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Sex Differences in the Association Between Depression, Anxiety, and Type 2 Diabetes Mellitus

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Demmer, Ryan T., Gelb, Sara, Suglia, Shakira F., Keyes, Katherine M., Aiello, Allison E., Colombo, Paolo C., Galea, Sandro, Uddin, Monica +2 more·2015·Psychosomatic Medicine
DOI 10.1097/psy.0000000000000169PMC PMC4431947
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Abstract

BACKGROUND: Depression and anxiety have been inconsistently associated with diabetes. Sex differences in the biological and behavioral correlates of these forms of distress could partially explain these inconsistencies. We investigated sex-specific associations between depression/anxiety symptoms and diabetes in two separate samples. METHODS: The First National Health and Nutrition Examination Survey enrolled 3233 participants aged 25 to 74 years from 1971 to 1974. Depression and anxiety symptoms were measured via General Well Being schedule subscales. Incident diabetes for 17 years was defined by the following: a) death certificate, b) participant self-report, or c) health care facility discharge. The Detroit Neighborhood Health Study enrolled 1054 participants 18 years or older from 2008 to 2010. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 assessed depression and anxiety. Participants' self-reported physician-diagnosed prevalent diabetes. RESULTS: In the First National Health and Nutrition Examination Survey, the risk ratio (RR; 95% confidence interval) for incident diabetes among men with high versus low anxiety symptoms was 0.85 (0.56-1.29) and that among women was 2.19 (1.17-4.09; p for interaction = .005). RRs comparing high versus low depressive symptoms for men and women were 0.69 (0.43-1.100) and 2.11 (1.06-4.19); p for interaction = .007. In the Detroit Neighborhood Health Study, the RRs for prevalent diabetes comparing those with high versus low anxiety symptoms were 0.24 (0.02-2.42) for men and 1.62 (0.61-4.32) for women (p for interaction = < .001), whereas RRs for depression were 1.30 (0.46-3.68) for men and 2.32 (1.10-4.89) for women (p for interaction = .16). CONCLUSIONS: In two separate samples, depressive symptoms were related to increased diabetes risk among women but not men. Although less robust, findings for anxiety were differentially associated with diabetes by sex.

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  • In two prospective cohorts (NHANES n=3,233; 17-year follow-up; Detroit Neighbourhood Study n=1,054; 18-year follow-up), anxiety measured by the generalized anxiety disorder-seven item questionnaire showed no association in the overall sample; dividing the groups by sex, in both studies association found in women only.

    “Two prospective cohorts; NHANES cohort ( n = 3,233; 17 year follow-up); The Detroit Neighbourhood Study ( n = 1,054; 18 year follow-up) | Anxiety using the generalized anxiety disorder-seven item questionnaire | ‡ No association in the overall sample. Dividing the groups by sex, in both studies association found in women only.”

    From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as Demmer (2015) 67

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  • Reported 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 [73]

