PTSD and Risk of Type 2 Diabetes in Women

Women suffering from post traumatic stress disorder (PTSD) are more likely to develop type 2 diabetes than women who have not experienced trauma, according to a new study published in JAMA Psychiatry.

What Is PTSD?

You may be familiar with PTSD in the context of war veterans. However, anyone who suffers a personal or community-wide trauma (such as a terrorist attack or catastrophic weather incidence) may develop this mental health disorder.

Symptoms include re-experiencing the traumatic event (for example, in flashbacks or dreams), avoiding places or situations that remind them of the event, or being on edge all the time. These behaviors are normal responses immediately following an event. However, if they last longer than a month, or appear long after the event has passed, the person may be suffering from PTSD. Approximately 44.7 million adults in the U.S. have PTSD, according to PTSD United, a non-profit based in Huntington, CA.

Treatment usually involves talk therapy, where individuals learn coping and relaxation skills.

Women and PTSD

Experts believe women are more at risk of developing PTSD than men. The National Center for PTSD notes that while four percent of men will develop PTSD after a trauma, 10 percent of women will. In fact, one of every 9 women will develop PTSD, according to PTSD United.

"We do not understand completely why womenís lifetime risk of PTSD is twice that of menís risk," says Karestan C. Koenen, PhD, Department of Epidemiology, Mailman School of Public Health at Columbia University and one of the study authors. "Women may be more prone to PTSD because they are exposed to events that are more likely to produce PTSD, such as rape or sexual abuse."

Female sex hormones may also predispose women to PTSD, says Charles R. Marmar, MD, Chair of the Department of Psychiatry at New York University Langone Medical Center.

PTSD and Type 2 Diabetes

PTSD is associated with risk factors for type 2 diabetes, including inflammation, dysfunction in the endocrine (hormone) and nervous systems, poor diet, and lack of physical activity. Koenen and his colleagues found the more PTSD symptoms a woman had, the greater her risk of developing diabetes. Those with diabetes also had higher BMI (body mass index).

Notably, use of antidepressants seemed to account for a large portion of the increased risk: "We actually donít know [why antidepressant use increases risk]," says Koenen. "This was a surprising finding for us that deserves further research. The most obvious answer would be that some classes of antidepressants put patients at greater risk of weight gain and obesity [risk factors for diabetes]. However, we accounted for this in our analyses, so this is unlikely the reason in our data."

Marmar says trauma exposure alone may predispose someone to diabetes, even if they donít develop PTSD. He strongly recommends that men and women with mild to severe PTSD be routinely screened for diabetes, hypertension, and lipids in the blood.

"Any person with high levels of stress, anxiety, and depression is at increased risk for developing chronic medical problems, including diabetes, heart disease, and stroke," says Marmar. These individuals may also have a possible increased risk of cancer.

"Women (and men) who have experienced a very traumatic event, or who have symptoms of PTSD, including avoiding reminders of the trauma, nightmares or flashbacks of the trauma, trouble sleeping, irritability, or sadness should seek mental health care to treat these symptoms," says Koenen. "PTSD can be effectively treated. Women with PTSD who are taking antidepressants should evaluate the costs and benefits with their doctors."

Amber Taylor, MD, reviewed this article.

Sources

"PTSD Statistics." PTSD United. Page accessed February 16, 2015.

"Women, Trauma, and PTSD." National Center for PTSD/U.S. Department of Veterans Affairs. Page last updated January 3, 2014.

Koenen, Karestan C., PhD. Department of Epidemiology, Mailman School of Public Health, Columbia University. Email to author, January 16, 2015.

Marmar, Charles R., MD. Chair of the Department of Psychiatry, . Phone interview with author. February 9, 2014.

"What Is Post-traumatic Stress Disorder (PTSD)?" National Institute of Mental Health. Accessed January 15, 2015.

"PTSD May Trigger Type 2 Diabetes." Medscape Medical News. January 08, 2015.

Roberts, Andrea L., PhD, Jessica C. Agnew-Blais, ScD, Donna Spiegelman, ScD, Laura D. Kubzansky, MPH, PhD,Susan M. Mason, PhD, Sandro Galea, MD, Frank B. Hu, MD, JanetW. Rich-Edwards, ScD, and Karestan C. Koenen, PhD. "Posttraumatic Stress Disorder and Incidence of Type 2 Diabetes Mellitus in a Sample of Women: A 22-Year Longitudinal Study." JAMA Psychiatry. Published online January 7, 2015doi:10.1001/jamapsychiatry.2014.2632.