Impact of the COVID-19 pandemic on depression, anxiety, loneliness, and satisfaction in the German general population: a longitudinal analysis.

PURPOSE: Cross-sectional studies found high levels of depression and anxiety symptoms, and loneliness during the first wave of the COVID-19 pandemic. Reported increases were lower in longitudinal population-based findings. Studies including positive outcomes are rare. This study analyzed changes in mental health symptoms, loneliness, and satisfaction. METHODS: Respondents of the German Socio-Economic Panel (N = 6038) were surveyed pre-pandemic (2017/2019) and during the first (June 2020) and second wave (January and February 2021) of the pandemic. Self-report screeners assessed depression and anxiety symptoms, loneliness, life and health satisfaction. Difference scores were analysed using ANCOVAs focusing on time, gender, age groups. RESULTS: Depression and anxiety symptoms and health satisfaction increased from pre-pandemic to the first wave, but declined in the second pandemic wave. Loneliness increased and life satisfaction decreased during the first and the second wave of the pandemic. Young adults and women reported more distress and loneliness, even after controlling for pre-pandemic scores, education, and income. All effects remained stable when controlling for self-reported previous diagnosis of depression or region of residence. CONCLUSION: Increases and decreases in mental health symptoms and health satisfaction showed little variation. Of concern are the strong increases of loneliness and decreased life satisfaction being important targets for interventions. Main risk factors are young age and female gender.

The impact of child maltreatment on non-suicidal self-injury: data from a representative sample of the general population.

BACKGROUND: Child maltreatment is an identified risk factor for Non-Suicidal Self-Injury (NSSI). The aim of the current study was to investigate effects of different types of maltreatment, and mediating effects of depression and anxiety on NSSI in the general population. METHODS: A representative sample of the German population, comprising N = 2498 participants (mean age = 48.4 years (SD = 18.2), 53.3% female) participated in this study. Child maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ),NSSI was assessed with a question on lifetime engagement in NSSI, depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-2) and anxiety symptoms by the General Anxiety Disorder questionnaire (GAD-2). RESULTS: Lifetime prevalence of NSSI in this sample was 3.3, and 30.8% reported at least one type of child maltreatment. Participants in the NSSI group reported significantly more experiences of child maltreatment. Emotional abuse was endorsed by 72% of all participants with NSSI. A path analytic model demonstrated an unmediated direct effect of emotional neglect, a partially mediated effect of emotional abuse, and a fully mediated effect of sexual abuse and physical neglect by depression and anxiety on NSSI. CONCLUSIONS: Especially emotional neglect and abuse seem to play a role in the etiology of NSSI above and beyond depression and anxiety, while sexual and physical abuse seem to have a rather indirect effect.

Long-term effects on adult attachment in German occupation children born after World War II in comparison with a birth-cohort-matched representative sample of the German general population.

BACKGROUND: Children born of war are a phenomenon of every conflict. At the end of World War II and thereafter, approximately 400,000 children were fathered by foreign soldiers and born to local women in Germany. Quantitative research on psychosocial consequences of growing up as German occupation child (GOC) has been missing so far. METHODS: This study examines adult attachment and its association with current depression in GOC (N = 146) using self-report instruments: Adult Attachment Scale, Patient Health Questionnaire. Data were compared to a birth-cohort-matched representative sample of the German population (BCMS; N = 786). RESULTS: GOC differ in both attachment dimensions (less comfortable with closeness/intimacy, lowered ability to depend on others) and adult attachment (more dismissive and fearful) compared to BCMS. Insecure adult attachment is associated with current depression. CONCLUSION: GOC grew up under difficult circumstances (e.g. poverty, adverse events, and stigmatization). Even decades later they display more insecure attachment in current relationships. Findings underline the complex and long-term impact of their developmental conditions on attachment and current mental health.

Psychometric analysis of the brief symptom inventory 18 (BSI-18) in a representative German sample.