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  1. [1]Eaton WW Armenian H Gallo J Pratt L Ford DE Depression and risk for onset of type II diabetes. A prospective population-based study Diabetes Care 19 1097 102 1996 8886555
  2. [2]Kawakami N Takatsuka N Shimizu H Ishibashi H Depressive symptoms and occurrence of type 2 diabetes among Japanese men Diabetes Care 22 1071 6 1999 10388970
  3. [5]Arroyo C Hu FB Ryan LM Kawachi I Colditz GA Speizer FE Manson J Depressive symptoms and risk of type 2 diabetes in women Diabetes Care 27 129 33 2004 14693978 PMC4502913
  4. [6]Everson-Rose SA Meyer PM Powell LH Pandey D Torrens JI Kravitz HM Bromberger JT Matthews KA Depressive symptoms, insulin resistance, and risk of diabetes in women at midlife Diabetes Care 27 2856 62 2004 15562197
  5. [7]Golden SH Williams JE Ford DE Yeh HC Paton Sanford C Nieto FJ Brancati FL Depressive symptoms and the risk of type 2 diabetes: the Atherosclerosis Risk in Communities study Diabetes Care 27 429 35 2004 14747224
  6. [8]Kumari M Head J Marmot M Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II study Archives of Internal Medicine 164 1873 80 2004 15451762
  7. [9]Palinkas LA Lee PP Barrett-Connor E A prospective study of Type 2 diabetes and depressive symptoms in the elderly: the Rancho Bernardo Study Diabetic medicine: a journal of the British Diabetic Association 21 1185 91 2004 15498084
  8. [10]van den Akker M Schuurman A Metsemakers J Buntinx F Is depression related to subsequent diabetes mellitus? Acta Psychiatr Scand 110 178 83 2004 15283737
  9. [12]Carnethon MR Biggs ML Barzilay JI Smith NL Vaccarino V Bertoni AG Arnold A Siscovick D Longitudinal association between depressive symptoms and incident type 2 diabetes mellitus in older adults: the cardiovascular health study Archives of Internal Medicine 167 802 7 2007 17452543
  10. [14]Edwards LE Mezuk B Anxiety and risk of type 2 diabetes: evidence from the Baltimore Epidemiologic Catchment Area Study Journal of psychosomatic research 73 418 23 2012 23148808 PMC3499773
  11. [15]Rotella F Mannucci E Diabetes mellitus as a risk factor for depression. A meta-analysis of longitudinal studies Diabetes research and clinical practice 99 98 104 2013 23265924
  12. [16]Knol MJ Twisk JW Beekman AT Heine RJ Snoek FJ Pouwer F Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis Diabetologia 49 837 45 2006 16520921
  13. [18]Njolstad I Arnesen E Lund-Larsen PG Sex differences in risk factors for clinical diabetes mellitus in a general population: a 12-year follow-up of the Finnmark Study American Journal of Epidemiology 147 49 58 1998 9440398
  14. [19]Willett WC Dietz WH Colditz GA Guidelines for healthy weight The New England journal of medicine 341 427 34 1999 10432328
  15. [20]Meisinger C Thorand B Schneider A Stieber J Doring A Lowel H Sex differences in risk factors for incident type 2 diabetes mellitus: the MONICA Augsburg cohort study Archives of Internal Medicine 162 82 9 2002 11784224
  16. [21]Ding EL Song Y Malik VS Liu S Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis JAMA: the journal of the American Medical Association 295 1288 99 2006 16537739
  17. [22]Thorand B Baumert J Kolb H Meisinger C Chambless L Koenig W Herder C Sex differences in the prediction of type 2 diabetes by inflammatory markers: results from the MONICA/KORA Augsburg case-cohort study, 1984–2002 Diabetes Care 30 854 60 2007 17392546
  18. [23]Demmer RT Jacobs DR Jr Desvarieux M Periodontal disease and incident type 2 diabetes: results from the First National Health and Nutrition Examination Survey and its epidemiologic follow-up study Diabetes Care 31 1373 9 2008 18390797 PMC2453650
  19. [25]Thurston RC Kubzansky LD Women, loneliness, and incident coronary heart disease Psychosomatic medicine 71 836 42 2009 19661189 PMC2851545
  20. [26]Low CA Thurston RC Matthews KA Psychosocial factors in the development of heart disease in women: current research and future directions Psychosomatic medicine 72 842 54 2010 20841557 PMC2978285
  21. [27]Nolen-Hoeksema S Sex differences in unipolar depression: evidence and theory Psychological Bulletin 101 259 82 1987 3562707
  22. [28]Hanninen V Aro H Sex differences in coping and depression among young adults Social science & medicine 43 1453 60 1996 8923617
  23. [30]Rohleder N Schommer NC Hellhammer DH Engel R Kirschbaum C Sex differences in glucocorticoid sensitivity of proinflammatory cytokine production after psychosocial stress Psychosomatic medicine 63 966 72 2001 11719636
  24. [31]Darnall BD Suarez EC Sex and gender in psychoneuroimmunology research: past, present and future Brain Behav Immun 23 595 604 2009 19272440 PMC2740642
  25. [32]Pradhan AD Manson JE Rifai N Buring JE Ridker PM C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus JAMA 286 327 34 2001 11466099
  26. [33]Pradhan AD Cook NR Buring JE Manson JE Ridker PM C-reactive protein is independently associated with fasting insulin in nondiabetic women Arterioscler Thromb Vasc Biol 23 650 5 2003 12692007
  27. [34]Wild S Roglic G Green A Sicree R King H Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 Diabetes Care 27 1047 53 2004 15111519
  28. [35]Cowie CC Rust KF Ford ES Eberhardt MS Byrd-Holt DD Li C Williams DE Gregg EW Bainbridge KE Saydah SH Geiss LS Full accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006 Diabetes Care 32 287 94 2009 19017771 PMC2628695
  29. [38]Keyes KM McLaughlin KA Demmer RT Cerda M Koenen KC Uddin M Galea S Potentially traumatic events and the risk of six physical health conditions in a population-based sample Depress Anxiety 30 451 60 2013 23495094 PMC4180235
  30. [39]Fazio AF A concurrent validational study of the NCHS General Well-Being Schedule Vital Health Stat 2 1 53 1977 610049
  31. [40]Thurston RC Kubzansky LD Kawachi I Berkman LF Do depression and anxiety mediate the link between educational attainment and CHD? Psychosomatic medicine 68 25 32 2006 16449408
  32. [41]Jonas BS Mussolino ME Symptoms of depression as a prospective risk factor for stroke Psychosomatic medicine 62 463 71 2000 10949089
  33. [42]Zonderman AB Costa PT Jr McCrae RR Depression as a risk for cancer morbidity and mortality in a nationally representative sample JAMA: the journal of the American Medical Association 262 1191 5 1989 2761060
  34. [43]Spitzer RL Kroenke K Williams JB Lowe B A brief measure for assessing generalized anxiety disorder: the GAD-7 Archives of Internal Medicine 166 1092 7 2006 16717171
  35. [44]Bieler GS Brown GG Williams RL Brogan DJ Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data American Journal of Epidemiology 171 618 23 2010 20133516
  36. [48]Golden SH A review of the evidence for a neuroendocrine link between stress, depression and diabetes mellitus Curr Diabetes Rev 3 252 9 2007 18220683
  37. [49]Hotamisligil GS Peraldi P Budavari A Ellis R White MF Spiegelman BM IRS-1-mediated inhibition of insulin receptor tyrosine kinase activity in TNF-alpha- and obesity-induced insulin resistance Science 271 665 8 1996 8571133
  38. [50]Nettleton JA Steffen LM Mayer-Davis EJ Jenny NS Jiang R Herrington DM Jacobs DR Jr Dietary patterns are associated with biochemical markers of inflammation and endothelial activation in the Multi-Ethnic Study of Atherosclerosis (MESA) The American journal of clinical nutrition 83 1369 79 2006 16762949 PMC2933059
  39. [51]Park K Steffes M Lee DH Himes JH Jacobs DR Jr Association of inflammation with worsening HOMA-insulin resistance Diabetologia 52 2337 44 2009 19680627 PMC5643149
  40. [52]Demmer RT Desvarieux M Holtfreter B Jacobs DR Jr Wallaschofski H Nauck M Volzke H Kocher T Periodontal status and A1C change: longitudinal results from the study of health in Pomerania (SHIP) Diabetes Care 33 1037 43 2010 20185742 PMC2858171
  41. [53]Demmer RT Squillaro A Papapanou PN Rosenbaum M Friedewald WT Jacobs DR Jr Desvarieux M Periodontal Infection, Systemic Inflammation, and Insulin Resistance: Results from the Continuous National Health and Nutrition Examination Survey (NHANES) 1999–2004 Diabetes Care 2012 PMC3476901 22837370
  42. [54]Jeon CY Haan MN Cheng C Clayton ER Mayeda ER Miller JW Aiello AE Helicobacter pylori infection is associated with an increased rate of diabetes Diabetes Care 35 520 5 2012 22279028 PMC3322696
  43. [55]Gregg EW Cadwell BL Cheng YJ Cowie CC Williams DE Geiss L Engelgau MM Vinicor F Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the U.S Diabetes Care 27 2806 12 2004 15562189
  44. [56]Nouwen A Winkley K Twisk J Lloyd CE Peyrot M Ismail K Pouwer F Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis Diabetologia 53 2480 6 2010 20711716 PMC2974923

