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Abstract
Objectives We sought to determine whether screening for anxiety and depression, an emerging risk factor for type 2 diabetes (T2D), adds clinically meaningful information beyond current T2D risk assessment tools.
Design Prospective cohort.
Participants and setting The 45 and Up Study is a large-scale prospective cohort of men and women aged 45 years and over, randomly sampled from the general population of New South Wales, Australia. 51 588 participants without self-reported diabetes at baseline (2006–2009) were followed up for approximately 3 years (2010).
Methods T2D status was determined by self-reported doctor who diagnosed diabetes after the age of 30 years, and/or current use of metformin. Current symptoms of anxiety and/or depression were measured by the 10-item Kessler Psychological Distress Scale (K10). We determined the optimal cut-off point for K10 for predicting T2D using Tjur’s R2 and tested risk models with and without the K10 using logistic regression. We assessed performance measures for the incremental value of the K10 using the area under the receiver operating characteristic (AROC), net reclassification improvement (NRI) and net benefit (NB) decision analytics with sensitivity analyses.
Results T2D developed in 1076 individuals (52.4% men). A K10 score of ≥19 (prevalence 8.97%), adjusted for age and gender, was optimal for predicting incident T2D (sensitivity 77%, specificity 53% and positive predictive value 3%; OR 1.70 (95% CI 1.41 to 2.03, P<0.001). K10 score predicted incident T2D independent of current risk models, but did not improve corresponding AROC, NRI and NB statistics. Sensitivity analyses showed that this was partially explained by the baseline model and the small effect size of the K10 that was similar compared with other risk factors.
Conclusions Anxiety and depressing screening with the K10 adds no meaningful incremental value in addition to current T2D risk assessments. The clinical importance of anxiety and depression screening in preventing T2D requires ongoing consideration.
- preventive medicine
- primary care
- anxiety disorders
- epidemiology
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors EA is guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to publication of article. All authors conceived and designed the study. EA was responsible for drafting the manuscript. SGP and FG were responsible for data analysis and interpretation. All authors contributed to drafting the work for important intellectual content, and approved the final completed article.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The analysis presented in this paper belongs to a broader research programme that was granted ethics approval by the NSW Population and Health Services Research Ethics Committee (reference: HREC/15/CIPHS/4).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The 45 and Up Study is ready and available to Australia’s researchers. Advice and instructions is available at https://www.saxinstitute.org.au/for-researchers/our-research/. The dataset is not available from the Dryad repository.