BACKGROUND: The BSI-18 contains the three six-item scales somatization, depression, and anxiety as well as the Global Severity Index (GSI), including all 18 items. The BSI-18 is the latest and shortest of the multidimensional versions of the Symptom-Checklist 90-R, but its psychometric properties have not been sufficiently clarified yet. METHODS: Based on a representative sample of N = 2516 participants (aged 14-94 years), detailed psychometric analyses were carried out. RESULTS: The internal consistency was good: Somatization α = .82, Depression α = .87, Anxiety α = .84 and GSI α = .93. Confirmatory factor analysis supported the three scales as second-order and GSI as first-order factors. The model fit based on RMSEA is good but that model fit based on CFI and TLI are too low. CONCLUSIONS: Therefore, it is a very short, reliable instrument for the assessment of psychological distress. The BSI-18 can be used to reliably assess psychological distress in the general population. However, further studies need to evaluate the usefulness of standardization in clinical samples.

Childhood maltreatment in children born of occupation after WWII in Germany and its association with mental disorders.

BACKGROUND: Children born of war are a common phenomenon of conflict. In the aftermath of World War II, more than 200,000 German occupation children (GOC) were fathered by occupation soldiers and born to local women. GOC often grew up under difficult conditions and showed high prevalence rates of mental disorders even decades later. METHODS: Experiences of childhood maltreatment and their association with Posttraumatic Stress Disorder (PTSD), depression, and somatization in GOC (N = 146) are investigated and compared with a representative birth-cohort-matched sample (BCMS) from the German general population (N = 920). RESULTS: Outcomes show significantly higher prevalence rates of emotional abuse/neglect, physical, and sexual abuse in GOC compared to BCMS. All five subtypes of childhood maltreatment increase the risk of PTSD and somatoform syndrome; depressive syndromes are associated with emotional abuse/neglect and physical abuse. GOC were at high risk of childhood maltreatment. CONCLUSIONS: Findings underline the complex, long-term impact of developmental conditions and childhood maltreatment on mental disorders even decades later.

Shadows of Beauty - Prevalence of Body Dysmorphic Concerns in Germany is Increasing: Data from Two Representative Samples from 2002 and 2013.

Body dysmorphic disorder (BDD) is a psychosomatic disease associated with reduced quality of life and suicidal ideations. Increasing attention to beauty and the development of beauty industries lead to the hypothesis that BDD is increasing. The aim of this study was to test this hypothesis in two representative samples of Germans, assessed in 2002 and 2013. In 2002, n = 2,066 and in 2013, n = 2,508 Germans were asked to fill in the Dysmorphic Concern Questionnaire (DCQ), which assesses dysmorphic concerns. Subclinical and clinical dysmorphic concerns increased from 2002 to 2013 (subclinical from 0.5% to 2.6%, OR = 5.16 (CI95% = 2.64; 10.06); clinical from 0.5% to 1.0%, OR = 2.20 (CI95% = 1.03; 4.73). Women reported more dysmorphic concerns than men, with rates of 0.7% subclinical and 0.8 clinical BDD in women and 0.3% subclinical and 0.1% clinical BDD in men in 2002. In 2013, 2.8% subclinical and 1.2% clinical BDD were found in women and 2.4% subclinical and 0.8% clinical BDD in men. Further studies should assess predictors for developing a BDD and evaluate factors determining the efficacy of disease-specific psychotherapeutic and psychotropic drug treatments.

Depression, Somatization, and Posttraumatic Stress Disorder in Children Born of Occupation After World War II in Comparison With a General Population.

At the end of World War II and during the first decade after the war, roughly 200,000 children were fathered in intimate contacts between German women and foreign soldiers. The experiences of these German occupation children (GOC) have been so far described in case reports and from historical perspective only. Research on psychosocial consequences of growing up as a GOC has been missing so far. This study examined traumatic experiences, posttraumatic stress disorder, somatization, and depression in GOC (N = 146) using self-report instruments: Posttraumatic Diagnostic Scale and Patient Health Questionnaire. Findings have then been compared with a representative birth cohort-matched sample from the German general population (N = 977). German occupation children showed significantly higher prevalence rates of most traumatic experiences, higher point prevalence rates of full and partial posttraumatic stress disorder, depression, and somatization than the control group. In summary, GOC often grew up under difficult conditions (e.g., poverty, single mothers, and stigmatization). Even decades later, they showed higher rates of different mental disorders and higher comorbidity. These findings underline the complex and long-term impact of their burdened social, financial, and familial conditions. The results underpin the importance of conceptualizing occupation children as a vulnerable group in postconflict settings.

The German Version of the Hopkins Symptoms Checklist-25 (HSCL-25) --factorial structure, psychometric properties, and population-based norms.

