Diabetes and stress: an anthropological review for study of modernizing populations in the US-Mexico border region.

INTRODUCTION

Diabetes is a growing worldwide problem, characterized by considerable ethnic variation and being particularly common in modernizing populations. Modernization is accompanied by a variety of stressful sociocultural changes that are believed to increase the risk of diabetes. Unfortunately, there is little accurate knowledge about impact of stress on the risk of diabetes in the US-Mexico border area.

METHODS

Literature searches were performed in PubMed and Google Scholar to identify anthropological studies on stress and diabetes. Snowball and opportunistic sampling were used to expand the identified literature. In total, 30 anthropological studies were identified concerning the role of stress and modernization on diabetes among Indigenous peoples. This article reviews the available information regarding stress and diabetes in different populations from various anthropological perspectives.

RESULTS

Four different concepts of stress were indentified: physiological, psychological, psychosocial and nutritional stress. Unlike physiological and nutritional theories of diabetes, psychological and psychosocial theories of stress and disease lack etiological specificity. No study addressed all four concepts of stress and few studies addressed more than two concepts. Most studies concerned nutritional stress and the developmental origins of diabetes. Most studies were conducted on the Pima Indians of Arizona and Mexico. All four stress concepts have some evidence as determinants of diabetes.

CONCLUSION

These theoretical concepts and ethnographic results can provide the basis for developing comprehensive research protocols and public health intervention targeted at diabetes. A comprehensive view of stress can potentially explain the high prevalence of diabetes in developing countries and among Indigenous peoples. These results can be used to inform public health interventions aimed at reducing diabetes in the US-Mexico border region or similar areas, help identify at-risk individuals, and guide health education and promotion.