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Four Negative Personality Traits Associated With Type 2 Diabetes (CME/CE)

Action Points

  • Four personality traits were significantly associated with the risk of type 2 diabetes in postmenopausal women: optimism, ambivalence over emotional expression, negative emotional expressiveness, and hostility.
  • Understand that it may be possible to tailor approaches to individual patients to help overcome some of the negative thinking patterns and to improve coping skills, and that individuals may benefit from knowing that their personality traits might heighten diabetes risk and thus potentially take preventive actions to reduce the risk.

CME Author: Vicki Brower

Study Authors: Juhua Luo, JoAnn Manson, et al.

Target Audience and Goal Statement:

Women’s health specialists, endocrinologists, family medicine specialists, internists, primary care physicians, psychologists, psychiatrists, and behavioral medicine specialists

The goal was to examine whether four personality traits — namely, optimism, ambivalence over emotional expression, negative emotional expressiveness, and hostility — were associated with the risk of developing type 2 diabetes in postmenopausal women.

Question Addressed:

  • Are negative personality traits linked to risk of diabetes in postmenopausal women?

Study Synopsis and Perspective:

Four personality traits — optimism, ambivalence over emotional expression, negative emotional expressiveness, and hostility — were found to be significantly associated with an increased risk for type 2 diabetes in postmenopausal women, according to a study based on data from the Women’s Health Initiative.

Juhua Luo, PhD, of Indiana University in Bloomington, and colleagues tracked approximately 140,000 postmenopausal women without diabetes at baseline, followed them for 14 years, and found that those in the highest quartile of optimism as determined by questionnaires were 12% less likely to develop diabetes compared with those in the lowest quartile (HR 0.88, 95% CI 0.84-0.92).

The study, found online in Menopause, the journal of the North American Menopause Society (NAMS), also found that compared with women in the lowest quartiles for hostility, those in the highest quartile were 17% more likely to develop diabetes (HR 1.17, 95% CI 1.12-1.23), and those in the highest quartile for negative emotional expressiveness were 9% more likely to be diagnosed with diabetes as well (HR 1.09, 95% CI 1.05-1.14). Conversely, compared with women in the lowest quartile of optimism, those in the highest quartile (i.e., the most optimistic) had a 12% lower risk of diabetes (HR 0.88; 95% CI 0.84-0.92).

The risk of diabetes in these women was independent of demographic characteristics, depressive symptoms, and health behaviors tied to personality traits that could affect diabetes risk, such as poor diet, physical inactivity, alcohol use, and smoking, the researchers said.

“Accumulating evidence demonstrates that depression is also associated with increased risk of diabetes,” the team wrote. “However, in addition to depression, little is known about whether other psychological factors, including personality traits, are associated with diabetes risk.”

Luo’s group analyzed data on 139,924 postmenopausal women ages 50-79 enrolled in the Women’s Health Initiative large prospective cohort study and followed them for a mean of 14 years. All participants were healthy and diabetes-free at baseline. Personality traits were determined by questionnaires. Optimism was assessed with the Life Orientation Test, and negative emotional expressiveness was assessed with four items from the Emotional Expressiveness Questionnaire.

At follow-up, 19,240 participants reported having incident type 2 diabetes. Associations were adjusted for common demographic factors, health behaviors, and depressive symptoms.

The association of hostility with risk of diabetes was stronger among nonobese than obese women. The researchers observed that there are both obesity-related and non-obesity-related pathways in the development of diabetes: “It is possible that factors related to emotions are overshadowed by obesity-related mechanisms in obese women,” Luo and co-authors wrote.

Also of note, they said, was the finding that compared with participants categorized as the least optimistic (i.e., those in the lowest quartile of optimism), women in the highest quartile (most optimistic) were white, more likely to be younger, more educated, have more family income, have less history of cardiovascular diseases, have prior hormone use, smoke less, consume moderate levels of alcohol, eat more healthily, and were less likely to have depressive symptoms.

All correlations between personality traits were significant, with the highest correlation between optimism and hostility, and the lowest between ambivalence over emotional expressiveness and negative emotional expressiveness, the researchers reported.

Source Reference:

Menopause, Jan. 21, 2019; DOI: 10.1097/GME.0000000000001296.

Study Highlights: Explanation of Findings

In this study, optimism was significantly associated with a lower risk of diabetes, and negative emotional expressiveness and hostility were significantly associated with an increased risk of diabetes. These associations remained significant after adjusting for demographic characteristics, modifiable health behaviors, and depressive symptoms.

The notion that personality might influence health has attracted a lot of attention, Luo and colleagues wrote. “Our findings are consistent with previous studies reporting that positive psychological well-being was associated with lower risk of incident coronary heart disease and longevity. Several studies have also reported that positive psychological traits, including optimism, were associated with better glucose control and lower mortality rates in patients with type 2 diabetes.”

The team explained that only one other study to date had assessed optimism and diabetes risk, and other studies have examined the relationships of stress and diabetes and angry temperament with diabetes.

The mechanisms underlying the findings are not yet clear, but several potential mechanisms may be considered, Luo and co-authors stated. “Psychosocial factors may influence the development of diabetes directly through mechanisms such as glucose dysregulation and inflammation. Our data suggest that additional biological mechanisms related to cortisol regulation, or reduced inflammation, may be more likely to reside on the pathway between personality characteristics and diabetes.”

In addition, the team said, “there is some evidence showing that a rise in the concentration of pro-inflammatory cytokines and glucocorticoids, particularly cortisol, is present in conditions of chronic stress and often in depression, which may lead to accumulation of visceral fat or lipolysis or release of free fatty acids and then insulin resistance.”

The investigators noted that since a personality trait is indicative of how a person thinks, knowing that, along with a person’s behavior “allows the attentive clinician to fashion the communication or treatment accordingly.”

The study results could be used to tailor treatment and prevention strategies to personality types, NAMS executive director JoAnn Pinkerton, MD, told MedPage Today. “For women with negative personality traits and early diabetes, the approach could include early testing and having a nutritionist work with the patient more intensively to get control of the blood sugar early in life. At the same time, an educator or counselor could work with the woman to identify strategies to overcome negative thinking and cynicism. Early intervention could decrease long-term health risks,” she said via email.

Defeating negative thinking is challenging but possible, Pinkerton added. “Although personality may be genetically based and difficult to change, women can learn to overcome some of the negativity and cynicism. Improved coping skills make women more likely to improve their blood sugar, which will improve their moods and quality of life.” Such skills include mindfulness training and learning to identify negative thought patterns.”

Luo and co-authors said that people may benefit from knowing how their own personality traits might heighten the risk for diabetes, and then potentially take protective actions to reduce risk. It may also be of benefit in future research to investigate whether diabetes prevention intervention may be tailored according to different personality traits, the team added.

Strengths of the study, the researchers said, include its prospective design, which included detailed information on possible confounders, a large sample size, long-term follow-up, and the assessment of a range of personality traits. Limitations include the fact that the diabetes diagnoses were self-reported; that the study included postmenopausal women in the U.S. who were healthy at baseline, so the results might not apply to other populations; and that personality traits were assessed only at baseline.

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