PURPOSE: The Hopkins Symptom Checklist-25 (HSCL-25) has often been used in cross-cultural settings and in studies focussing on asylum seekers, refugees etc. It is available in a number of languages. The present study investigates the psychometric properties of the German version of the HSCL-25 and delivers population-based norms. METHODS: Psychometric properties are investigated in a population-based representative sample of the German general population (N=2516). Seven different factorial models are compared using confirmatory factor analysis. RESULTS: Two out of the seven models show the best model fit. Because of the high inter-correlations of the factors of the tripartite model, the bifactor model is the preferable factor solution. The internal consistencies (Cronbach's alpha) were 0.84, 0.92, and 0.94 for the anxiety, the depression and the total score, respectively. The correlations of both subscales of this model with the subscales of the Brief-Symptom-Inventory-18 or the Patient Health Questionnaire-4 point out, that there is only marginal differential information of the subscales. CONCLUSION: Considering the third ("general") factor of the bifactor model with all items loading on it and the absence of differential correlations of the subscales with the external criteria (PHQ-4, BSI-18) the HSCL-25 seems to assess something like "mental distress" with a focus on symptoms of depression and anxiety. The population-based norms support the application of the HSCL-25 for individual diagnostics as well as for the comparison of specific samples with the general population.

Life satisfaction and health-related quality of life in immigrants and native-born Germans: the role of immigration-related factors.

PURPOSE: There is a lack of population-based studies on health-related quality of life (HRQoL) and satisfaction with life (SWL) of immigrants compared to the native populations. Findings of previous research are inconclusive. Our study compares HRQoL and SWL in immigrants and native-born Germans, investigating immigration-related factors as suspected determinants of HRQoL and SWL in immigrants. METHODS: In the German Socio-economic panel from 2006, HRQoL (measured with the SF-12v2) and SWL as well as immigration-related factors were assessed in 21,079 subjects (including 2,971 immigrants). Analyses of variance were applied as statistical tests in our study. RESULTS: Native-born Germans report a higher amount of SWL and of HRQoL on the physical health component compared to the immigrants. With effect sizes ranging from E² = 0.001 to 0.111, these findings are of minimal practical relevance. In immigrants, the physical health component of HRQoL is significantly associated with younger age at migration and with country of origin. As the effect sizes are extremely low, these findings have limited practical relevance. CONCLUSION: There are small differences in SWL and HRQoL of immigrants and native-born Germans. Some immigration-related factors are related to HRQoL, but not to SWL. As immigrants are a quite heterogeneous group, it seems useful to focus on immigration-related factors, not simply comparing immigrants and the native-born. Our findings suggest that research on the association of immigration-related factors with quality of life in immigrants seems a promising approach to better identify subgroups of immigrants with lower levels of quality of life.

What is the General Health Questionnaire-12 assessing? Dimensionality and psychometric properties of the General Health Questionnaire-12 in a large scale German population sample.

Since the dimensionality and the related psychometric properties of the 12-item General Health Questionnaire (GHQ-12) are still under debate, the present study compares different factor solutions from the literature to determine which shows the best fit and to investigate reliability and construct validity. The analyses are based on a German population based representative sample (N=2,041), using face-to-face-interviews. The confirmatory factor analysis indicates the best fit to the one-factor model including response bias on the negative worded items according to Hankins. Thus, the importance of methodical aspects for the dimensionality was emphasized. Moreover, the correlations of the different subscales of the two- and three-factor models with several external criteria (BDI, PHQ-2, SF-36, PHQ-Anxiety, SPIN) do not substantially differ. The preferred unidimensional model shows good psychometric properties. According to its associations with the external criteria under study, the GHQ-12 as a unidimensional measure seems to be a useful screening tool for the assessment of mental distress or a minor psychiatric morbidity with a main focus on depressive symptomatology.

The impact of forced displacement in World War II on mental health disorders and health-related quality of life in late life - a German population-based study.

