Type 2 diabetes risk appears to be nearly twice as high for women with six or seven posttraumatic stress disorder (PTSD) symptoms when compared with those who were not exposed to a traumatic event, new data published in JAMA Psychiatry suggest.
“Posttraumatic stress disorder has been associated with inflammation, neuroendocrine dysfunction, poor diet, and low physical activity, all risk factors for type 2 diabetes mellitus,” the researchers wrote.
“Research has shown an association of PTSD with [type 2 diabetes], raising important questions about whether women with PTSD are at an increased risk of [type 2 diabetes] and whether the treatment of PTSD would prevent [type 2 diabetes].”
Previous studies, however, were limited in their ability to show a causal association between PTSD and type 2 diabetes.
To investigate this potential connection, Andrea L. Roberts, PhD, of the Harvard School of Public Health in Boston, and colleagues conducted a longitudinal study of PTSD and the incidence of type 2 diabetes using data from the Nurses’ Health Study II (n=49,739) during 22 years of follow-up.
A total of 3,091 women (6.2%) developed type 2 diabetes, with the incidence appearing to be higher among women with PTSD symptoms vs. those who were not exposed to a traumatic event.
A dose-response relationship between PTSD symptoms and type 2 diabetes incidence also became apparent. Specifically, hazard ratios (HRs) were 1.4 (95% CI, 1.2-1.6) for women with one to three symptoms; 1.5 (95% CI, 1.3-1.7 for women with four or five symptoms; and 1.8 (95% CI, 1.5-2.1) for women with six or seven symptoms, according to the study results.
The researchers noted that nearly half of the increased type 2 diabetes risk among women with PTSD was attributable to antidepressant use and higher BMI. Smoking, diet, alcohol intake and physical activity, however, did not further account for this heightened risk.
PTSD was assessed using the Short Screening Scale for DSM-IV PTSD. Type 2 diabetes was self-reported and confirmed with self-report of diagnostic tests, symptoms and medications.
“Our findings have implications for research and practice. Further research must identify the biochemical and possible additional behavioral changes, such as sleep disturbance, that mediate the relationship between PTSD and onset of [type 2 diabetes]. A better understanding of pathways will facilitate interventions to prevent this disabling disease,” the researchers wrote.
They also added that treatment for PTSD should be broadened “to address the health behaviors that contribute to obesity and chronic disease in PTSD-affected populations.”