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Psychosom Med. 2015 May;77(4):467-77. doi: 10.1097/PSY.0000000000000169.

Sex differences in the association between depression, anxiety, and type 2 diabetes mellitus.

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From the Department of Epidemiology (Demmer, Gelb, Suglia, Keyes, Galea, Koenen), Mailman School of Public Health, Columbia University, New York, New York; New York State Psychiatric Institute (Keyes), New York, New York; Gillings School of Global Public Health (Aiello), University of North Carolina, Chapel Hill, North Carolina; Department of Medicine (Colombo), College of Physician's and Surgeons, Columbia University, New York, New York; Department of Psychology and Institute for Genomic Biology (Uddin), University of Illinois Urbana-Champaign, Champaign, Illinois; Department of Social and Behavioral Sciences (Kubzansky), Harvard School of Public Health, Boston, Massachusetts.



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.


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.


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).


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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