Mental Health
Posttraumatic stress disorder symptom remission and risk of incident type 2 diabetes Kelsey Serier* Kelsey Serier Jeanine Nasser Karestan Koenen Jaimie Gradus
Posttraumatic stress disorder (PTSD) is a mental health condition with metabolic consequences. While individuals with PTSD are more likely to develop type 2 diabetes mellitus (T2DM), little is known about the impact of PTSD symptom remission on T2DM.
Using data from 41,106 women from the Nurses Health Study (NHS-II), we estimated the association between remitted and current PTSD symptoms and diagnosed incident T2DM between 2009 and 2019 using Cox proportional hazard regression. Lifetime trauma exposure and lifetime and past four-week PTSD symptoms were assessed in 2008. PTSD was defined as a score of 4 or higher on the Short Screening Scale for DSM-IV PTSD, with scores of 1-3 reflecting subthreshold PTSD. We defined remitted PTSD as endorsement of lifetime but not past month symptoms; current PTSD was defined as past month symptoms. Our comparison group for all analyses was women who experienced trauma but did not develop PTSD. We adjusted for confounders, including age, race, parental education, parental diabetes, somatotype at age 5, oral contraceptive use, and menopause status. We incorporated health behaviors (body mass index, diet, physical activity, alcohol use, and smoking) and antidepressant use as potential mediators.
Current PTSD had the strongest association with T2DM (HR = 1.56; 95% CI = 1.34, 1.82), followed by current subthreshold PTSD (HR = 1.15; 95% CI = 1.02, 1.28). The remitted PTSD groups had a comparable rate of T2DM to the trauma/no PTSD group (remitted subthreshold PTSD: HR = 1.01, 95% CI = 0.94, 1.19; remitted PTSD: HR = 1.03, 95% CI = 0.86 1.21). Associations for subthreshold (HR = 1.03; 95% CI = 0.92, 1.16) and current PTSD (HR = 1.18, 95% CI = 1.01, 1.39) were attenuated when considering mediators.
Overall, these findings suggest that while current PTSD symptoms may increase the rate of incident T2DM, remitted PTSD symptoms do not. PTSD symptom reduction may have important clinical implications for improving long-term metabolic health outcomes.