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

Table 1 Baseline characteristics of the participants

Source	Variable	Overall	Total depressive symptom			Somatic depressive symptom				Cognitive-affective depressive symptom
			Yes	No	P value	Yes	No	Unknown	P value	Yes	No	Unknown	P value
HRS	Number	18633	4547	14086		4414	14191	28		17755	840	38
	Age, mean (SD)	66.7 (10.2)	67.9 (10.9)	66.3 (9.9)	< 0.001	67.7 (10.7)	66.4 (10.0)	71.5 (13.3)	< 0.001	66.8 (10.2)	65.6 (10.8)	67.6 (11.6)	0.002
	BMI, mean (SD)	26.9 (5.2)	27.4 (6.0)	26.8 (4.9)	< 0.001	27.7 (6.1)	26.7 (4.9)	25.8 (4.7)	< 0.001	26.9 (5.2)	26.9 (5.3)	26.0 (4.6)	0.553
	Sex, n (%)
	Female	11015 (59.1)	3050 (67.1)	7965 (56.5)	< 0.001	2871 (65.0)	8129 (57.3)	15 (53.6)	< 0.001	10533 (59.3)	458 (54.5)	24 (63.2)	0.019
	Male	7618 (40.9)	1497 (32.9)	6121 (43.5)		1543 (35.0)	6062 (42.7)	13 (46.4)		7222 (40.7)	382 (45.5)	14 (36.8)
	Education, n (%)
	Below high school	4990 (26.8)	1884 (41.4)	3106 (22.1)	< 0.001	1833 (41.5)	3144 (22.2)	13 (46.4)	< 0.001	4775 (26.9)	201 (23.9)	14 (36.8)	< 0.001
	High school	6704 (36.0)	1561 (34.3)	5143 (36.5)		1555 (35.2)	5142 (36.2)	7 (25.0)		6416 (36.1)	279 (33.2)	9 (23.7)
	College or above	6937 (37.2)	1101 (24.2)	5836 (41.4)		1026 (23.2)	5903 (41.6)	8 (28.6)		6563 (37.0)	359 (42.7)	15 (39.5)
	Other	2 (0.0)	1 (0.0)	1 (0.0)		0 (0.0)	2 (0.0)	0 (0.0)		1 (0.0)	1 (0.1)	0 (0.0)
	Marital status, n (%)
	Married or partnered	12433 (66.7)	2425 (53.3)	10008 (71.0)	< 0.001	2628 (59.5)	9787 (69.0)	18 (64.3)	< 0.001	11860 (66.8)	553 (65.8)	20 (52.6)	0.005
	Never married	558 (3.0)	151 (3.3)	407 (2.9)		139 (3.1)	418 (2.9)	1 (3.6)		520 (2.9)	36 (4.3)	2 (5.3)
	Separated/divorced/widowed	5620 (30.2)	1963 (43.2)	3657 (26.0)		1641 (37.2)	3970 (28.0)	9 (32.1)		5357 (30.2)	247 (29.4)	16 (42.1)
	Unknown	22 (0.1)	8 (0.2)	14 (0.1)		6 (0.1)	16 (0.1)	0 (0.0)		18 (0.1)	4 (0.5)	0 (0.0)
	Smoking status, n (%)
	Ever smokers	10943 (58.7)	2745 (60.4)	8198 (58.2)	0.028	2687 (60.9)	8241 (58.1)	15 (53.6)	0.021	10398 (58.6)	527 (62.7)	18 (47.4)	0.024
	Never smokers	7567 (40.6)	1770 (38.9)	5797 (41.2)		1698 (38.5)	5856 (41.3)	13 (46.4)		7243 (40.8)	304 (36.2)	20 (52.6)
	Unknown	123 (0.7)	32 (0.7)	91 (0.6)		29 (0.7)	94 (0.7)	0 (0.0)		114 (0.6)	9 (1.1)	0 (0.0)
	Drinking status, n (%)
	Ever drinkers	9023 (48.4)	1713 (37.7)	7310 (51.9)	< 0.001	1575 (35.7)	7438 (52.4)	10 (35.7)	< 0.001	8561 (48.2)	442 (52.6)	20 (52.6)	0.163
	Never drinkers	9609 (51.6)	2833 (62.3)	6776 (48.1)		2838 (64.3)	6753 (47.6)	18 (64.3)		9193 (51.8)	398 (47.4)	18 (47.4)
	Unknown	1 (0.0)	1 (0.0)	0 (0.0)		1 (0.0)	0 (0.0)	0 (0.0)		1 (0.0)	0 (0.0)	0 (0.0)
