Psychosocial factors and type 1 diabetes

Introduction: Psychosocial factors have been associated with outcomes in the general population\ud and type 2 diabetes, yet rarely in those with type 1 diabetes. We previously demonstrated that\ud type A behavior is associated with lower mortality risk, while higher depression symptoms are\ud associated with an increased risk. In addition, stressful life events have been previously\ud demonstrated to lead to increased depression and poor glycemic control in those with type 1\ud diabetes.\ud Methods: We aimed to further understand the type A behavior and mortality relationship through\ud assessment of potential mediators, moderators, and confounders, and well as by examining the\ud different Bortner Rating Scale scoring methods using Cox proportional hazards modeling. We\ud also investigated which psychosocial factors, including trait-anger, interacted with depressive\ud symptoms to predict mortality, again utilizing Cox proportional hazards modeling. Lastly, we\ud investigated whether increased life events scores were associated with high depression symptoms\ud or a change in glycemic control using logistic and linear regression.\ud Results: We found that type A behavior was no longer significantly predictive of mortality after\ud the additions of age, inflammatory markers/stress reactants, and waist-to-hip ratio, and that the\ud item “fast eater, walker, etc.” was the best type A predictor of mortality, but also lost\ud significance in multivariable modeling. Next, we found that increased depressive symptoms,independent of anxiety and stress, were associated with increased mortality risk only in those with low anger scores. Lastly, we found that increased life events scores were predictive of high\ud depressive symptomatology, but not with change in glycemic control.\ud Discussion: Along with the well established, physiological and diabetes care risk factors, psychosocial factors also play an important role in outcome development. These factors in type 1 diabetes were very understudied, thus this work has a large public health impact. In line with\ud earlier theories of health locus of control, psychosocial factors may impact on mortality risk through a variety of pathways following a diabetes diagnosis. Future research should focus on further exploring these psychosocial factors as individual predictors of mortality, and examining\ud them in a clinical trial setting to potentially improve outcomes