Adverse childhood experiences and the risk of diabetes: Examining the roles of depressive symptoms and cardiometabolic dysregulations in the Whitehall II cohort study

Abstract

OBJECTIVE: Adverse childhood experiences (ACEs) are associated with an increased risk of diabetes in adulthood. However, the potential mediating roles of depression and cardiometabolic dysregulations in this association are not clear. RESEARCH DESIGN AND METHODS: Prospective data were from the Whitehall II cohort study, with the phase 5 assessment (1997-1999) serving as baseline (n = 5,093, age range = 44-68 years, 27.3% female). ACEs were retrospectively reported at phase 5. Depressive symptoms (Center for Epidemiologic Studies Depression Scale) and cardiometabolic dysregulations (inflammation, central obesity, HDL cholesterol, triglycerides, impaired fasting glucose, and hypertension) were examined at phase 7 (2002-2004). Incident diabetes was examined at phases 8-11 (2006-2013) via self-report and blood samples. Participants reporting diabetes prior to phase 8 were excluded. Statistical mediation was examined with path analysis using structural equation modeling. ACEs were modeled as an observed continuous variable, whereas depressive symptoms and cardiometabolic dysregulations were modeled as latent variables. Unstandardized probit regression coefficients with 95% CI are reported for mediation analysis. RESULTS: ACEs were associated with an increased likelihood of diabetes, with every addition of ACE associated with an ∼11% increase in odds of diabetes (odds ratio 1.11 [95% CI 1.00, 1.24], P = 0.048). In mediation analysis, ACEs were indirectly associated with diabetes via depressive symptoms (indirect effect 0.03 [95% CI 0.02, 0.04], P < 0.001) and cardiometabolic dysregulations (indirect effect 0.03 [95% CI 0.01, 0.05], P = 0.03). CONCLUSIONS: This study provides further evidence of the detrimental psychological and physiological effects of ACEs and suggests that depression and cardiometabolic dysregulations may be pathways linking ACEs with diabetes in adulthood.