	Hypertension, n (%)
	Yes	8067 (43.3)	2316 (50.9)	5751 (40.8)	< 0.001	2328 (52.7)	5730 (40.4)	9 (32.1)	< 0.001	7696 (43.3)	355 (42.3)	16 (42.1)	0.816
	No	10566 (56.7)	2231 (49.1)	8335 (59.2)		2086 (47.3)	8461 (59.6)	19 (67.9)		10059 (56.7)	485 (57.7)	22 (57.9)
	Heart problem, n (%)
	Yes	3671 (19.7)	1251 (27.5)	2420 (17.2)	< 0.001	1304 (29.5)	2361 (16.6)	6 (21.4)	< 0.001	3480 (19.6)	182 (21.7)	9 (23.7)	0.28
	No	14962 (80.3)	3296 (72.5)	11666 (82.8)		3110 (70.5)	11830 (83.4)	22 (78.6)		14275 (80.4)	658 (78.3)	29 (76.3)
ELSA
	Number	9052	2035	7017		1993	7045	14		8660	344	48
	Age, mean (SD)	65.1 (10.4)	66.5 (11.2)	64.7 (10.1)	< 0.001	66.6 (11.2)	64.7 (10.1)	73.3 (9.7)	< 0.001	65.1 (10.4)	64.6 (11.5)	69.8 (12.2)	0.006
	BMI, mean (SD)	28.0 (4.9)	28.4 (5.4)	27.8 (4.7)	< 0.001	28.9 (5.5)	27.7 (4.6)	27.7 (5.2)	< 0.001	28.0 (4.9)	28.1 (5.1)	26.9 (4.2)	0.428
	Sex, n (%)
	Female	4985 (55.1)	1319 (64.8)	3666 (52.2)	< 0.001	1268 (63.6)	3710 (52.7)	7 (50.0)	< 0.001	4784 (55.2)	169 (49.1)	32 (66.7)	0.022
	Male	4067 (44.9)	716 (35.2)	3351 (47.8)		725 (36.4)	3335 (47.3)	7 (50.0)		3876 (44.8)	175 (50.9)	16 (33.3)
	Education, n (%)
	Below high school	3453 (38.1)	1049 (51.5)	2404 (34.3)	< 0.001	1044 (52.4)	2401 (34.1)	8 (57.1)	< 0.001	3322 (38.4)	109 (31.7)	22 (45.8)	0.047
	High school	1683 (18.6)	336 (16.5)	1347 (19.2)		320 (16.1)	1362 (19.3)	1 (7.1)		1611 (18.6)	67 (19.5)	5 (10.4)
	College or above	3180 (35.1)	485 (23.8)	2695 (38.4)		461 (23.1)	2716 (38.6)	3 (21.4)		3019 (34.9)	145 (42.2)	16 (33.3)
	Other	736 (8.1)	165 (8.1)	571 (8.1)		168 (8.4)	566 (8.0)	2 (14.3)		708 (8.2)	23 (6.7)	5 (10.4)
	Marital status, n (%)
	Married or partnered	5994 (66.2)	1009 (49.6)	4985 (71.0)	< 0.001	1072 (53.8)	4914 (69.8)	8 (57.1)	< 0.001	5768 (66.6)	204 (59.3)	22 (45.8)	< 0.001
	Never married	453 (5.0)	136 (6.7)	317 (4.5)		117 (5.9)	333 (4.7)	3 (21.4)		412 (4.8)	37 (10.8)	4 (8.3)
	Separated/divorced/widowed	2304 (25.5)	842 (41.4)	1462 (20.8)		754 (37.8)	1548 (22.0)	2 (14.3)		2190 (25.3)	94 (27.3)	20 (41.7)
	NA	301 (3.3)	48 (2.4)	253 (3.6)		50 (2.5)	250 (3.5)	1 (7.1)		290 (3.3)	9 (2.6)	2 (4.2)
	Smoking status, n (%)
	Ever smokers	5608 (62.0)	1365 (67.1)	4243 (60.5)	< 0.001	1342 (67.3)	4257 (60.4)	9 (64.3)	< 0.001	5365 (62.0)	213 (61.9)	30 (62.5)	0.996
	Never smokers	3440 (38.0)	670 (32.9)	2770 (39.5)		651 (32.7)	2784 (39.5)	5 (35.7)		3291 (38.0)	131 (38.1)	18 (37.5)
	NA	4 (0.0)	0 (0.0)	4 (0.1)		0 (0.0)	4 (0.1)	0 (0.0)		4 (0.0)	0 (0.0)	0 (0.0)
	Drinking status, n (%)
