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Original article Prospective associations between psychosocial stress and the risk of type 2 diabetes in middle-aged adults: findings from the KoGES_CAVAS
Ji Eun Kim2,3orcid , Hye Won Woo2,3orcid , Yu-Mi Kim1,3orcid , Min-Ho Shin4orcid , Sang Baek Koh5orcid , Mi Kyung Kim1,3orcid
Epidemiol Health 2025;e2025061
DOI: https://doi.org/10.4178/epih.e2025061 [Accepted]
Published online: October 31, 2025
1College of Medicine, Hanyang University, Korea , Seoul, Korea
2Department of Preventive Medicine, Hanyang University, College of Medicine, Seoul, Korea
3Institute for Health and Society, Hanyang University, Seoul, Korea
4Department of Preventive Medicine, Chonnam National University, Medical School, Gwangju, Korea
5Department of Preventive Medicine and Institute of Occupational Medicine, Yonsei Wonju College of Medicine, Wonju, Korea
Corresponding author:  Mi Kyung Kim,
Email: kmkkim@hanyang.ac.kr
Received: 24 June 2025   • Revised: 29 September 2025   • Accepted: 16 October 2025
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Abstract

OBJECTIVES
Psychosocial stress is a potential risk factor for type 2 diabetes (T2D); however, the influence of the timing of stress exposure remains uncertain. We examined the prospective associations of baseline, cumulative average, and recent psychosocial stress with the risk of incident T2D in middle-aged adults.
METHODS
We analyzed data from 7,880 participants aged 40–64 years without T2D at baseline. Psychosocial stress was assessed repeatedly using the Psychosocial Well-Being Index–Short Form. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using modified Poisson regression models with robust error estimators.
RESULTS
A total of 437 T2D cases occurred over 47,621 person-years. While baseline stress showed a non-significant association, both cumulative and recent stress demonstrated positive associations with T2D risk. Recent stress exhibited the strongest association in both men (stress vs. healthy group: IRR=2.23, 95% CI, 1.41–3.52; highest [T3] vs. lowest tertile [T1]: IRR=1.50, 95% CI, 1.07–2.10) and women (stress vs. healthy group: IRR=1.72, 95% CI, 1.11–2.66; T3 vs. T1: IRR=1.73, 95% CI, 1.26–2.37). These associations were more pronounced among participants with abdominal obesity, showing a significant positive linear trend (Bonferroni-corrected threshold, p<0.0035).
CONCLUSIONS
Recent psychosocial stress was associated with an increased incidence of T2D, underscoring the importance of integrating psychosocial factors into diabetes prevention strategies, particularly for individuals with abdominal obesity.

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