Depression Mediates the Association Between Childhood Emotional Abuse and the Onset of Type 2 Diabetes: Findings From German Multi-Cohort Prospective Studies

Seryan Atasoy; Hamimatunnisa Johar; Toni Fleischer; Manfred Beutel; Harald Binder; Elmar Braehler; Georg Schomerus; Daniela Zöller; Johannes Kruse; Karl-Heinz Ladwig

doi:10.3389/fpsyt.2022.825678

Depression Mediates the Association Between Childhood Emotional Abuse and the Onset of Type 2 Diabetes: Findings From German Multi-Cohort Prospective Studies

Front Psychiatry. 2022 Apr 6:13:825678. doi: 10.3389/fpsyt.2022.825678. eCollection 2022.

Authors

Seryan Atasoy^{1

2

3}, Hamimatunnisa Johar^{1

3}, Toni Fleischer⁴, Manfred Beutel⁵, Harald Binder⁶, Elmar Braehler⁵, Georg Schomerus⁴, Daniela Zöller⁶, Johannes Kruse¹, Karl-Heinz Ladwig^{2

7}

Affiliations

¹ Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, Giessen, Germany.
² Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
³ Institute of Epidemiology, Helmholtz Zentrum München, Munich, Germany.
⁴ Department of Psychiatry, Medical Faculty, Leipzig University, Leipzig, Germany.
⁵ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.
⁶ Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.
⁷ German Center for Diabetes Research (DZD), Munich, Germany.

Abstract

Background: The dysregulation of glucose homeostasis via mental health stress is increasingly acknowledged, whereby depression independently increases the risk of the onset of type 2 diabetes by up to 60%. Contributing mental health factors starting in early life have further been considered, indicating that exposure to childhood emotional abuse is associated with both depression and an increased onset of type 2 diabetes in adulthood. However, the potential role of depression within the emotional abuse and type 2 diabetes link remains unknown.

Methods: Data were derived from community-dwelling participants in southern and northeastern Germany who participated in the longitudinal KORA-F4 and SHIP-3 studies. Multivariable logistic regression analyses adjusted for lifestyle, somatic, and psychological risk factors were used to investigate the association between childhood emotional abuse, assessed retrospectively by the Childhood Trauma Screener, and newly diagnosed type 2 diabetes cases, which were confirmed using a standard oral glucose tolerance test. The mediating role of depressive symptoms between childhood emotional abuse and type 2 diabetes was assessed by the Patient Health Questionnaire-9 and calculated by using the Sobel test for mediation.

Results: A total of 2,973 (53.2% women, 46.8% men) participants with a mean age of 49.7 were included in the analyses, of whom 5.9% (7.1% women, 4.5% men) reported emotional abuse in childhood. Participants exposed to childhood emotional abuse had a 1.70 (1.12-2.56; p = 0.02) times higher odds of depression in the fully adjusted model than unexposed participants. During the 6.5-year follow-up period, 104 (3.5%) participants developed type 2 diabetes. Participants who were exposed to childhood emotional abuse had a 2.56 (1.31-4.98, p = 0.005) times higher odds of developing type 2 diabetes than unexposed participants. This association was significantly mediated by the increased odds of depression in participants with childhood emotional abuse (Sobel Test, 1.84, p = 0.06; Goodman Test, 1.91, p = 0.05).

Conclusion: The current results indicate that the increased likelihood of type 2 diabetes onset in participants who were exposed to childhood emotional abuse is significantly attributed to increased depression in adulthood.

Keywords: childhood emotional abuse; depression; epidemiology; longitudinal; type 2 diabetes.