I completed my BSc in Psychology and Neuroscience at the University of Liverpool (2004). After this I obtained my PhD from Trinity College Dublin in 2010. My PhD was concerned with exploring the link between depression and inflammation by studying the psychological impact of the Hepatitis C treatment Interferon-alpha. After completing my PhD I completed a postdoctoral fellowship in Psychiatry at McGill University in Canada (2011-2014) where we examined the link between depression and diabetes. I returned to the UK in 2014 to undertake a lectureship at Brunel University London (2014-2016) prior to joining the School of Psychology at the University of Surrey in 2016.
University roles and responsibilities
- Programme Leader for MSc Health Psychology
In the media
My main research interest is in ageing well, with regards to the intersection of physical, mental and social wellbeing. I have a particular interest in ageing well with lifelong conditions and disability. Ongoing projects I am involved in include the following:
- Developing the UK-Irish consortium for ageing well with a lifelong disability (co-principal investigator; co-funded ESRC and IRC).
- Co-producing research into stigma and discrimination experienced by adults living with cerebral palsy (principal investigator; funded by BA/Leverhulme)
- The development of chronic conditions in adults with cerebral palsy (co-investigator; funded by Brunel University London)
- Understanding the experience of transitions within a retirement community setting (principal investigator; funded by Pargiter trust)
- Developing a conservation intervention for older adults in a retirement community (co-investigator; funded by Dunhill Medical Trust)
- Loneliness and healthcare utilisation in older adults (collaborative project with Brunel University London)
- The impact of COVID-19 on social prescribing for older adults (funded by ARC-KSS)
- Professor Christina Victor (Brunel University London)
- Dr. Jennifer Ryan (Royal College of Surgeons in Ireland)
- Dr. Silvia Liverani (Queen Mary's University London)
- Professor Jorg Huber (University of Brighton)
- Professor Mark Peterson (University of Michigan)
Postgraduate research supervision
I am currently lead supervisor to 4 PhD students who are conducting projects in the following areas:
- Sleep and challenging behaviours in adults with intellectual disability
- Depression, cardiometabolic abnormalities and the risk of dementia
- Ageing with HIV
- The impact of the pandemic on social prescribing for older adults
DClinPsy and PhD supervision - areas of interest
I am interested in supervising projects related to the following areas:
- Ageing with a lifelong disability, chronic conditions or severe mental illness
- Living well with lifelong and acquired disability in older age
- Co-morbidity of mental and physical illness
- Loneliness, social isolation, solitude and health
- Social prescribing and social activities for improving wellbeing and health in diverse ageing populations
I teach on the following modules:
- Clinical Psychology (PSY3097)
- Contemporary Health Psychology and Professional Practice (PSYM115)
- Academic Research Training for Health Psychology (PSYM136)
Courses I teach on
Smith KJ. Overview of Haemochromatosis UK patient report. Hameochromatosis UK patient report launch event. House of Commons, UK, 31st October 2018.
Smith KJ. Psychosocial predictors of quality of life in adults with Usher Syndrome. 4th International symposium for Usher syndrome. Mainz, Germany, 21st July 2018.
Smith KJ. Social and emotional loneliness. Loneliness in older people (soledad en las personas mayores). UIMP (in association with the International Association of Gerontology and Geriatrics), Valencia, Spain, 23rd November 2017.
Smith KJ. Typologies of loneliness and social isolation in an English community sample. Autumn Research and Policy Forum on Loneliness with the Campaign to End Loneliness, in collaboration with Brunel University London. Brunel University London, London, UK, 30th October 2017.
Smith KJ. Investigating the association between loneliness and health (part of a symposium titled "Loneliness in older adults: Public health issue or moral panic"). Meeting of the British Society of Gerontology, Liverpool, UK, 10th-12th July 2019.
Smith KJ, Gavey S, Riddel N, Victor C. Investigating the association between inflammation and loneliness: A systematic review (part of a symposium titled "Loneliness in older adults: Public health issue or moral panic"). Meeting of the Gerontological Society of America, Boston, USA, 14th-19th November 2018.
Smith KJ, Kontari P. Risk of dementia associated with cardiometabolic abnormalities and depression. Meeting of the Gerontological Society of America, Boston, USA, 14th-19th November 2018.
