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Irrational beliefs trigger depression and anxiety symptoms, and associated with increased inflammation and oxidative stress markers in the 10-year diabetes mellitus risk: the ATTICA epidemiological study

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Abstract

Purpose

To investigate the combined role of irrational beliefs, anxiety and depression in the 10-year incidence of type 2 diabetes, and the underlying effect of biochemical, and socio-behavioural factors.

Methods

Within the context of the ATTICA cohort study (2002–2012), 853 participants without evidence of CVD [453 men (45 ± 13 years) and 400 women (44 ± 18 years)] underwent psychological evaluation through the Irrational Beliefs Inventory (IBI) (range 0–88), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI). Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association (ADA).

Results

Mean IBI score was 53 ± 10 in men and 51 ± 11 in women (p = 0.68). Participants with high irrational beliefs who also had anxiety symptoms had a 93% excess risk of developing diabetes during the 10-year follow-up (Hazard Ratio 1.93; 95%CI 1.34, 2.78) as compared to those without anxiety. Moreover, diabetes risk was 73% higher among individuals with high levels of irrational beliefs and depression as compared to those where depression was absent (1.73; 1.21, 2.46). Lower education status, family history of diabetes, hypercholesterolemia, high BMI, as well as tumor necrosis factor and total antioxidant capacity were revealed as mediating risk factors related to the tested associations.

Conclusion

Irrational beliefs among apparently healthy adults trigger depression and anxiety symptomatology, and through the increased inflammation and oxidative stress profile, were associated with increased diabetes risk. This observation moves psychological research a step forward in supporting and guiding primary prevention of mental health and metabolic conditions.

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Data availability

The data that support the findings of this study are available from the ATTICA study but restrictions apply to the availability of these data, which were used under license for the current study, and so are not yet publicly available. Data are however available from the authors upon reasonable request and with permission of the ATTICA project.

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Acknowledgments

The authors would like to thank the ATTICA study group of investigators: Yannis Skoumas, Natassa Katinioti, Labros Papadimitriou, Constantina Masoura, Spiros Vellas, Yannis Lentzas, Manolis Kambaxis, Konstadina Palliou, Vassiliki Metaxa, Agathi Ntzouvani, Dimitris Mpougatsas, Nikolaos Skourlis, Christina Papanikolaou, Georgia-Maria Kouli, Aimilia Christou, Adella Zana, Maria Ntertimani, Aikaterini Kalogeropoulou, Evangelia Pitaraki, Alexandros Laskaris, Mihail Hatzigeorgiou and Athanasios Grekas for their assistance in the initial physical examination and follow-up evaluation, Efi Tsetsekou for her assistance in psychological evaluations, as well as the laboratory team: Carmen Vassiliadou and George Dedoussis (genetic analysis), Marina Toutouza-Giotsa, Constadina Tselika and Sia Poulopoulou (biochemical analysis) and Maria Toutouza for the database management.

Funding

The ATTICA study was supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

Author information

Authors and Affiliations

  1. Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece

    Christina Vassou, Mary Yannakoulia & Demosthenes B. Panagiotakos

  2. School of Medicine Sydney, University of Notre Dame, Sydney, Australia

    Ekavi N. Georgousopoulou

  3. First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece

    Christina Chrysohoou & Christos Pitsavos

  4. School of Psychology, University of Surrey, Guildford, UK

    Mark Cropley

Authors
  1. Christina Vassou
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  2. Ekavi N. Georgousopoulou
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  5. Christos Pitsavos
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  7. Demosthenes B. Panagiotakos
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Correspondence to Demosthenes B. Panagiotakos.

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Ethics approval

The study was approved by the Institutional Ethics (#017/1.5.2001) committee and all participants were informed about the aims and procedures and agreed to participate providing written consent.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

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Appendix

Appendix

Table 1 Baseline sociodemographic, lifestyle and clinical characteristics of the ATTICA study participants, according to IBI tertiles (n = 845)
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Table 2 Baseline characteristics of the ATTICA study’s participants according to the 10-year diabetes incidence (n = 845)
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Table 3 Characteristics of participants with high IBI score (≥ 52), who also had anxiety symptoms (i.e., STAI > 40) or depression (ZDRS > 34) (n = 845)
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Table 4 Results from nested, multi-adjusted models that evaluated the association between irrational beliefs and anxiety with the 10-year incidence of diabetes (results are presented as Hazard Ratios and 95% confidence intervals)
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Table 5 Results from nested, multi-adjusted models that evaluated the association between irrational beliefs and depression with the 10-year incidence of diabetes (results are presented as Hazard Ratios and 95% confidence intervals)
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Fig. 1
figure 1

A path-model, that illustrates the direct and indirect effect of increased irrational beliefs and anxiety symptoms on the risk of developing diabetes (data presented as beta-coefficients and p-values and derived from the logistic regression models)

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Fig. 2
figure 2

A path-model, that illustrates the direct and indirect effect of increased irrational beliefs and depressive symptoms on the risk of developing diabetes (data presented as beta-coefficients and p-values and derived from the logistic regression models)

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Vassou, C., Georgousopoulou, E.N., Chrysohoou, C. et al. Irrational beliefs trigger depression and anxiety symptoms, and associated with increased inflammation and oxidative stress markers in the 10-year diabetes mellitus risk: the ATTICA epidemiological study. J Diabetes Metab Disord 20, 727–739 (2021). https://doi.org/10.1007/s40200-021-00805-3

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