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Am J Public Health. 2008 Aug;98(8):1480-5. doi: 10.2105/AJPH.2007.126441. Epub 2008 Jun 12.

The influence of educational attainment on depression and risk of type 2 diabetes.

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  • 1Department of Epidemiology, University of Michigan, 3644 SPH Tower, 109 Observatory, Ann Arbor, MI 48109, USA.



We investigated the association between major depressive disorder and type 2 diabetes, whether that association is explained by health behaviors, and whether it is influenced by educational attainment.


We used discrete-time Cox proportional hazards models to determine the risk of type 2 diabetes associated with depression in a 23-year population-based cohort study.


Major depressive disorder was associated with higher risk of type 2 diabetes (hazard ratio [HR]=1.62) after we controlled for age, gender, race, education, smoking status, alcohol use, social network size, and antidepressant use. This association was more pronounced after we controlled for body mass index, family history, and health behaviors (HR=2.04; 95% confidence interval=1.09, 3.81). In stratified analyses, the risk associated with major depressive disorder was elevated among those with 12 or fewer years of education compared with those with at least some education beyond high school.


The risk of type 2 diabetes associated with major depressive disorder persists over the life course and is independent of the effects of health behaviors, body mass index, and family history. Education is an important moderator of this association.

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