Persistently high and fluctuating trajectories of total and somatic depressive symptoms increase diabetes risk: Two prospective cohort studies

doi:10.4239/wjd.v16.i8.106683

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 16, Issue 8

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (26)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-3) series, Tables (1-2) series.

Item

Count

PDF

HTML

Figures (1-3)

Tables (1-2)

Sum=25

Aug 15, 2025 (publication date) through Aug 14, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Diabetes

ISSN

1948-9358

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

World J Diabetes. Aug 15, 2025; 16(8): 106683
Published online Aug 15, 2025. doi: 10.4239/wjd.v16.i8.106683

Persistently high and fluctuating trajectories of total and somatic depressive symptoms increase diabetes risk: Two prospective cohort studies

Xue-Lun Zou, Chang Zhou

Xue-Lun Zou, Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China

Chang Zhou, Department of Oncology, Third Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China

Author contributions: Zou XL and Zhou C designed the research and the manuscript structure, chose the references, participated in the writing, and contributed to the statistical analysis; Zhou C contributed to revision and completing the manuscript; All authors read and approved the final draft of the manuscript.

Institutional review board statement: The health and retirement study cohort received approval from the Institute for Social Research and the Survey Research Center at the University of Michigan, while the ELSA cohort was approved by the London Multicentre Research Ethics Committee.

Informed consent statement: All participants provided written informed consent, either personally or through a legal guardian.

Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The original contributions presented in the study are included in the manuscript. Further inquiries can be directed to the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Chang Zhou, PhD, Department of Oncology, Third Xiangya Hospital, Central South University, No. 138 Tongzipo Street, Yuelu District, Changsha 410008, Hunan Province, China. csuzhouchang@163.com

Received: March 5, 2025
Revised: April 20, 2025
Accepted: June 26, 2025
Published online: August 15, 2025
Processing time: 163 Days and 6.1 Hours

Abstract

BACKGROUND

Depression is a significant risk factor for diabetes, particularly type 2 diabetes. However, depressive symptoms differ from clinical depression. Previous research has not fully considered the relationship between the trajectory of depressive symptoms and the risk of developing diabetes over time.

AIM

To investigate the association between depressive symptoms, their trajectories, and the risk of developing diabetes in two prospective cohort studies.

METHODS

In the first phase we analyzed the association between depressive symptoms and the risk of developing diabetes separately using the Health and Retirement Study (HRS). Depressive symptom trajectories were assessed by examining changes in depressive symptoms at baseline and again 8 years later. We then identified specific depressive symptom trajectories that increased the risk of diabetes in the second phase. Finally, we confirmed the association between depressive symptoms and their trajectories with diabetes risk using the English Longitudinal Study of Ageing (ELSA) as a validation study. Depressive symptom trajectories were categorized into five states based on changes in the modified 8-item Center for Epidemiological Studies-Depression scores: Persistently high; increasing; fluctuating; decreasing; and persistently low. Diabetes mellitus was defined as self-reported, physician-diagnosed diabetes. Cox proportional hazards models were used to assess hazard ratios (HR) and 95% confidence intervals (CI), adjusting for potential confounders.

RESULTS

In the first phase a total of 27658 participants were included (HRS: 18633, ELSA: 9025), among whom 6582 had depressive symptoms (HRS: 4547, ELSA: 2035), 6407 had somatic depressive symptoms (HRS: 4414, ELSA: 1993), and 26415 had cognitive-affective depressive symptoms (HRS: 17755, ELSA: 8660). We found that overall depressive symptoms (HRS: HR = 1.14, 95%CI: 1.07-1.22; ELSA: HR = 1.18, 95%CI: 1.03-1.34) and somatic depressive symptoms (HRS: HR = 1.14, 95%CI: 1.07-1.22; ELSA: HR = 1.25, 95%CI: 1.10-1.42) increased the risk of diabetes, while cognitive depressive symptoms were not associated with diabetes risk. Over an 8-year follow-up we identified 19729 trajectories of overall, somatic, and cognitive-affective depressive symptoms (HRS: 13918, ELSA: 5811). In the second phase we found that persistently high (HRS: HR = 1.22, 95%CI: 1.06-1.40, ELSA: HR = 1.54, 95%CI: 1.16-2.05 in total and HRS: HR = 1.24, 95%CI: 1.07-1.43, ELSA: HR = 1.79, 95%CI: 1.36-2.35 in somatic) and fluctuating (HRS: HR = 1.09, 95%CI: 1.01-1.17, ELSA: HR = 1.33, 95%CI: 1.14-1.55 in total and HRS: HR = 1.10, 95%CI: 1.02-1.18, ELSA: HR = 1.31, 95%CI: 1.13-1.53 in somatic) trajectories of overall and somatic depressive symptoms increased the risk of diabetes, while increasing trajectories may also raise diabetes risk. However, decreasing trajectories were not associated with diabetes risk. Cognitive-affective depressive symptoms showed no association with diabetes risk regardless of trajectory changes. Sensitivity analyses confirmed the reliability of the findings.

CONCLUSION

Persistently high and fluctuating trajectories of overall and somatic depressive symptoms increased the risk of diabetes, while decreasing trajectories were not associated with diabetes risk. In contrast trajectories of cognitive-affective depressive symptoms show no relationship with diabetes risk. Focusing on depressive symptom trajectories, particularly those of somatic depressive symptoms, represented a viable strategy for future diabetes prevention.

Keywords: Depressive symptom; Trajectories; Diabetes; Cohort study; Epidemiology

Core Tip: Overall and somatic depressive symptoms increased the risk of developing diabetes, while cognitive-affective depressive symptoms did not. Furthermore, persistently high and fluctuating trajectories of overall and somatic depressive symptoms were associated with an increased risk of diabetes, whereas trajectories of cognitive-affective depressive symptoms were not.