Smith KJ, Peterson M, Victor C, Ryan J. Incidence of dementia in adults with cerebral palsy: a UK cohort study. Meeting of the Gerontological Society of America, Boston, USA, 14th-19th November 2018.
Smith KJ, Victor C. Investigating the longitudinal association between loneliness and cardiometabolic conditions. Meeting of the Gerontological Society of America, Boston, USA, 14th-19th November 2018.
Smith KJ, Peterson M, O'Connell N, Victor C, Liverani S, Anoyade N, Ryan J. The incidence of common mental illness in adults with Cerebral Palsy (as part of mini-symposium titled "Ageing with Cerebral Palsy: perspectives from the UK and USA"). European Association of Childhood Disability meeting, Tbilisi, Georgia, 28th-31st May 2018.
Chan C, Smith KJ (presenting author), Cockhaw W, Holmes-Truscott E, Ventura A, Browne J, Speight J. The relationship between social support, diabetes distress and blood glucose levels in people with diabetes: Diabetes-MILES Australia. Diabetes UK professional conference, London, UK 14th-16th March 2018
Background and objective: Loneliness is proposed to be linked with increased service use. This review examined the proposed association between loneliness and health and social care utilisation (HSCU) in older adults from the general population. Methods: Four databases were screened for studies that examined the association between loneliness (predictor) with HSCU (outcome) in older adults (defined as majority of sample 60 or older). Study quality was assessed with the NIH scale for observational cohorts and cross-sectional studies. Results: We identified 32 studies, of which 9 prospective studies were evaluated as being of good or good-fair quality. Two good-fair quality studies suggested that loneliness at baseline was associated with subsequent admission to a residential care home. There was emerging evidence that loneliness was associated with emergency department use (n=1), and CVD-specific hospitalisation (n=1). Once adjusted for confounders the highest quality studies found no association between baseline loneliness with physician utilisation, outpatient service utilisation, skilled nursing facility use, and planned or unplanned hospital admissions. The remaining, studies were cross-sectional, or of fair to poor quality, and inadequate to reliably determine whether loneliness was associated with a subsequent change in HSCU. Discussion and implications: There was heterogeneity in study design, measurement, and study quality. This generated an inconsistent evidence base where we cannot determine clear inferences about the relationship between loneliness and HSCU. Only one consistent finding was observed between two good-fair quality studies regarding care home admission. To determine clinical implications and make reliable inferences additional good quality longitudinal research is needed.
Objectives: Depression and cardiometabolic abnormalities are independently associated with a high risk of dementia. This study aimed to examine the association of comorbid depressive symptoms and cardiometabolic abnormalities with risk of dementia. Methods: The sample comprised 4859 participants aged 50 or older without baseline dementia who took part in the English Longitudinal Study of Ageing (Waves 2-7). Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression tool. Cardiometabolic abnormalities were defined as three or more cardiometabolic risk factors (inflammation, central obesity, raised triglycerides, low high-density lipoprotein (HDL) cholesterol, hypertension and hyperglycaemia or diabetes). Participants were classified into four groups based on presence of depressive symptoms and cardiometabolic abnormalities. Results were analysed using Cox Proportional Hazards Regression adjusted for covariates. Results: A total of 216 cases of incident dementia were reported over 10 years of follow-up. The group with high depressive symptoms only had an increased hazard of developing incident dementia during follow-up (HR 2.68, 95% CI [1.70 - 4.23]) which was attenuated after adjustment for baseline cognition. No evidence was found for an association of overall cardiometabolic abnormalities with incident dementia, though hyperglycaemia, hypertension and abdominal obesity with depressive symptoms had an unadjusted association with incident dementia. Only low-HDL cholesterol with depressive symptoms had an adjusted association with incident dementia (HR 0.18: 95% CI [0.04 – 0.75]). Conclusions: This work confirms depressive symptoms as a risk factor for incident dementia. However, low HDL-cholesterol with depressive symptoms may be protective against dementia, though more work is required to confirm this association.
