Could PTSD Increase Risk for Diabetes in Women?
Women experiencing symptoms of post-traumatic stress disorder (PTSD) could have a significantly higher risk of developing type 2 diabetes, according to new research in JAMA Psychiatry.
Triggered by either experiencing or witnessing a traumatic event, PTSD is a relatively common condition among American women and its symptoms include flashbacks to the event, nightmares, and severe anxiety.
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PTSD is also associated with several risk factors for type 2 diabetes, including inflammation, neuroendocrine dysfunction, and poor diet.
“Women with the highest number of PTSD symptoms were nearly twice as likely to develop type 2 diabetes during the study period compared with women who did not experience a traumatic event…suggesting women with more severe PTSD may be particularly at risk,” says lead study analyst Jessica Agnew-Blais, MS, of Brigham and Women’s Hospital in Boston.
Using data from the Nurses’ Health Study II, a longitudinal cohort of nearly 50,000 women in the US, Agnew-Blais and her colleagues studied the association between PTSD symptoms and the incidence of type 2 diabetes over a 22-year period.
Of the 49,739 participants, 3,091 women developed type 2 diabetes during the follow-up period. Findings showed that the rate of type 2 diabetes increased as the number of PTSD symptoms increased:
• Women with 1 to 3 symptoms had 40% higher rates.
• Women with 4 to 5 symptoms had 50% higher rates.
• Women with 6 to 7 symptoms had 80% higher rates.
The researchers also examined longitudinal assessments of body mass index, smoking, alcohol intake, diet quality, physical activity, and antidepressant use as mediators of possible increased risk of type 2 diabetes for women with PTSD.
“We found that antidepressant use and higher BMI accounted for almost half the increased risk of type 2 diabetes in women with PTSD, so these represent potential pathways between PTSD and risk of type 2 diabetes,” Agnew-Blais says. “Additional pathways could relate to dysfunction of the body’s stress response, namely dysfunction of the hypothalamic-pituitary-adrenal axis, which has been associated with insulin resistance.”
Smoking, diet quality, alcohol intake, and physical activity, however, did not further account for increased risk of type 2 diabetes for women with PTSD.
“Our data suggest that comprehensive treatment for PTSD should include attention to health behaviors that contribute to chronic disease; treatment for PTSD needs to consider the long-term health consequences of the disorder,” Agnew-Blais says. “Our data also suggest that weight gain may be one central way in which PTSD is associated with increased risk for type 2 diabetes, therefore a focus on preventing weight gain could be a potential area of intervention.”
In order to provide better preventive care for patients with PTSD, physicians should monitor health indicators related to increased risk of diabetes and screen patients for type 2 diabetes to identify untreated cases.
“Future research in this area will explore whether PTSD could be related to increased risk of other poor health outcomes, such as cardiovascular disease and stroke,” Agnew-Blais says. “Additionally, we will explore whether remission of symptoms of PTSD may ameliorate the negative effects of the disorder on type 2 diabetes risk.”
—Colleen Mullarkey
Reference
Roberts AL, Agnew-Blais JC, Spiegelman D, Kubzansky LD, Mason SM, Galea S, et al. Posttraumatic stress disorder and incidence of type 2 diabetes mellitus in a sample of women: a 22-year longitudinal study. JAMA Psychiatry. 7 January 2015. [Epub ahead of print].