Psychosocial Stress at Work Doubles the Risk of Type 2 Diabetes in Middle-Aged Women

Evidence from the Whitehall II Study

  1. Alexandros Heraclides, MSC,
  2. Tarani Chandola, PHD,
  3. Daniel R. Witte, PHD and
  4. Eric J. Brunner, PHD
  1. From the Department of Epidemiology and Public Health, Royal Free and University College London Medical School, London, U.K.
  1. Corresponding author: Alexandros Heraclides, a.heraclides{at}


OBJECTIVE To investigate the effect of psychosocial stress at work on risk of type 2 diabetes, adjusting for conventional risk factors, among a sample of British, white-collar, middle-aged men and women.

RESEARCH DESIGN AND METHODS This was a prospective analysis (1991–2004) from the Whitehall II cohort study. The current sample consists of 5,895 Caucasian middle-aged civil servants free from diabetes at baseline. Type 2 diabetes was ascertained by an oral glucose tolerance test supplemented by self-reports at baseline and four consecutive waves of data collection including two screening phases. The job strain and iso-strain models were used to assess psychosocial work stress.

RESULTS Iso-strain in the workplace was associated with a twofold higher risk of type 2 diabetes in age-adjusted analysis in women but not in men (hazard ratio 1.94 [95% CI 1.17–3.21). This effect remained robust to adjustment for socioeconomic position and outside work stressors and was only attenuated by 20% after adjustment for health behaviors, obesity, and other type 2 diabetes risk factors.

CONCLUSIONS Psychosocial work stress was an independent predictor of type 2 diabetes among women after a 15-year follow-up. This association was not explained by potential confounding and mediating factors. More evidence from prospective studies using the same work stress models is needed to support the current findings and provide further information on sex differences.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received January 23, 2009.
    • Accepted August 17, 2009.
| Table of Contents

This Article

  1. Diabetes Care vol. 32 no. 12 2230-2235
  1. All Versions of this Article:
    1. dc09-0132v1
    2. 32/12/2230 most recent