Background Current literature highlights higher prevalence rates of sleep difficulties amongst adults with an intellectual disability. However, no synthesis has been conducted to assess the effectiveness of existing interventions in this population. Thus, the aim of this review was to assess the effectiveness of sleep interventions in adults with an intellectual disability (ID). Method Eight databases were searched to identify interventions for sleep difficulties amongst adults with an ID. The study quality was assessed with the Risk Of Bias In Non‐randomised Studies – of Interventions. Nine studies (n = 97) were eligible for inclusion in the review. Results There was a notable study on heterogeneity in terms of the population, study design, intervention studied, sleep assessment and outcome assessments used. Eight of the nine studies reported improvement in sleep following intervention. However, these findings need additional support as only 97 participants involving a variety of interventions and measurement systems were used across all studies. Furthermore, eight of the nine studies had serious to critical risk of bias. The only study identified as having low risk of bias was a placebo‐controlled randomised controlled trial for the use of melatonin. Conclusions This review highlights the need for objective measures such as actigraphy and studies with greater experimental control investigating sleep interventions in adults with ID.
The review synthesised evidence examining the association between a.) loneliness with inflammation and b.) social isolation with inflammation in adults aged 16 or older from the general population. From an initial 7,400 articles we identified 14 papers that examined loneliness, and 16 that examined social isolation. Qualitative syntheses indicated mixed results, variable study quality, and methodological heterogeneity. Most studies provided associations for C-reactive protein (CRP), fibrinogen and Interleukin-6 (IL-6), and these results were synthesised using random-effects meta-analyses. There was no association between loneliness with CRP or fibrinogen, but there was a significant association between loneliness and IL-6 for most-adjusted (but not least-adjusted) analyses. There was also a significant least-adjusted association between social isolation with CRP and fibrinogen, which remained significant for fibrinogen in most-adjusted analyses. There was no association between social isolation with IL-6. Sensitivity analyses indicated that methodological heterogeneity impacted on results. Results indicate that social isolation and loneliness could be linked with systemic inflammation, but more robust methodology is needed to confirm these associations and unpack mechanisms.
The relationship between living alone, loneliness and social isolation and how they are associated with health remains contentious. We sought to explore typologies based on shared experiences of loneliness, social isolation and living alone using Latent Class Analysis and determine how these groups may differ in terms of their physical and mental health. We used Wave 7 of the English Longitudinal Study of Ageing (n=7032, mean age 67.3) and responses to the UCLA loneliness scale, household composition, participation in social/societal activities plus frequency of contact with friends, family and relatives for the Latent Class Analysis. The optimal number of groups were identified using model fit criteria. The sociodemographic characteristics of groups and health outcomes were explored using descriptive statistics and logistic regression. We identified a 6-cluster typology: 1.) No loneliness or isolation; 2.) Moderate loneliness 3.) Living alone; 4.) Moderate isolation; 5.) Moderate loneliness, living alone 6.) High loneliness, moderate isolation (with high likelihood of living alone). Groups experiencing loneliness and/or isolation were more likely to report poorer physical and mental health even after adjusting for sociodemographic confounders, this was particularly notable for group 6. Our results indicate that different typologies of living alone, loneliness and isolation can be identified using data-driven techniques, and can be differentiated by the number and severity of issues they experience.
Importance: Cerebral palsy (CP) is considered a paediatric condition despite most people living into adulthood. Due to this we lack evidence in adults with CP, this includes a paucity of research examining mental health in this population. Objectives: Determine the risk of depression and anxiety in adults with a diagnosis of CP compared with an age-, sex-, and practice-matched reference group of adults without CP, using primary care data. Design, setting and participants: Retrospective longitudinal cohort study set in UK primary care. Data were analysed using Cox proportional hazards regression analyses adjusted for chronic conditions and visits to their physician. The study period ran from 1987 to 2015. Data for 1,705 adults aged 18 or older with CP and 5,115 matched adults who did not have CP were extracted. CP was identified using diagnostic codes, and each person with CP was compared with 3 age, sex and practice matched controls. Exposure: Diagnosis of CP, with a second analysis accounting for co-morbidity of intellectual disability (ID). Main outcomes: Time to diagnosis for depression or anxiety following the date of entry into the study in adults with CP (with and without ID) when compared with matched controls. Results: The mean age of the CP and matched group was 33.3 and 46.8% (n=798) were female. People with CP had an increased adjusted hazard of depression (HR 1.28, 95% CI: 1.09-1.51) and anxiety (HR 1.40, 95% CI: 1.21-1.63) when compared with the matched reference group. When we accounted for ID co-morbidity there were 363 adults with CP who also had ID (mean age 32.1, 47.6% (n=159) female) and 1342 adults with CP who did not have ID (mean age 33.6, 43.8% (n=639) female). Only those people with CP and no co-morbid ID had a higher risk of incident depression (HR 1.44: 95% CI 1.20-1.72) and anxiety (HR 1.55: 95% CI 1.28-1.87) than their matched controls. Conclusions: The results demonstrate that adults with CP have an increased risk of depression or anxiety. In particular, our results indicate that this association is driven largely by those individuals with CP with no co-occurring ID. Future work is needed in community-based samples in order to fully elucidate the causal mechanisms driving these associations.
