An association of adverse psychosocial factors with diabetes mellitus: a meta-analytic review of longitudinal cohort studies

Abstract

Aims/hypothesis There has been substantial interest in the association between psychosocial stress and risk of diabetes mellitus, but no data on the systematic quantification of the causal relationship have been published. This analysis aims to evaluate the association between adverse psychosocial factors and diabetes mellitus. Methods We performed a search of Medline, PsycINFO, Web of Science and PubMed up to July 2008. The studies included were prospective cohort studies investigating the association between adverse psychosocial factors and risk of diabetes mellitus. Results There were 22 relationships between psychosocial factors and disease-related factors (in 14 papers), of which 16 evaluated the associations of adverse psychosocial factors with diabetes control in diabetic populations and six evaluated the associations of adverse psychosocial factors with the incidence of diabetes in populations without any diagnosed diabetes. The overall meta-analysis demonstrated that adverse psychosocial factors were significantly associated with poor diabetes control (combined correlation coefficient, r=0.096, p=0.006), whereas adverse psychosocial factors were not associated with incident diabetes mellitus. More notably, sensitivity analyses showed that low social support was more robustly associated with poor diabetes control than stressful events per se or stress-prone personality or coping style, and that adverse psychosocial factors were associated with poor control of type 1 and type 2 diabetes. Conclusions/interpretation The current review revealed a detrimental association of psychosocial factors with the prognosis of both type 1 and type 2 diabetes. However, any aetiological effect of adverse psychosocial factors remains elusive as a result of the small number of individuals enrolled in the cohorts studied.

Health behaviours, socioeconomic status and diabetes incidence: the Australian Diabetes Obesity and Lifestyle Study (AusDiab)

“…Other pathways must therefore exist to explain a proportion of this relationship. Previous research indicates that psychosocial risk factors, such as depression and work stress, may provide other mechanisms through which SES influences diabetes risk [11,27].…”

Barriers to Addressing Psychological Problems in Diabetes: Perspectives of Diabetologists on Routine Diabetes Consultations in Denmark

“…Also, there is a significant association between psychological problems and poor diabetes outcomes [4,[12][13][14][15][16][17]. Depression is, for example, associated with both 'non-adherence' [14] and risk of hyperglycaemia [16].…”

Commentary: Reconsidering the Role of Context in Diabetes Prevention

“…17 Thus, they are exposed to different ends of the distribution of stressors both in in terms of quantity (ie, number of events) and quality (ie, the to differentially impact mental and physical health. While stress is a hypothesized contributor to disparities in diabetes, 21 empirical support for this notion is mixed for two reasons: first, there is a lack of high-quality data on the biological mechanisms thought to underlie this relationship; and second, little attention has been given to the role of self-regulatory (ie, coping) behaviors that are prompted in response to stress. Some of these self-regulatory behaviors reduce risk of diabetes (eg, exercise, social support) while others increase diabetes risk (eg, tobacco and alcohol use, eating foods high in fat and sugar).…”