Relationship Between Psychological Distress And Type 2 Diabetes Mellitus In Male Police Officers: Prospective Cohort Study

Objective: Analyze the relationship between male police's occupational stressors and type 2 diabetes mellitus(T2DM),occupational stress and diabetes in different people who are at risk,to provide epidemiological evidence for diabetes screening and formulating preventive interventions of the male police at high risk.Method: 1.Select the male police as the research subject in Tianjin public security hospital for medical examination from March 2007 to October 2007,every subject was asked to fill in general situation questionnaire,Occupational Stress Inventory-Revised(OSI-R)and Symptom Check List 90-Revised(SCL-90-R).In this study,a total of 6559 people filled in the questionnaire,excluding people with oral hypoglycemic agents or were using insulin or with a self-reported history of diabetes at baseline and incomplete data.6075 subjects were participanted the dynamic follow-up.Until to 2011,5811 subjects were included.2.According to the OSI-R score,the score of the 14 items was converted with standardized T score.The T score of the 14 items was divided into three equal parts,forming high,medium and low groups.Multivariate Cox proportional hazard regression analysis was used to analyze the relationship between occupational stressors and T2 DM.3.Evaluation of mental stress uses SCL-90-R,the total score greater than 160 points is deemed as mental strain.According to the Chinese Hong Kong Diabetes Risk score(Hong Kong Chinese Diabetes Risk score,HKCDRS),the study subjects were divided into high risk group(HKCDRS > 7)and low risk group(HKCDRS 0-7),and then combines with the mental stress and HKCDRS,the study subjects were finally divided into four groups :(1)HKCDRS 0-7,no mental tension;(2)HKCDRS 0-7 mental tension;(3)HKCDRS > 7,no mental tension;(4)HKCDRS > 7,mental tension.Using the multivariate Cox regression analysis to compare the relationship between mental stress and diabetes in different risk groups and using hierarchical analysis method to analyze the relationship between mental stress and diabetes in traffic police.Results: 1.The relationship between occupational stressors and T2 DM in male police Role overload(RO),role boundary(RB),physical environment(PE),interpersonal strain(IS),physical strain(PHS)increase the risk of suffering from T2DM(RO: HR = 1.59,95% CI = 1.07-2.37;RB: HR = 1.65,95% CI = 1.14-2.37;PE: HR = 2.29,95% CI = 1.55-3.40;IS: HR = 1.54,95% CI = 1.08-2.19;PHS: HR = 1.68,95% CI = 1.17-2.42)(P<0.025).2.The relationship between the traffic police's occupational stressors and T2 DM in traffic police Subgroup analysis method results show that after adjustment for conventional risk factors,RB,PE,IS,PHS are T2 DM risk factors(RB: HR = 1.76,95% CI = 1.13-2.76;PE: HR = 1.80,95% CI = 1.11-2.91;IS: HR = 2.04,95% CI = 1.25-3.33;PHS: HR = 1.81,95% CI = 1.93-2.91)(P<0.025).3.The number of new-oneset diabetes during the follow-up period During the four-year follow up,a total of 179 new-onset diabetes appears.Low risk and high risk of T2 DM is 54 cases(1.63%)and 125 cases(4.98%)respectively.Two groups of four years cumulative incidenceof diabetes difference is statistically significant(P < 0.05);in low risk population,mental stress and no mental stress group of four years cumulative incidenceof diabetes are 2.02% and 1.53% respectively,the difference is not statistically significant(P > 0.05),while in the high risk population,diabetes incidence of mental stress and no mental stress in diabetic group are 7.03% and 4.43% respectively,two groups of difference is statistically significant(P < 0.05).4.Multivariate Cox regression analysis of psychological stress,HKCDRS and T2 DM in male police A significant difference in the association between the HKCDRS and incidence of T2 DM was observed among subjects without psychological distress(HKCDRS of > 7: HR = 2.66,95% CI: 1.82 to 3.88).Similar results were observed among subjects with psychological distress(HKCDRS of > 7: HR = 3.36,95% CI: 1.81 to 6.23).Among subjects with a HKCDRS > 7,the presence of psychological distress was associated with an increased risk of T2DM(HR = 1.61,95% CI,1.10 to 2.37).However,when compared to subjects with a HKCDRS of 0-7,with nopsychological distress,the HR was 1.28(95% CI,0.69 to 2.35).5.Multivariate Cox regression analysis of psychological distress,HKCDRS and T2 DM in traffic police Traffic Police population without psychological distress,the high risk group sufferring from T2 DM is 2.20 times as much as low risk group(95% CI: 1.40-3.47);in the psychological distress,the high risk group sufferring from T2 DM is 7.09 times as much as low risk group(95% CI: 2.07-24.29).Psychological distress is the risk factors of T2DM(HR = 1.84,95% CI: 1.06-3.17)in low risk group.However,the relationship between psychological distress and T2 DM is not statistically significant(HR = 0.57,95% CI: 0.17-1.88)in low risk group.Conclusion: 1.About the relationship between occupational stressors and T2 DM,the results show that RO,RB,PE,IS,PHS are the risk factors of T2 DM,subgroup analysis shows that RB,PE,IS and PHS are the risk factors of T2 DM in traffic police.2.In male police population,psychological distress is a risk factor of T2 DM.HKCDRS could divide the study subjects into high risk and low risk group.In the process of the development of T2 DM,psychological distress mainly affected the high-risk groups.