Aim: To compare mortality rates for cardiovascular disease, cancer, and respiratory disease between adults with cerebral palsy (CP) and the general population. Method: A cohort study was conducted using data from adults with CP in England, identified through a primary care dataset (the Clinical Practice Research Datalink), with linked data on death registrations from the Office for National Statistics. Cause of death was categorised according to ICD codes. Standardised mortality ratios were calculated to compare mortality rates between adults with CP and the general population, adjusted for age, sex, and calendar-year. Results: 958 adults with CP were identified (median age at start of follow-up 31 yr; 52.5% males) and followed for a total of 7693 person-years. 142 patients (15%) died during follow-up. Adults with CP had an increased risk of death due to cardiovascular disease (SMR: 3.19, 95% CI 2.20 to 4.62) and respiratory disease (SMR: 13.59, 95% CI to 18.67), but not from malignant neoplasms (SMR: 1.42, 95% CI 0.83 to 2.45). Interpretation: We found that adults with CP in England have increased risk of death due to diseases of the circulatory and respiratory systems, supporting findings from two studies that compared cause-specific mortality rates between adults with CP in the US and the general population. Further research is required into primary and secondary prevention of cardiovascular and respiratory disease in people with CP worldwide.
Objectives: Determine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls.DesignRetrospective cohort study.SettingUK GPs linked into the Clinical Practice Research Datalink (CPRD). Participants:CPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with CP and 5109 matched controls were included in the analysis. The mean baseline age of participants was 33.30 years (SD: 15.48 years) and 46.8% of the sample were female. Primary outcome: New diagnosis of dementia during the follow-up period (earliest date of 1987 to latest date of 2015). Results:During the follow-up, 72 people were identified with a new diagnosis of dementia. The overall proportion of people with and without CP who developed dementia was similar (CP: n=19, 1.1%; matched controls n=54, 10.0%). The unadjusted HR suggested that people with CP had an increased hazard of being diagnosed with dementia when compared with matched controls (HR 2.69, 95% CI 1.44 to 5.00). This association was attenuated when CP comorbidities (sensory impairment, intellectual disability and epilepsy) were accounted for (HR 1.92, 95% CI 0.92 to 4.02). Conclusions: There was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia during the follow-up. Furthermore, while there was evidence for an increased hazard of dementia among people with CP, the fact that this association was attenuated after controlling for comorbidities indicates that this association may be explained by comorbidities rather than being a direct result of CP. Findings should be interpreted with caution due to the low number of incident cases of dementia.
Background People with cerebral palsy (CP) may be at increased risk of musculoskeletal conditions due to various factors including malnutrition and abnormal levels of skeletal loading. This study aimed to compare the incidence of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases between adults with and without CP. Methods A population based cohort study was conducted using data from the Clinical Practice Research Datalink collected between 1987 and 2015. Adults with CP were matched to adults without CP for age, sex and general practice. Cox models, stratified by matched set and adjusted for potential confounders, were fitted to compare the risk of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases. Results 1705 adults with CP were matched to 5115 adults without CP. Adults with CP had an increased risk of osteoporosis in unadjusted (Hazard Ratio (HR) 3.67, 95% Confidence Interval (CI) 2.32 to 5.80, p ˂ 0.001) and adjusted (HR 6.19, 95% CI 3.37 to 11.39, p ˂ 0.001) analyses. No evidence of increased risk of inflammatory musculoskeletal diseases was observed in unadjusted or adjusted analyses. For osteoarthritis no evidence of increased risk was seen in the unadjusted analysis, but evidence of an increased risk was seen when the analysis was adjusted for alcohol consumption, smoking status, and mean yearly general practice (GP) visits (HR 1.54, 95% CI 1.17 to 2.02, p ˂ 0.001). Conclusions After accounting for potential confounding variables, we found that CP is associated with increased risk of osteoporosis and osteoarthritis. These findings provide the strongest epidemiological evidence to date for increased risk of osteoporosis and osteoarthritis in people with CP, and highlight need for clinical awareness of such conditions in this population.