BACKGROUND: Long-term effects of World War II experiences affect psychological and physical health in aged adults. Forced displacement as a traumatic event is associated with increased psychological burden even after several decades. This study investigates the contribution of forced displacement as a predictor for mental health disorders and adds the aspect of health-related quality of life (QoL). METHOD: A sample of 1,659 German older adults aged 60-85 years was drawn from a representative survey. Post-traumatic stress disorder (PTSD), somatoform symptoms, depressive syndromes, and health-related QoL were assessed as outcome variables. Chi-square and t-test statistics examined differences between displaced and non-displaced people. Logistic regression analyses were performed to examine the impact of forced displacement on mental health disorders and QoL. RESULTS: Displaced people reported higher levels of PTSD, depressive and somatoform symptoms, and lower levels of health-related QoL. Displacement significantly predicted PTSD and somatoform symptoms in late life, but not depressive disorders. Health-related QoL was predicted by forced displacement and socio-demographic variables. CONCLUSION: Forced displacement is associated with an elevated risk for PTSD and somatoform symptoms and lowered health-related QoL in aged adults. Its unique impact declines after including socio-demographic variables. Long-term consequences of forced displacement need further investigations and should include positive aspects in terms of resilience and protective coping strategies.

Associations of self-reported skin symptoms with age, sex, and living with a partner: Findings from a representative survey in view of the biomedical and the biopsychosocial model.

Introduction: Social and demographic characteristics are crucial determinants of health. The objective of this contribution is to study the associations of skin symptoms and sociodemographic variables in the general population, and to discuss these findings in view of the biomedical and the biopsychosocial models of skin diseases. Methods: A national face-to-face household survey with a representative sample of the German general population assessed 19 self-reported skin symptoms (N = 2,487). Associations with age, sex, and living situation (alone vs. with partner) were analyzed using logistic regression analyses. Results: The frequencies of pimples and biting of the nails decreased by approximately 30% per age decade, and oily skin, the feeling of disfigurement, excoriations, and sun damages decreased by 8%-15% per age decade. Dryness of the skin increased by 7% per decade. Sensitive skin and dryness were approx. twice as likely in females as in males. Dryness of the skin, itch, and excoriations were 23%-32% more frequent in participants living without a partner. Discussion: The biomedical model explains some of the findings well (e.g., reduction of pimples with age). The interpretation of other results is facilitated by the biopsychosocial model (e.g., association of living without a partner and itch). This suggests a stronger integration of psychological and social factors into the understanding and treatment of symptoms of the skin.

Validation of the irritation scale on a representative German sample: new normative data.

The irritation scale is a widely used and reliable self-report scale for measuring cognitive and emotional strain related to the work environment. It extends existing measures by providing a sensitive assessment for pre-clinical stress at work. Existing normative data are based on convenience samples and are therefore not representative. This study provides new normative data for the irritation scale based on a representative German sample (N = 1480). The new normative data indicate that the overall level of irritation in the German workforce is significantly lower compared to previously published data. Convergent and discriminant validity is confirmed by correlations with depression and anxiety (Patient Health Questionnaire-4 for Depression and Anxiety), somatic symptom scales (Bodily Distress Syndrome 25 checklist, Somatic Symptom Scale-8, Giessen Subjective Complaints List-8, comorbidity), psychological functioning (Mini-ICF rating for activity and participation disorders in mental illness), work-related stressors (overcommitment and bullying) and individual resources (self-efficacy). The results confirm the utility of the irritation scale and provide new benchmarks that avoid an underestimation of the levels of irritation in future studies.

Art therapy in psycho-oncology--recruitment of participants and gender differences in usage.

PURPOSE: Over the last years, there has been increasing focus on the effect of art therapy for oncological patients. The small sample sizes of these studies show that recruiting participants is difficult and has been poorly investigated. It is also apparent that women participate in art therapy more often than men. The question remains why this difference exists and if participating men benefit from these courses more, less or in a different way than women do. METHODS: We developed and tested an outpatient art intervention for cancer patients, whereby different recruitment strategies were documented. Participants were questioned about their mental health (HADS), coping strategies (FKV), and quality of life (EORTC QLQ-C30) at the beginning and end of the intervention. RESULTS: The recruitment strategies included personal letters, referrals from the "Information Center For Cancer Patients", press releases and leaflets/posters distributed to hospitals and medical practices. About half of the participants (N=35), especially the male ones, took part in response to receiving a personal letter. All in all, 14 men and 60 women took part in the intervention whereby all 18 drop-outs were female. There were no significant gender differences regarding distress and quality of life before and after the intervention (men=14; women=41). CONCLUSIONS: A variety of approaches and intense public relations are necessary to recruit patients for art therapy. Describing recruitment strategies more in detail is suggested for upcoming art therapy studies. First gender specific differences were found in recruitment and usage. Exploring further questions in this area referring to quality of life and distress larger and uniformly distributed samples are desirable.