	Ever drinkers	6722 (74.3)	1266 (62.2)	5456 (77.8)	< 0.001	1261 (63.3)	5457 (77.5)	4 (28.6)	< 0.001	6451 (74.5)	248 (72.1)	23 (47.9)	< 0.001
	Never drinkers	848 (9.4)	294 (14.4)	554 (7.9)		301 (15.1)	545 (7.7)	2 (14.3)		798 (9.2)	45 (13.1)	5 (10.4)
	NA	1482 (16.4)	475 (23.3)	1007 (14.4)		431 (21.6)	1043 (14.8)	8 (57.1)		1411 (16.3)	51 (14.8)	20 (41.7)
	Hypertension, n (%)
	Yes	3758 (41.5)	961 (47.2)	2797 (39.9)	< 0.001	993 (49.8)	2757 (39.1)	8 (57.1)	< 0.001	3599 (41.6)	141 (41.0)	18 (37.5)	0.833
	No	5294 (58.5)	1074 (52.8)	4220 (60.1)		1000 (50.2)	4288 (60.9)	6 (42.9)		5061 (58.4)	203 (59.0)	30 (62.5)
	Heart problem, n (%)
	Yes	1508 (16.7)	468 (23.0)	1040 (14.8)	< 0.001	489 (24.5)	1015 (14.4)	4 (28.6)	< 0.001	1439 (16.6)	56 (16.3)	13 (27.1)	0.149
	No	7544 (83.3)	1567 (77.0)	5977 (85.2)		1504 (75.5)	6030 (85.6)	10 (71.4)		7221 (83.4)	288 (83.7)	35 (72.9)

HRS: Health and Retirement Study; ELSA: English Longitudinal Study of Ageing; BMI: Body mass index; SD: Standard deviation; NA: Not available.

Table 2 Basic characteristics of total depressive symptom trajectories in the second study

Source	Variable	Overall	Persistently high	Persistently low	Decreasing	Fluctuating	Increasing	P value
HRS	Number	13918	682	7252	215	5465	304
	BMI, mean (SD)	70.7 (9.7)	70.7 (9.7)	69.9 (9.0)	71.1 (10.2)	71.7 (10.5)	71.9 (9.8)	< 0.001
	Age, mean (SD)	27.3 (5.6)	29.0 (7.5)	27.0 (5.1)	27.8 (6.9)	27.5 (5.9)	27.3 (6.3)	< 0.001
	Sex, n (%)
	Female	8654 (62.2)	519 (76.1)	4127 (56.9)	170 (79.1)	3629 (66.4)	209 (68.8)	< 0.001
	Male	5264 (37.8)	163 (23.9)	3125 (43.1)	45 (20.9)	1836 (33.6)	95 (31.2)
	Education, n (%)
	Below high school	3113 (22.4)	311 (45.6)	1105 (15.2)	72 (33.5)	1540 (28.2)	85 (28.0)	< 0.001
	College or above	5630 (40.5)	133 (19.5)	3480 (48.0)	49 (22.8)	1862 (34.1)	106 (34.9)
	High school	5175 (37.2)	238 (34.9)	2667 (36.8)	94 (43.7)	2063 (37.7)	113 (37.2)
	Marital status, n (%)
	Married or partnered	8268 (59.4)	277 (40.6)	5253 (72.4)	99 (46.0)	2465 (45.1)	174 (57.2)	< 0.001
	Never married	373 (2.7)	23 (3.4)	199 (2.7)	10 (4.7)	135 (2.5)	6 (2.0)
	Separated/divorced/widowed	4338 (31.2)	381 (55.9)	1797 (24.8)	106 (49.3)	1931 (35.3)	123 (40.5)
	Unknown	939 (6.7)	1 (0.1)	3 (0.0)	0 (0.0)	934 (17.1)	1 (0.3)
	Smoking status, n (%)
	Ever smokers	7455 (53.6)	416 (61.0)	4072 (56.2)	128 (59.5)	2657 (48.6)	182 (59.9)	< 0.001
	Never smokers	5439 (39.1)	266 (39.0)	3130 (43.2)	85 (39.5)	1837 (33.6)	121 (39.8)
	Unknown	1024 (7.4)	0 (0.0)	50 (0.7)	2 (0.9)	971 (17.8)	1 (0.3)
	Drinking status, n (%)
	Ever drinkers	6030 (43.3)	189 (27.7)	3852 (53.1)	72 (33.5)	1807 (33.1)	110 (36.2)	< 0.001