Objectives: To determine whether psychosocial wellbeing is associated with the health-related quality of life (HRQOL) of people with Usher syndrome. Setting: The survey was advertised online and through deafblind-related charities, support groups and social groups throughout the UK. Participants: 90 people with Usher syndrome took part in the survey. Inclusion criteria are having a diagnosis of Usher syndrome, being 18 or older and being a UK resident. Primary and secondary outcome measures: All participants took part in a survey that measured depressive symptoms, loneliness and social support ( predictors) and their physical and mental HRQOL (outcomes). Measured confounders included agerelated, sex-related and health-related characteristics. Hierarchical multiple linear regression analyses examined the association of each psychosocial wellbeing predictor with the physical and mental HRQOL outcomes while controlling for confounders in a stepwise manner. Results: After adjusting for all confounders, psychosocial well-being was shown to predict physical and mental HRQOL in our population with Usher syndrome. Increasing depressive symptoms were predictive of poorer physical (β=−0.36, p
Objective: This study aimed to compare the incidence of non-communicable diseases between adults with and without cerebral palsy (CP). Methods: A cohort study was conducted using primary care data from the Clinical Practice Research Datalink. Cox models, stratified by matched set and adjusted for potential confounders, were fitted to compare the risk of any non-communicable disease, cancer, cardiovascular disease, type 2 diabetes, and respiratory disease between adults with and without CP. Results: The analysis included 1,705 adults with CP and 5,115 age-, sex-, and general practice matched adults without CP. There was evidence from adjusted analyses that adults with CP had 75% increased risk of developing any non-communicable disease compared to adults without CP (HR: 1·75, 95% CI 1·58 to 1·94). Specifically, they had increased risk of cardiovascular disease (HR: 1.76, 95% CI 1.48 to 2.11) and respiratory disease (HR: 2.61, 95% CI 2.14 to 3.19). There was no evidence of increased risk of cancer or type 2 diabetes. Conclusions: Adults with CP had increased risk of non-communicable disease, specifically cardiovascular and respiratory disease. These findings highlight the need for clinical vigilance regarding identification of non-communicable disease in people with CP, and further research into the etiology and management of non-communicable disease in this population.
Previous research indicates there may be an association between inflammation and depression in older adults but results are inconsistent. Therefore, the aim of this review was to determine the cross-sectional and longitudinal associations of two inflammatory markers C-reactive protein (CRP) and Interleukin-6 (IL-6) with depression in older adults. We searched five databases for cross-sectional and longitudinal studies reporting an association between CRP or IL-6 with depression among adults sampled from the community aged 50 or older. We found 32 studies (23 cross-sectional, 7 longitudinal, and 2 assessing both cross-sectional and longitudinal associations) that met eligibility criteria. These studies were entered into a random-effects meta-analysis to determine the cross-sectional association and longitudinal direction of association between both IL-6 and CRP with depression. Results indicated a cross-sectional and longitudinal association between both CRP and IL-6 with depression in older adults, with inflammation leading to depression in longitudinal studies rather than depression to inflammation. However, there was notable heterogeneity between studies as results differed based on adjusting for confounders and on how inflammation and depression were measured. These sources of heterogeneity could explain differences in study results.
