Related depression and anxiety might contribute to diabetes risk
by Jeff Minerd Jeff Minerd, Contributing Writer, MedPage Today November 13, 2017
Action Points
- Bullying and violence in the workplace were linked with an increased risk for type 2 diabetes.
- The study suggests that research is warranted on bullying and violence prevention policies with workplaces as the target to determine whether these policies could be effective means of reducing the incidence of type 2 diabetes.
Bullying and violence in the workplace were linked with an increased risk for type 2 diabetes in a large Scandinavian cohort study.
Over approximately 12 years of follow-up, being bullied at work was associated with a 46% increase in risk for developing type 2 diabetes (hazard ratio 1.46, 95% CI 1.23-1.74), after adjusting for factors including age, sex, education level, and marital status, reported Tianwei Xu, a PhD fellow at the University of Copenhagen in Denmark, and colleagues.
Similarly, exposure to workplace violence or threats of violence was linked with a 26% rise in type 2 diabetes risk (HR 1.26, 95% CI 1.02-1.56), the authors wrote online in Diabetologia.
“Recent meta-analyses have suggested that psychosocial work characteristics, such as job insecurity and long working hours, are associated with a moderately higher risk of diabetes, while the health effects of highly adverse social work stressors, such as bullying and violence at work, are far less well documented,” Xu’s group said. “To the best of our knowledge, no previous longitudinal studies have addressed the relationships between workplace bullying and workplace violence and type 2 diabetes.
“In this large multinational, multi-cohort study, approximately one in ten employees reported being exposed to bullying or violence/threats of violence at work,” they noted. “Both men and women who were exposed to these severe social stressors were at a higher risk of developing type 2 diabetes. The higher risk was consistent across cohorts and independent of follow-up length or the method of case ascertainment.”
The study included 45,905 men and women, ages 40-65 ,who did not have diabetes at baseline. The study population was derived from four Scandinavian cohort studies: the Swedish Work Environment Survey (SWES), the Swedish Longitudinal Occupational Survey of Health (SLOSH), the Finnish Public Sector Study (FPS), and the Danish Work Environment Cohort Study (DWECS).
The investigators used questionnaires to assess exposure to workplace bullying, defined as unkind or negative behavior from colleagues, and workplace violence, defined as having been the target of violent actions, or threats of violence, in the previous 12 months. They obtained information on new diabetes diagnoses through national medical records.
Approximately 9% of participants reported bullying at work, and 12% said they had experienced workplace violence. The exposure to violence varied greatly among different occupations. The highest prevalence of violence or threats of violence were found among occupations with frequent client contact, including social workers (46%), personal and protective service workers (29%), healthcare professionals (25%), and teachers (16%).
Bullying and type 2 diabetes risk were significantly associated for both men (HR 1.61, 95% CI 1.24-2.09) and women (HR 1.36, 95% CI 1.06-1.74). There were no differences between men and women for exposure to workplace violence and diabetes risk, the authors reported.
When they adjusted for BMI, the results were attenuated but still significant for bullying (HR 1.37, 95% CI 1.11-1.69) and borderline significant for violence (HR 1.27, 95% CI 0.96-1.70). Xu’s group suggested that obese employees may be more frequent targets of workplace bullying or violence, or that the stress of these conditions might lead to negative emotions and comfort eating behavior.
The depression and anxiety resulting from workplace bullying or violence might contribute to diabetes risk by chronic activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, the authors said, adding that impaired sleep might also increase diabetes risk indirectly.
“Furthermore, stress-related coping strategies, such as comfort eating behavior with an increased preference for energy and nutrient dense foods, may result in weight gain or an increase in waist circumference, which are both pivotal risk factors for diabetes,” they said.
Study limitations included its reliance on self-reporting. It also only measured workplace bullying and violence at baseline and did not assess the effects of these conditions over time, the authors stated.
“Both bullying and violence or threats of violence are common in the workplace. Research on bullying and violence prevention policies with workplaces as the target are warranted to determine whether these policies could be effective means of reducing the incidence of type 2 diabetes,” they said.
The study was funded by NordForsk, the Nordic Research Program on Health and Welfare, the Project on Psychosocial Work Environment and Healthy Ageing, and Danish Working Environment Foundation.
Xu and co-authors disclosed relevant relationships with industry.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
- Primary Source
Diabetologia