	Never drinkers	6955 (50.0)	493 (72.3)	3399 (46.9)	143 (66.5)	2726 (49.9)	194 (63.8)
	Unknown	933 (6.7)	0 (0.0)	1 (0.0)	0 (0.0)	932 (17.1)	0 (0.0)
	Hypertension, n (%)
	Yes	6944 (49.9)	454 (66.6)	3605 (49.7)	122 (56.7)	2583 (47.3)	180 (59.2)	< 0.001
	No	6042 (43.4)	228 (33.4)	3647 (50.3)	93 (43.3)	1950 (35.7)	124 (40.8)
	Unknown	932 (6.7)	0 (0.0)	0 (0.0)	0 (0.0)	932 (17.1)	0 (0.0)
	Heart problem, n (%)
	Yes	3076 (22.1)	257 (37.7)	1439 (19.8)	63 (29.3)	1228 (22.5)	89 (29.3)	< 0.001
	No	9910 (71.2)	425 (62.3)	5813 (80.2)	152 (70.7)	3305 (60.5)	215 (70.7)
	Unknown	932 (6.7)	0 (0.0)	0 (0.0)	0 (0.0)	932 (17.1)	0 (0.0)
ELSA
	Number	5811	263	3439	100	1877	132
	BMI, mean (SD)	28.2 (5.2)	29.2 (5.9)	27.9 (4.8)	29.2 (5.6)	28.5 (5.6)	28.4 (5.5)	< 0.001
	Age, mean (SD)	69.2 (9.3)	69.9 (10.6)	68.7 (8.8)	70.3 (9.7)	69.7 (9.9)	72.2 (9.9)	< 0.001
	Sex, n (%)
	Female	3318 (57.1)	181 (68.8)	1749 (50.9)	72 (72.0)	1242 (66.2)	74 (56.1)	< 0.001
	Male	2493 (42.9)	82 (31.2)	1690 (49.1)	28 (28.0)	635 (33.8)	58 (43.9)
	Education, n (%)
	Below high school	1861 (32.0)	129 (49.0)	920 (26.8)	56 (56.0)	705 (37.6)	51 (38.6)	< 0.001
	College or above	2309 (39.7)	71 (27.0)	1534 (44.6)	17 (17.0)	642 (34.2)	45 (34.1)
	High school	1184 (20.4)	39 (14.8)	726 (21.1)	18 (18.0)	376 (20.0)	25 (18.9)
	Other	457 (7.9)	24 (9.1)	259 (7.5)	9 (9.0)	154 (8.2)	11 (8.3)
	Marital status, n (%)
	Married or partnered	3834 (66.0)	111 (42.2)	2534 (73.7)	44 (44.0)	1061 (56.5)	84 (63.6)	< 0.001
	Never married	265 (4.6)	23 (8.7)	141 (4.1)	3 (3.0)	94 (5.0)	4 (3.0)
	Separated/divorced/widowed	1542 (26.5)	126 (47.9)	653 (19.0)	52 (52.0)	668 (35.6)	43 (32.6)
	Unknown	170 (2.9)	3 (1.1)	111 (3.2)	1 (1.0)	54 (2.9)	1 (0.8)
	Smoking status, n (%)
	Ever smokers	3684 (63.4)	193 (73.4)	2118 (61.6)	73 (73.0)	1207 (64.3)	93 (70.5)	< 0.001
	Never smokers	2127 (36.6)	70 (26.6)	1321 (38.4)	27 (27.0)	670 (35.7)	39 (29.5)
	Drinking status, n (%)
	Ever drinkers	4471 (76.9)	147 (55.9)	2859 (83.1)	67 (67.0)	1297 (69.1)	101 (76.5)	< 0.001
	Never drinkers	703 (12.1)	76 (28.9)	318 (9.2)	21 (21.0)	275 (14.7)	13 (9.8)
	Unknown	637 (11.0)	40 (15.2)	262 (7.6)	12 (12.0)	305 (16.2)	18 (13.6)
	Hypertension, n (%)
	Yes	2691 (46.3)	150 (57.0)	1491 (43.4)	61 (61.0)	924 (49.2)	65 (49.2)	< 0.001
	No	3120 (53.7)	113 (43.0)	1948 (56.6)	39 (39.0)	953 (50.8)	67 (50.8)
	Heart problem, n (%)
	Yes	1209 (20.8)	89 (33.8)	615 (17.9)	21 (21.0)	449 (23.9)	35 (26.5)	< 0.001
	No	4602 (79.2)	174 (66.2)	2824 (82.1)	79 (79.0)	1428 (76.1)	97 (73.5)

HRS: Health and Retirement Study; ELSA: English Longitudinal Study of Ageing; BMI: Body mass index; SD: Standard deviation.