Stress resilience and subsequent risk of type 2 diabetes in 1.5 million young men

Aims/hypothesis: Psychosocial stress in adulthood is associated with a higher risk of type 2 diabetes, possibly mediated by behavioural and physiological factors. However, it is unknown whether low stress resilience earlier in life is related to subsequent development of type 2 diabetes. We examined whether low stress resilience in late adolescence is associated with an increased risk of type 2 diabetes in adulthood. Methods: We conducted a national cohort study of all 1,534,425 military conscripts in Sweden during 1969–1997 (97–98% of all 18-year-old men nationwide each year) without prior diagnosis of diabetes, who underwent standardised psychological assessment for stress resilience (on a scale of 1–9) and were followed up for type 2 diabetes identified from outpatient and inpatient diagnoses during 1987–2012 (maximum attained age 62 years). Results: There were 34,008 men diagnosed with type 2 diabetes in 39.4 million person-years of follow-up. Low stress resilience was associated with an increased risk of developing type 2 diabetes after adjusting for BMI, family history of diabetes, and individual and neighbourhood socioeconomic factors (HR for lowest vs highest quintile: 1.51; 95% CI 1.46, 1.57; p < 0.0001), including a strong linear trend across the full range of stress resilience (p_trend < 0.0001). This association did not vary by BMI level, family history of diabetes or socioeconomic factors. Conclusions/interpretation: These findings suggest that low stress resilience may play an important long-term role in aetiological pathways for type 2 diabetes. Further elucidation of the underlying causal factors may help inform more effective preventive interventions across the lifespan.