symptoms in patients with diabetes
Collins, M. M., Corcoran, P., & Perry, I. J. (2009) · Diabetic Medicine · doi:10.1111/j.1464-5491.2008.02648.x · Cited by 465 · see citing works
The role of depression and anxiety in onset of diabetes in a large population-based study
Engum, A. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.07.009 · Cited by 330 · see citing works
Hermanns, N., Kulzer, B., Krichbaum, M., Kubiak, T., & Haak, T. (2005) · Diabetic Medicine · doi:10.1111/j.1464-5491.2005.01414.x · Cited by 170 · cited 2× · see citing works
“, 2003), but there was no significant association in four studies (Fisher et al., 2008; Hall et al., 2009; Bouwman et al., 2010; Hermanns et al., 2005).”
BackgroundGolden, S. H., Williams, J. E., Ford, D. E., Yeh, H.-C., Sanford, C. P., Nieto, F. J., & Brancati, F. L. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.08.008 · Cited by 55 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 32
- Almawi W Tamim H Al-Sayed N Association of comorbid depression, anxiety, and stress disorders with type 2 diabetes in Bahrain, a country with a very high prevalence of type 2 diabetes J Endocrinol Invest 2008 31 11 1020 1024 19169060
- Anderson RJ Grigsby AB Freedland KE Anxiety and poor glycemic control: A meta-analytic review of the literature Int J Psychiatry Med 2002 32 3 235 247 12489699
- Appelhans BM Whited MC Schneider KL Oleski J Pagoto SL Response style and vulnerability to anger-induced eating in obese adults Eat Behav 2011 12 1 9 14 21184967 PMC3011972
- Beekman AT Deeg DJ Van Limbeek J Braam AW De Vries MZ Van Tilburg W Criterion validity of the center for epidemiologic studies depression scale (CES-D): Results from a community-based sample of older subjects in the Netherlands Psychol Med 1997 27 1 231 235 9122304
- Bild DE Bluemke DA Burke GL Multi-ethnic study of atherosclerosis: Objectives and design Am J Epidemiol 2002 156 9 871 881 12397006
- Bouwman V Adriaanse MC van 't Riet E Snoek FJ Dekker JM Nijpels G Depression, anxiety and glucose metabolism in the general Dutch population: The new hoorn study PLoS One 2010 5 4 e9971 20376307 PMC2848610
- Chobanian AV Bakris GL Black HR Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure Hypertension 2003 42 6 1206 1252 14656957
- DeWall CN1 Deckman T Gailliot MT Bushman BJ Sweetened blood cools hot tempers: physiological self-control and aggression Aggress Behav 2011 Jan-Feb 37 1 73 80 21064166 PMC4073202
- Engel SG Boseck JJ Crosby RD The relationship of momentary anger and impulsivity to bulimic behavior Behav Res Ther 2007 45 3 437 447 16697350
- Fisher L Skaff MM Mullan JT Arean P Glasgow R Masharani U A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes Diabet Med 2008 25 9 1096 1101 19183314 PMC2635496
- Friedewald WT Levy RI Fredrickson DS Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge Clin Chem 1972 18 6 499 502 4337382
- Golden SH A review of the evidence for a neuroendocrine link between stress, depression and diabetes mellitus Curr Diabetes Rev 2007 3 4 252 259 18220683
- Golden SH Lazo M Carnethon M Examining a bidirectional association between depressive symptoms and diabetes JAMA 2008 299 23 2751 2759 18560002 PMC2648841
- Hall PA Rodin GM Vallis TM Perkins BA The consequences of anxious temperament for disease detection, self-management behavior, and quality of life in type 2 diabetes mellitus J Psychosom Res 2009 67 4 297 305 19773022
- Julian LJ Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A) Arthritis Care Res 2011 11 63 Suppl 11 S467 S472 PMC3879951 22588767
- Katon W Roy-Byrne P Anxiety disorders: Efficient screening is the first step in improving outcomes Ann Intern Med 2007 146 5 390 392 17339624
- Khuwaja AK Lalani S Dhanani R Azam IS Rafique G White F Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors Diabetol Metab Syndr 2010 2 72 21171976 PMC3022608
- Lynch CP Gebregziabher M Echols C Gilbert GE Zhao Y Egede LE Racial disparities in all-cause mortality among veterans with type 2 diabetes J Gen Intern Med 2010 25 10 1051 1056 20532659 PMC2955466
- Mayer-Davis EJ Validity and reproducibility of a food frequency interview in a Multi-Cultural Epidemiology Study Ann Epidemiol 1999 9 5 314 324 10976858
- Mills JF Kroner DG Forth AE Novaco Anger Scale: reliability and validity within an adult criminal sample Assessment 1998 9 5 3 237 248 9728031
- Ni H Wu C Prineas R Comparison of dinamap PRO-100 and mercury sphygmomanometer blood pressure measurements in a population-based study Am J Hypertens 2006 19 4 353 360 16580569