More than 60 years later: the mediating role of trauma and posttraumatic stress disorder for the association of forced displacement in world war II with somatization in old age.

Up to now, it has remained unclear whether displacement itself is the pathogenetic factor for the impairment of mental health in uprooted individuals or whether the effect is mediated by the amount of traumatic events experienced during forced displacement and/or by the development of posttraumatic stress disorder (PTSD). A total of 1657 participants were included in this population-based study, who were then administered with the Patient Health Questionnaire, a modified trauma list of the PTSD module of the Munich Composite International Diagnostic Interview, and the Posttraumatic Diagnostic Scale. Displacement was associated with increased rates of traumatic events. The displaced participants were significantly more affected by somatoform symptoms and PTSD than the nondisplaced population. It was not displacement itself but the amount of trauma experienced during displacement that predicts current somatization in the population-based sample. The results highlight the necessity for prevention and treatment of posttraumatic conditions in displaced individuals and underpin the importance to understand somatization as one condition of the posttraumatic symptoms spectrum in the elderly.

Posttraumatic stress disorder and its comorbidity with depression and somatisation in the elderly - a German community-based study.

OBJECTIVES: Even 60 years after World War II, the German elderly population is significantly more often affected by posttraumatic symptomatology compared to the younger cohorts. This study is addressing prevalence rates of posttraumatic symptomatology and its comorbidity with depression and somatisation. METHODS: This study examines posttraumatic stress disorder (PTSD) according to DSM-IV, partial PTSD, depression and somatisation in a randomly selected sample of the German general population aged 60-85 years (N = 1.659) using self-rating instruments (Patient Health Questionnaire, PHQ; Post Traumatic Diagnostic Scale, PTDS). RESULTS: One-month prevalence rate was 4.0% for DSM-IV PTSD; another 12.2% fulfilled the criteria of partial PTSD. A significant increase across the age groups was found for partial PTSD. 11.5% of the persons affected by posttraumatic symptomatology fulfil the criteria of a somatoform syndrome, 8.6% fulfil the criteria of major depression and 10.4% fulfil the criteria of other depressive syndromes according to the PHQ. A current posttraumatic symptomatology is associated with increased prevalence rates of somatoform and depressive disorders. Moreover, traumatic experiences without a current PTSD are associated with increased rates of somatoform disorders. CONCLUSION: Posttraumatic symptomatology is a common phenomenon in the German elderly population. Especially, subsyndromal disorders are very common and increasing across the age groups. Posttraumatic symptomatology is associated with an increased risk of depressive and somatoform disorders. As posttraumatic symptoms are often neglected in geriatric health care, future effort should address the recognition and treatment of posttraumatic symptoms in elderly patients.

Quality of Life: Updated Psychometric Properties and New Norm Values in a Representative German Sample Focusing Socioeconomics and Mental Health.

Objectives: Quality of life (QOL) is increasingly used as indicator in health research. The aim of this paper was an updated psychometric validation and a new standardization of the German version of the EUROHIS-QOL using a sample of the German general population assessed in 2021. The study focused on socio-economic characteristics and on anxiety and depressiveness as major indicators of mental health. Methods: With 8 items, the EUROHIS-QOL is an economical instrument for self-assessment. Results: Statistical tests revealed good psychometric properties. Gender- and age-group-specific norm values were calculated. The EUROHIS-QOL showed good discriminant validity for anxiety and depression symptoms. Participants without clinically relevant scores for depressiveness and anxiety reported significantly higher QOL. Multiple regression analysis showed that unemployment, younger age, not living with a partner, and an immigrant background were important predictors of lower QOL, whereas higher income, living in one's own home, and a high level of education predicted higher QOL. Conclusion: The EUROHIS-QOL was confirmed as an economical and reliable instrument for assessing QOL in the German general population.

Development of the Hedonic Overeating-Questionnaire (HEDO-Q).

