This body of research extends to the effects of depression on obesity, physical activity, insulin resistance, and glycemic control.

Depression may trigger diabetogenic processes by influencing both behavioural and biological pathways (Fig. It has long been suggested that the risk of Type 2 diabetes is elevated by depression, and a growing evidence base has established depression as an independent risk factor for diabetes onset. Alongside these traditional risk factors, psychological factors are increasingly noted as being important to the pathogenesis of diabetes. To address what is increasingly referred to as a global health crisis, many countries are investing in programs aimed at reducing the main modifiable risk factors of diabetes: obesity, smoking, unhealthy eating, and physical inactivity. Over 400 million adults worldwide are currently diagnosed with Type 2 diabetes, a prevalence that has more than doubled over the past three decades and continues to rise. This study highlights the importance of risk factor clustering in diabetes onset, and is the first that we know of to quantify the excess fraction of incident diabetes associated with psychological risk factor interactions. Men appeared to be particularly vulnerable to the interaction between metabolic, behavioural and psychological risk factors. Baseline anxiety and depression contributed a further 13.6% of new cases to this combination. Individuals exposed to both behavioural and metabolic factors were at highest risk of diabetes onset (PAF = 22.9%).

Overall, the studied risk factors accounted for 50.5% of new diabetes cases (78.2% in men and 47.0% in women).

PAFs were calculated using Miettinen’s case-based formula, using relative risks estimated from multivariate regression models. Using data from the population-based HUNT cohort, we examined incident diabetes in 36,161 Norwegian adults from 1995 to 2008. This study aimed to examine Type 2 diabetes incidence associated with multiple risk factor combinations, including the metabolic syndrome, behavioural factors, and specifically, depression and anxiety. Population attributable fractions (PAFs) are frequently used to quantify the proportion of Type 2 diabetes cases due to single risk factors, an approach which may result in an overestimation of their individual contributions.

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