- Paddison CA Eborall HC French DP Predictors of anxiety and depression among people attending diabetes screening: A prospective cohort study embedded in the ADDITION (Cambridge) randomized control trial Br J Health Psychol 2011 16 Pt 1 213 226 21226792
- Pickering TG Hall JE Appel LJ Recommendations for blood pressure measurement in humans and experimental animals: Part 1: Blood pressure measurement in humans: A statement for professionals from the subcommittee of professional and public education of the American Heart Association council on high blood pressure research Circulation 2005 111 5 697 716 15699287
- Raikkonen K Matthews KA Kuller LH Reiber C Bunker CH Anger, hostility, and visceral adipose tissue in healthy postmenopausal women Metabolism 1999 48 9 1146 1151 10484055
- Scherwitz LW Perkins LL Chesney MA Hughes GH Sidney S Manolio TA Hostility and health behaviors in young adults: The CARDIA study. Coronary artery risk development in young adults study Am J Epidemiol 1992 136 2 136 145 1415137
- Spielberger C Gorsuch R Lushene R Vaag P Jacobs G Manual for the State-Trait Anxiety Inventory 1983 Palo Alto Consulting Psychologist Press
- Thomas J Jones G Scarinci I Brantley P A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses Diabetes Care 2003 26 8 2311 2317 12882854
- Tuncay T Musabak I Gok DE Kutlu M The relationship between anxiety, coping strategies and characteristics of patients with diabetes Health Qual Life Outcomes 2008 6 79 18851745 PMC2572593
- Williams JE Paton CC Siegler IC Eigenbrodt ML Nieto FJ Tyroler HA Anger proneness predicts coronary heart disease risk: Prospective analysis from the atherosclerosis risk in communities (ARIC) study Circulation 2000 101 17 2034 2039 10790343
- Williams JE Nieto FJ Sanford CP Tyroler HA Effects of an angry temperament on coronary heart disease risk: The atherosclerosis risk in communities study Am J Epidemiol 2001 154 3 230 235 11479187
- Wing RR Matthews KA Kuller LH Meilahn EN Plantinga P Waist to hip ratio in middle-aged women. Associations with behavioral and psychosocial factors and with changes in cardiovascular risk factors Arterioscler Thromb 1991 11 5 1250 1257 1911710
- Wu SF Huang YC Liang SY Wang TJ Lee MC Tung HH Relationships among depression, anxiety, self-care behaviour and diabetes education difficulties in patients with type-2 diabetes: A cross-sectional questionnaire survey Int J Nurs Stud 2011 21683360
Cited by
Sorted by citations
Type 2 diabetes mellitus and psychological stress — a modifiable risk factor
Hackett, R. A., & Steptoe, A. (2017) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2017.64 · Cited by 480 · see citing works
Psychosocial Factors in Diabetes and Cardiovascular Risk
Hackett, R. A., & Steptoe, A. (2016) · Current Cardiology Reports · doi:10.1007/s11886-016-0771-4 · Cited by 152 · see citing works
- Authors
- Abraham, S., Shah, N. G., Roux, A. D., Hill-Briggs, F., Seeman, T., Szklo, M., Schreiner, P. J., & Golden, S. H.
- Affiliations
- Johns Hopkins University (US)
- University of California, Los Angeles (US)
- University of Minnesota (US)
- Corresponding author
- Golden, Sherita Hill
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 60
- Pages
- 105-113
- ISSN
- 0306-4530 (ISSN-L)
- PMC
- PMC4526333
- OpenAlex
- W2131860885
- Cited by
- 37
- References
- 7
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 6 · 2019: 5 · 2018: 2 · 2017: 2 · 2016: 4
- FWCI
- 2.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc95165-34-0-1, n01hc095169-003, n01hc95162-31-0-1, n01hc95159-40-0-1)
- National Heart, Lung, and Blood Institute (N01 HC-95159, N01-HC095169, N01-HC-095165, N01 HC95165, N01-HC-095159, N01-HC-095162, N01 HC95169)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079637)
- National Institute on Minority Health and Health Disparities (P60MD002249)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 2 diabetes, trait anger, trait anxiety, anger reactions, new-onset diabetes, depression, modifiable risk factors, waist circumference, Multi-Ethnic Study of Atherosclerosis
- MeSH terms
- Anger, Anxiety, Asian, Black or African American, Diabetes Mellitus, Type 2, Ethnicity, Female, Hispanic or Latino, Humans, Life Style, Male, Middle Aged, Neuropsychological Tests, Predictive Value of Tests, Prospective Studies, United States, Prevalence, White People, Atherosclerosis, Waist Circumference
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