Addictive-like eating is prevalent, but a clear conceptualization and operationalization outside of an addiction framework is lacking. By adopting a biopsychological framework of food reward, this study sought to develop and evaluate a brief self-report questionnaire for the trait assessment of hedonic overeating and dyscontrol. Items in the Hedonic Overeating-Questionnaire (HEDO-Q) were constructed following a rational approach and psychometrically evaluated in a large random sample from the German population (N = 2531). A confirmatory factor analysis supported the unidimensional nature of the six-item HEDO-Q with the three postulated components of wanting, liking, and dyscontrol. Psychometric properties were favorable with good corrected item-total correlations, acceptable item difficulty and homogeneity, and high internal consistency. Population norms were provided. The HEDO-Q revealed strict measurement invariance for sex and partial invariance for age and weight status. Discriminant validity was demonstrated in distinguishing participants with versus without eating disturbances or obesity. Associations with the established measures of eating disorder and general psychopathology supported the convergent and divergent validity of the HEDO-Q. This first evaluation indicates good psychometric properties of the HEDO-Q in the general population. Future validation work is warranted on the HEDO-Q's stability, sensitivity to change, and predictive and construct validity.

Conspiracy endorsement and its associations with personality functioning, anxiety, loneliness, and sociodemographic characteristics during the COVID-19 pandemic in a representative sample of the German population.

BACKGROUND: In the context of the COVID-19 pandemic, many individuals have been found to endorse conspiracy beliefs. Socio-demographic variables, personality functioning, anxiety, and loneliness could be risk factors for this endorsement. METHODS: In a representative sample of the German population (N = 2,503) measures of conspiracy mentality, conspiracy-related beliefs toward COVID-19, personality functioning (OPD-SQS), anxiety (HADS), and loneliness (UCLA) were assessed. Pearson product-moment correlations and multiple linear regression analyses were conducted. RESULTS: Conspiracy mentality and conspiracy-related beliefs toward COVID-19 were strongly correlated. Regression analyses found younger age, male gender, lower education, and lower income to be associated with conspiracy mentality. The subscales relationship model and self-perception of the OPD-SQS were positively related to conspiracy mentality whereas interpersonal contact was negatively associated. Higher levels of anxiety were statistically predictive for conspiracy mentality. CONCLUSION: Our findings indicate a contribution of personality functioning to the understanding of conspiracy mentality and thus to the advancement of interventions during the pandemic.

Depression Mediates the Association Between Childhood Emotional Abuse and the Onset of Type 2 Diabetes: Findings From German Multi-Cohort Prospective Studies.

Background: The dysregulation of glucose homeostasis via mental health stress is increasingly acknowledged, whereby depression independently increases the risk of the onset of type 2 diabetes by up to 60%. Contributing mental health factors starting in early life have further been considered, indicating that exposure to childhood emotional abuse is associated with both depression and an increased onset of type 2 diabetes in adulthood. However, the potential role of depression within the emotional abuse and type 2 diabetes link remains unknown. Methods: Data were derived from community-dwelling participants in southern and northeastern Germany who participated in the longitudinal KORA-F4 and SHIP-3 studies. Multivariable logistic regression analyses adjusted for lifestyle, somatic, and psychological risk factors were used to investigate the association between childhood emotional abuse, assessed retrospectively by the Childhood Trauma Screener, and newly diagnosed type 2 diabetes cases, which were confirmed using a standard oral glucose tolerance test. The mediating role of depressive symptoms between childhood emotional abuse and type 2 diabetes was assessed by the Patient Health Questionnaire-9 and calculated by using the Sobel test for mediation. Results: A total of 2,973 (53.2% women, 46.8% men) participants with a mean age of 49.7 were included in the analyses, of whom 5.9% (7.1% women, 4.5% men) reported emotional abuse in childhood. Participants exposed to childhood emotional abuse had a 1.70 (1.12-2.56; p = 0.02) times higher odds of depression in the fully adjusted model than unexposed participants. During the 6.5-year follow-up period, 104 (3.5%) participants developed type 2 diabetes. Participants who were exposed to childhood emotional abuse had a 2.56 (1.31-4.98, p = 0.005) times higher odds of developing type 2 diabetes than unexposed participants. This association was significantly mediated by the increased odds of depression in participants with childhood emotional abuse (Sobel Test, 1.84, p = 0.06; Goodman Test, 1.91, p = 0.05). Conclusion: The current results indicate that the increased likelihood of type 2 diabetes onset in participants who were exposed to childhood emotional abuse is significantly attributed to increased depression in adulthood.