The relationship between waist to hip ratio (WHR) and psychosocial factors has seldom been investigated, although both may contribute to cardiovascular risk. Therefore, these variables were examined in adults with insulin-dependent diabetes mellitus ([IDDM] N = 592; mean age, 29 years; mean duration, 20 years), a population at increased risk of developing cardiovascular disease. Moreover, the association between changes in psychosocial factors and change in WHR was considered. After adjusting for body mass index (BMI), WHR in men was correlated with higher levels of depressive symptomatology (r = .19, P < .001), greater anxiety (r = .13, P < .05), less social support (r = -.20, P < .01), and lower type A scores (r = -.25, P < .001). In women, WHR was significantly correlated with higher levels of depressive symptomatology (r = .18, P < .01), greater stress (r = .16, P < .01), and alcohol consumption (r = .12, P < .05). For both sexes, smokers had a significantly greater mean WHR than nonsmokers (P < .01). For men, multiple regression analyses adjusting for BMI and age demonstrated that smoking, lower income, less exercise, and lower type A scores were the most significant variables associated with WHR. In women, the independent predictors of WHR were a history of smoking, lower educational level, and depressive symptomatology. The most significant independent predictors of change in WHR from baseline to 2-year follow-up study were change in weight (men), change in BMI (women), and change in depression scores (both sexes). These results suggest that psychosocial factors may affect cardiovascular disease risk through their influence on body fat distribution, and both may be important in identifying those most at risk for cardiovascular disease in populations with IDDM.