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Authors
Demmer, R. T., Gelb, S., Suglia, S. F., Keyes, K. M., Aiello, A. E., Colombo, P. C., Galea, S., Uddin, M., Koenen, K. C., & Kubzansky, L. D.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • Columbia University (US)
  • New York State Psychiatric Institute (US)
  • University of Illinois Urbana-Champaign (US)
  • Harvard University (US)
Corresponding author
Demmer, Ryan T.
ORCID
Venue
Psychosomatic Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-05
Volume
77
Issue
4
Pages
467-477
ISSN
0033-3174 (ISSN-L)
DOI
10.1097/psy.0000000000000169
PMC
PMC4431947
OpenAlex
W2312474649
Cited by
104
References
10
Citations by year
2026: 2 · 2025: 7 · 2024: 15 · 2023: 11 · 2022: 11 · 2021: 14 · 2020: 4 · 2019: 9 · 2018: 4 · 2017: 10 · 2016: 15 · 2015: 2
FWCI
8.98
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Alcohol Abuse and Alcoholism (K01AA021511)
  • National Heart, Lung, and Blood Institute (HL103199, K01HL103199)
  • National Institute of Mental Health (MH 070627, R01MH082729, R01MH078152, MH-092526, R01MH078928, MH 082729, RC1MH088283, MH-078928, MH088283, K08MH070627, K01MH092526, MH 078152)
  • National Institute on Drug Abuse (DA 022720, R01DA022720, DA 022720-S1)
  • National Institute of Dental and Craniofacial Research (DE-018739, K99DE018739, R00DE018739)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD050924)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression, anxiety, type 2 diabetes, sex differences, depressive symptoms, anxiety symptoms, diabetes risk, new-onset diabetes
MeSH terms
Adolescent, Adult, Aged, Anxiety, Depression, Diabetes Mellitus, Type 2, Female, Health Surveys, Humans, Male, Middle Aged, Sex Factors, United States, Comorbidity, Incidence, Prevalence, Young Adult

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