, Volume 57, Issue 4, pp 699-709

First online:

Associations between DSM-IV mental disorders and diabetes mellitus: a role for impulse control disorders and depression

  • Peter de JongeAffiliated withInterdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen Email author 
  • , Jordi AlonsoAffiliated withCIBER en Epidemiología y Salud Pública (CIBERESP), Spain
  • , Dan J. SteinAffiliated withDepartment of Psychiatry and Mental Health, University of Cape Town
  • , Andrzej KiejnaAffiliated withDepartment of Psychiatry, Wroclaw Medical University
  • , Sergio Aguilar-GaxiolaAffiliated withCenter for Reducing Health Disparities, School of Medicine
  • , Maria Carmen VianaAffiliated withDepartment of Social Medicine, Federal University of Espírito Santo (UFES)
  • , Zhaorui LiuAffiliated withInstitute of Mental Health, Peking University
  • , Siobhan O’NeillAffiliated withSchool of Psychology, University of Ulster
  • , Ronny BruffaertsAffiliated withUniversity Hospital Gasthuisberg
    • , Jose Miguel Caldas-de-AlmeidaAffiliated withChronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa
    • , Jean-Pierre LepineAffiliated withHôpital Lariboisiére Fernand Widal
    • , Herbert MatschingerAffiliated withClinic of Psychiatry, University of Leipzig
    • , Daphna LevinsonAffiliated withMental Health Services, Ministry of Health
    • , Giovanni de GirolamoAffiliated withHealth Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM-Hospital del Mar), IRCCS Centro S. Giovanni di Dio Fatebenefratelli
    • , Akira FukaoAffiliated withDepartment of Public Health, Yamagata University School of Medicine
    • , Brendan BuntingAffiliated withPsychology Research Institute, University of Ulster
    • , Josep Maria HaroAffiliated withParc Sanitari Sant Joan de Déu, CIBERSAM, University of Barcelona
    • , Jose A. Posada-VillaAffiliated withInstituto Colombiano del Sistema Nervioso
    • , Ali Obaid Al-HamzawiAffiliated withAl-Qadisiya University, College of Medicine
    • , Maria Elena Medina-MoraAffiliated withNational Institute of Psychiatry
    • , Marina PiazzaAffiliated withFacultad de Salud Publica y Administración (FASPA), Universidad Peruana Cayetano Heredia
    • , Chiyi HuAffiliated withShenzhen Institute of Mental Health and Shenzhen Kangning Hospital
    • , Carmen SasuAffiliated withNational School of Public Health, Management and Professional Development
    • , Carmen C. W. LimAffiliated withDepartment of Psychological Medicine, University of Otago
    • , Ronald C. KesslerAffiliated withDepartment of Healthcare Policy, Harvard Medical School
    • , Kate M. ScottAffiliated withDepartment of Psychological Medicine, University of Otago



No studies have evaluated whether the frequently observed associations between depression and diabetes could reflect the presence of comorbid psychiatric conditions and their associations with diabetes. We therefore examined the associations between a wide range of pre-existing Diagnostic Statistical Manual, 4th edition (DSM-IV) mental disorders with self-reported diagnosis of diabetes.


We performed a series of cross-sectional face-to-face household surveys of community-dwelling adults (n = 52,095) in 19 countries. The World Health Organization Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Diabetes was indicated by self-report of physician’s diagnosis together with its timing. We analysed the associations between all mental disorders and diabetes, without and with comorbidity adjustment.


We identified 2,580 cases of adult-onset diabetes mellitus (21 years +). Although all 16 DSM-IV disorders were associated with diabetes diagnosis in bivariate models, only depression (OR 1.3; 95% CI 1.1, 1.5), intermittent explosive disorder (OR 1.6; 95% CI 1.1, 2.1), binge eating disorder (OR 2.6; 95% CI 1.7, 4.0) and bulimia nervosa (OR 2.1; 95% CI 1.3, 3.4) remained after comorbidity adjustment.


Depression and impulse control disorders (eating disorders in particular) were significantly associated with diabetes diagnosis after comorbidity adjustment. These findings support the focus on depression as having a role in diabetes onset, but suggest that this focus may be extended towards impulse control disorders. Acknowledging the comorbidity of mental disorders is important in determining the associations between mental disorders and subsequent diabetes.


Comorbidity Depression Epidemiology Impulse control disorders Mental disorders