Columbia University. US: Women with post-traumatic stress disorder are nearly twice as likely to develop
type 2 diabetes compared with women who don’t have PTSD, according to
researchers at the Mailman School of Public Health at Columbia
University and Harvard School of Public Health. The longitudinal cohort study provides the strongest evidence to date
of a causal relationship between PTSD and type 2 diabetes. Results are
published online in the journal JAMA Psychiatry.
The researchers analyzed survey data collected between 1989 and 2011
from 49,739 women enrolled in the Nurses Health Study II and found a
dose-response relationship: the greater the number and severity of PTSD
symptoms, the greater a woman’s risk of type 2 diabetes. Four percent of
the nurses reported the highest number of PTSD symptoms By age 60,
nearly 12 percent of women with the highest number of PTSD symptoms had
developed type 2 diabetes, whereas fewer than 7 percent of women with no
trauma exposure had diabetes.
Antidepressant use and elevated body mass index accounted for nearly
half of the increased risk of type 2 diabetes, or 34 and 14 percent,
respectively. On the other hand, smoking, diet quality, alcohol intake,
and physical activity did not explain the association.
One in nine women will have PTSD at sometime over the course of her
lifetime—twice the rate of men. Women are also more likely to experience
extreme traumatic events like rape that carry a high risk for the
disorder.
“Not only is PTSD devastating to mental health, but it affects
physical health too, raising risk for cardiovascular disease, diabetes,
and obesity,” said senior author Karestan C. Koenen, PhD, professor in the Department of Epidemiology at the Mailman School.
“Women with PTSD and the health professionals who care for them
should be aware that these women are at greater risk for diabetes,” said
first author Andrea L. Roberts, PhD, research associate in the
Department of Social and Behavioral Sciences at Harvard School of Public
Health. “As fewer than half of Americans with PTSD receive treatment,
our study adds urgency to the effort to improve access to mental health
care to address factors that contribute to diabetes and other chronic
diseases.”
To assess type 2 diabetes, the researchers used a validated survey
method that first asked women whether they had been diagnosed by a
doctor, then confirmed diagnosis with information about test results,
symptoms, and medications. PTSD was assessed using the Short Screening
Scale. The nurses reported a range of trauma, including sexual assault,
domestic violence, car accidents, and unexpected death of a loved one.
The study builds on past findings by the researchers, including a 2013 study
that reported a link between PTSD and obesity. Other research has shown
a link between mental health issues like anxiety, social phobia, and
agoraphobia and type 2 diabetes.
Further research is needed to identify the biochemical and possible
additional behavioral changes, such as sleep disturbance, that mediate
the relationship between PTSD and type 2 diabetes.
Co-authors include Jessica C. Agnew-Blais, Donna Spiegelman, Susan M.
Mason, Laura Kubzansky and Frank B. Hu of Harvard; Sandro Galea of the
Mailman School; and Janet W. Rich-Edwards of Brigham and Women’s
Hospital, Boston.
The study was supported by National Institutes of Health grants to
Dr. Roberts (MH078928 and MH093612); Dr. Agnew-Blais (T32MH017119); Dr.
Galea (MH095718, MH082598, MH 082729, DA013336, and DA034244); Dr.
Koenen (MH078928, MH093612). The Nurses' Health Study II is funded in
part by NIH CA50385. Dr. Galea supported by Department of Defense grant
W81XWH-07-1-0409.