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Open Access Highly Accessed Research article

Higher levels of psychological distress are associated with a higher risk of incident diabetes during 18 year follow-up: results from the British household panel survey

Paula MC Mommersteeg1*, Raphael Herr2, Wobbe P Zijlstra13, Sven Schneider2 and François Pouwer1

Author Affiliations

1 CoRPS, Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands

2 MIPH, Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Mannheim, Germany

3 Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands

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BMC Public Health 2012, 12:1109  doi:10.1186/1471-2458-12-1109

Published: 23 December 2012



Reviews have shown that depression is a risk factor for the development of type 2 diabetes. However, there is limited evidence for general psychological distress to be associated with incident diabetes. The aim of the present study was to test whether persons who report higher levels of psychological distress are at increased risk to develop type 2 diabetes during 18 years follow up, adjusted for confounders.


A prospective analysis using data from 9,514 participants (41 years, SD=14; 44% men) of the British Household Panel Survey. The General Health Questionnaire 12 item version was used to assess general psychological distress, diabetes was measured by means of self-report. Cox proportional hazards regression models were used to calculate the multivariate-adjusted hazard ratio (HR) of incident diabetes during 18 years follow up, comparing participants with low versus high psychological distress at baseline (1991).


A total of 472 participants developed diabetes 18 year follow up. Those with a high level of psychological distress had a 33% higher hazard of developing diabetes (HR=1.33, 95% CI 1.10–1.61), relative to those with a low level of psychological distress, adjusted for age, sex, education level and household income. After further adjustment for differences in level of energy, health status, health problems and activity level, higher psychological distress was no longer associated with incident diabetes (HR=1.10, 95% CI 0.91-1.34).


Higher levels of psychological distress are a risk factor for the development of diabetes during an 18 year follow up period. This association may be potentially mediated by low energy level and impaired health status.

Type 2 diabetes; Psychological distress; Prospective; Risk factor; British household panel survey