According to a new study published in JAMA Psychiatry, women with multiple post-traumatic stress disorder (PTSD) symptoms are nearly twice as likely to develop type 2 diabetes  as women without PTSD.

It’s the strongest indication yet of a possible causal relationship, or cause and effect, between PTSD and type 2 diabetes, said researchers from Columbia University’s Mailman School of Public Health in New York.

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“Our mental health affects our physical health. Disorders like PTSD that often begin in a woman’s teens or twenties have negative physical consequences for their whole lives,” said Karestan Koenen, Ph.D., a senior author of the study and a professor of epidemiology at the Mailman School. “Perhaps earlier treatment of the mental disorders can prevent some of the physical disorders.”

Researchers analyzed 22 years of data collected from 49,739 women in the Nurses Health Study II. The study is a national, long- term investigation of the health of women who were between the ages of 24 and 42 when the study began in 1989.

The researchers found that PTSD and type 2 diabetes have what’s known as a dose-response relationship. This means that the likelihood and severity of type 2 diabetes is related to the amount and condition of exposure to PTSD.

Diabetes Risk Increases with More PTSD Symptoms

The risk of type 2 diabetes increased with more reported PTSD symptoms, according to the researchers. What’s more, by the time women reached age 60, nearly 12 percent of those with the highest number of PTSD symptoms had developed type 2 diabetes. Among those with no reported trauma, less than 7 percent had the disease.

Participants were asked questions about trauma history, PTSD symptoms, and any later diabetes diagnosis. Lifestyle factors, including alcohol intake, smoking, antidepressant use, body mass index, diet quality, and physical activity level were also taken into account. Diagnoses were then independently confirmed through medical records.

Antidepressant use and elevated body mass index (a measure of body fat) were linked to nearly half of the increased risk of type 2 diabetes. None of the other lifestyle issues researchers studied impacted the link between the two conditions.

“It was surprising how important antidepressant use was. We didn’t expect this and are trying to understand it better, especially considering how widely prescribed antidepressants are,” said Koenen.

The most common kinds of trauma reported were child abuse and interpersonal violence, which includes rape, sexual assault, and partner violence. “It’s similar to what is seen in the general population. These are women you would know in the community,” Koenen explained.

Learn More About Post Traumatic Stress Disorder »

High Risk Populations, Minority Groups Need PTSD Screening

It’s important for women and their doctors to know that PTSD and trauma have profound effects on physical health, not just mental health. They can’t be seen as separate problems, Koenen stressed. She said that about 50 percent of Americans with PTSD do not receive treatment. This is especially true among minority groups.

“So it’s critically important to improve access to mental health care in the United States and provide more access and equity to treatment. Primary care providers need to be screening for PTSD among high-risk populations,” she said.

Koenen said  there are effective, relatively short-term treatments available for women with PTSD. The Anxiety and Depression Association of America provides hotlines to get people directly connected to treatment. Sliding fee scales are usually available.

Unfortunately, many symptoms of the disorder can get in the way of women taking care of their physical health, Koenen explained. “They might avoid certain locations or people. That can get in the way of exercising, socializing, and eating well,” she said.

“I was always struck by how many chronic diseases women with PTSD experienced, especially conditions like cardiovascular disease, obesity, and diabetes, which we know are huge public health problems,” Koenen added.

Although this study focused only on women with PTSD, Koenen said the data is consistent with studies conducted by the military on all or mostly male groups.