Aim To compare the rate of falls between adults with and without cerebral palsy (CP). Method We used primary care data on 1705 adults with CP and 5115 adults without CP matched for age, sex, and general practice attended. We compared odds of experiencing a fall between adults with and without CP using conditional logistic regression. We compared the rate of falls using a negative binomial model. Results Participants were 3628 males (53%) and 3192 females (47%) (median age 29y, interquartile range 20–42y) at the start of follow‐up. Follow‐up was 14 617 person‐years for adults with CP and 56 816 person‐years for adults without CP. Of adults with CP, 15.3% experienced at least one fall compared to 5.7% of adults without CP. Adults with CP had 3.64 times (95% confidence interval [CI] 2.98–4.45) the odds of experiencing a fall compared to adults without CP. The rate of falls was 30.5 per 1000 person‐years and 6.7 per 1000 person‐years for adults with and without CP respectively (rate ratio 5.83, 95% CI 4.84–7.02) Interpretation Adults with CP are more likely to fall, and fall more often, than adults without CP. The causes and consequences of falls in adults with CP need examination.
The aim of the present study was to evaluate the interaction between depressive symptoms and metabolic dysregulations as risk factors for type 2 diabetes. The sample comprised of 2525 adults who participated in a baseline and a follow-up assessment over a 4.5-year period in the Emotional Health and Wellbeing Study (EMHS) in Quebec, Canada. A two-way stratified sampling design was used, on the basis of the presence of depressive symptoms and metabolic dysregulation (obesity, elevated blood sugar, high blood pressure, high levels of triglycerides and decreased high-density lipoprotein). A total of 87 (3.5%) individuals developed diabetes. Participants with both depressive symptoms and metabolic dysregulation had the highest risk of diabetes (adjusted odds ratio=6.61, 95% confidence interval (CI): 4.86–9.01), compared with those without depressive symptoms and metabolic dysregulation (reference group). The risk of diabetes in individuals with depressive symptoms and without metabolic dysregulation did not differ from the reference group (adjusted odds ratio=1.28, 95% CI: 0.81–2.03), whereas the adjusted odds ratio for those with metabolic dysregulation and without depressive symptoms was 4.40 (95% CI: 3.42–5.67). The Synergy Index (SI=1.52; 95% CI: 1.07–2.17) suggested that the combined effect of depressive symptoms and metabolic dysregulation was greater than the sum of individual effects. An interaction between depression and metabolic dysregulation was also suggested by a structural equation model. Our study highlights the interaction between depressive symptoms and metabolic dysregulation as a risk factor for type 2 diabetes. Early identification, monitoring and a comprehensive management approach of both conditions might be an important diabetes prevention strategy.
OBJECTIVE To evaluate the association between recurrent subthreshold depressive episodes and functioning in a prospective community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS A prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n = 1,064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (Patient Health Questionnaire [PHQ]-9). Functioning (World Health Organization Disability Assessment Schedule II [WHODAS-II]) and health-related quality of life (Centers for Disease Control and Prevention [CDC] unhealthy days) at 4- and 5-year follow-up assessments were the outcome measures. RESULTS Nearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/impaired health–related quality of life was nearly three times higher (relative risk = 2.86) for participants with four subthreshold depressive episodes compared with participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/impaired health–related quality of life increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, P < 0.001). CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring, and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.
Objectives: Previous research has indicated that there is an association between diabetes and anxiety. However, no synthesis has determined the direction of this association. Therefore, the aim of this study was to determine the longitudinal relationship between anxiety and diabetes. Method: We searched seven databases for studies examining the longitudinal relationship between anxiety and diabetes. Two independent reviewers screened studies from a population aged 16 or older that either a) examined anxiety as a risk factor for incident diabetes or b) examined diabetes as a risk factor for incident anxiety. Studies that met eligibility criteria were put forward for data extraction and meta-analysis. Results: In total 14 studies (n=1,760,800) that examined anxiety as a risk factor for incident diabetes and 2 studies (n=88,109) that examined diabetes as a risk factor for incident anxiety were eligible for inclusion in the review. Only studies examining anxiety as a risk factor for incident diabetes were put forward for the meta-analysis. The least adjusted (unadjusted or adjusted for age only) estimate indicated a significant association between baseline anxiety with incident diabetes (OR 1.47: 1.23-1.75). Furthermore, most-adjusted analyses indicated a significant association between baseline anxiety and incident diabetes. Included studies that examined diabetes to incident anxiety found no association. Conclusions: There was an association between baseline anxiety with incident diabetes. Results also indicate the need for more research to examine the direction of association from diabetes to incident anxiety. This work adds to the growing body of evidence that poor mental health increases the risk of developing diabetes.