Depressive symptoms, insulin resistance, and risk of diabetes in women at midlife

Diabetes Care. 2004 Dec;27(12):2856-62. doi: 10.2337/diacare.27.12.2856.


Objective: To examine depression and 3-year change in insulin resistance and risk of diabetes and whether associations vary by race.

Research design and methods: We analyzed data from 2,662 Caucasian, African-American, Hispanic, Japanese-American, and Chinese-American women without a history of diabetes from the Study of Women's Health Across the Nation. We estimated regression coefficients and odds ratios to determine whether depression (Center for Epidemiological Studies Depression Scale score > or =16) predicted increases in homeostasis model assessment of insulin resistance (HOMA-IR) and greater risk of incident diabetes, respectively, over 3 years.

Results: Mean baseline HOMA-IR was 1.31 (SD 0.86) and increased 0.05 units per year for all women (P <0.0001). A total of 97 incident cases of diabetes occurred. Depression was associated with absolute levels of HOMA-IR (P <0.04) but was unrelated to changes in HOMA-IR; associations did not vary by race. The association between depression and HOMA-IR was eliminated after adjustment for central adiposity (P=0.85). Depression predicted a 1.66-fold greater risk of diabetes (P <0.03), which became nonsignificant after adjustment for central adiposity (P=0.12). We also observed a depression-by-race interaction (P <0.05) in analyses limited to Caucasians and African Americans, the only groups with enough diabetes cases to reliably test this interaction. Race-stratified models showed that depression predicted 2.56-fold greater risk of diabetes in African Americans only, after risk factor adjustment (P=0.008).

Conclusions: Depression is associated with higher HOMA-IR values and incident diabetes in middle-aged women. These associations are mediated largely through central adiposity. However, African-American women with depression experience increased risk of diabetes independent of central adiposity and other risk factors.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Blood Glucose / metabolism
  • Depression / epidemiology*
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Ethnicity
  • Female
  • Humans
  • Incidence
  • Insulin Resistance / physiology*
  • Longitudinal Studies
  • Middle Aged
  • Racial Groups
  • Risk Factors
  • United States / epidemiology


  • Blood Glucose