Phobic anxiety symptom scores and incidence of type 2 diabetes in US men and women

Abstract

Context Emotional stress may be a risk factor for type 2 diabetes (T2D), but the relation between phobic anxiety symptom scores and risk of T2D is uncertain. Objective To evaluate prospectively the association between phobic anxiety symptom scores and incident T2D in three cohorts of US men and women. Design, Setting and Patients We followed 30,830 men in the Health Professional’s Follow-Up Study (HPFS) (1988–2008), 69,336 women in the Nurses’ Health Study (NHS) (1988–2008), and 80,120 women in the Nurses’ Health Study II (NHS II) (1993–2011). Phobic anxiety symptom scores, as measured by the Crown-Crisp index (CCI), calculated from 8 questions, was administered at baseline and updated in 2004 for NHS, in 2005 for NHS II, and in 2000 for HPFS. Incident T2D was confirmed by a validated supplementary questionnaire. We used Cox proportional hazards analysis to evaluate associations with incident T2D. Results During 3,110,248 person-years of follow-up, we documented 12,876 incident T2D cases. In multivariable Cox regression models with adjustment for major lifestyle and dietary risk factors, the HRs of T2D across categories of increasing levels of CCI (scores= 2-<3, 3-<4, 4-<6, 6), compared with a score of <2, were increased significantly by 6%, 10%, 11% and 13% (Ptrend =0.0005) for NHS; and by 19%, 11%, 22%, and 29% (Ptrend <0.0001) for NHS II. Each score increment in CCI was associated with 3% higher risk of T2D in NHS (HRs, 1.03, 95%CI:1.02-1.04) and 4% higher risk of T2D in NHS II (HRs, 1.04, 95%CI:1.03-1.05). Further adjustment for self-reported depression and antidepressant use did not change the results. In HPFS, the association between CCI and T2D was not significant after adjusting for lifestyle variables. Conclusion Our results suggest that higher phobic anxiety symptom scores are associated with an increased risk of T2D in women.

Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta‐analysis

“…However, the association in the study that only included men (Healthcare Professionals Study) was no longer significant after adjustment for confounders, whereas the two studies in women (Nurses Health Studies I and II) remained significant 27.…”

“…Types of anxiety measurements included the assessment of non‐specific anxiety symptoms, a composite of different anxiety disorders, PTSD, phobic anxiety symptoms, panic, GAD and/or other anxiety (Table 1). Anxiety was determined using a variety of validated symptom scales 22, 23, 24, 25, 27, 28, 30, 33, 37, diagnostic interviews 26, 32, 33 and examination of medical records 31, 35, 36. Most studies examined general anxiety or defined anxiety or anxiety disorders using DSM‐V criteria 22, 24, 28, 33, 35, 37.…”

Self-Reported Experiences of Discrimination and Health: Scientific Advances, Ongoing Controversies, and Emerging Issues

“…Additionally, given the strong associations observed between reports of discrimination and other types of mental disorders (e.g. generalized anxiety, PTSD) (see Table 1) and the emerging literature linking these disorders to disease states (Farvid et al 2014, Goetz et al 2014, Lambiase et al 2014, Vaccarino et al 2013), future studies should also consider the role of psychological disorders outside of depression in order to further our understanding of psychological pathways through which discriminatory experiences impact clinical disease.…”

Diet, Lifestyle, and Genetic Risk Factors for Type 2 Diabetes: A Review from the Nurses’ Health Study, Nurses’ Health Study 2, and Health Professionals’ Follow-Up Study

“…The risk of T2DM increased across categories of PAS measured by Crown-Crisp Index (CCI) after adjusting for depression and major confounding variables. 93 …”