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CME Activity

Increased Risk of Diabetes Mellitus Among Persons With Psychotic Symptoms: Results From the WHO World Health Survey

Roberto Nuevo, PhD; Somnath Chatterji, MD; David Fraguas, MD; Emese Verdes, PhD; Nirmala Naidoo, MA; Celso Arango, MD; and José Luis Ayuso-Mateos, MD

Published: December 15, 2011

Article Abstract

Objective: To analyze with a symptom-based approach the relationship between psychosis and diabetes mellitus in the general population.

Method: Nationally representative samples from the World Health Organization (WHO) World Health Survey, totaling 224,743 randomly selected adults 18 years and older from 52 countries worldwide, were interviewed to establish the presence of psychotic symptoms and diabetes mellitus. Presence of psychotic symptoms was established using questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Presence of diabetes was established with a response of "yes" to the question, "Have you ever been diagnosed with diabetes (high blood sugar)?" The World Health Survey was conducted between 2002 and 2004.

Results: An increasing number of psychotic symptoms was related to increasing likelihood of diabetes mellitus (OR = 1.27; 95% CI, 1.24-1.30). As compared to no symptoms, at least 1 psychotic symptom substantially elevated the risk (OR = 1.71; 95% CI, 1.61-1.81). In people with a lifetime diagnosis of schizophrenia or psychosis, the prevalence of diabetes was higher in those with current psychotic symptoms (7.3% vs 5.2%; OR = 1.65; 95% CI, 1.21-2.26), suggesting that the persistence of symptoms over time could play a central role. After controlling for different potential confounders, there was a clear increase in the probability of having diabetes as the number of psychotic symptoms increased. The relationship between psychotic symptoms and diabetes was tested with multiple mediation models and path analyses for categorical outcomes. Only body mass index appeared as a relevant mediator in a model with a good fit (ie, χ21 = 3.2, P = .0742; comparative fit index = 0.999).

Conclusions: Psychotic symptoms are related to increased rates of diabetes mellitus in nonclinical samples, independent of several potential confounders—including a clinical diagnosis of psychosis or schizophrenia, previous antipsychotic treatment, depression, lifestyle, and individual or country socioeconomic status. The findings highlight the worldwide relevance of the problem and the importance of identifying the specific paths of this association.

J Clin Psychiatry 2011;72(12):1592-1599

Submitted: December 17, 2010; accepted March 18, 2011 (doi:10.4088/JCP.10m06801).

Corresponding author: José Luis Ayuso-Mateos, MD, Department of Psychiatry, Facultad de Medicina, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo 4, 28029 Madrid (Spain) (

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