Dataset Information

Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological studies.

ABSTRACT:

Background

Multiple studies have demonstrated that rates of smoking and nicotine dependence are increased in individuals with anxiety disorders. However, significant variability exists in the epidemiological literature exploring this relationship, including study design (cross-sectional versus prospective), the population assessed (random sample versus clinical population) and diagnostic instrument utilized.

Methods

We undertook a systematic review of population-based observational studies that utilized recognized structured clinical diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD)) for anxiety disorder diagnosis to investigate the relationship between cigarette smoking, nicotine dependence and anxiety disorders.

Results

In total, 47 studies met the predefined inclusion criteria, with 12 studies providing prospective information and 5 studies providing quasiprospective information. The available evidence suggests that some baseline anxiety disorders are a risk factor for initiation of smoking and nicotine dependence, although the evidence is heterogeneous and many studies did not control for the effect of comorbid substance use disorders. The identified evidence however appeared to more consistently support cigarette smoking and nicotine dependence as being a risk factor for development of some anxiety disorders (for example, panic disorder, generalized anxiety disorder), although these findings were not replicated in all studies. A number of inconsistencies in the literature were identified.

Conclusions

Although many studies have demonstrated increased rates of smoking and nicotine dependence in individuals with anxiety disorders, there is a limited and heterogeneous literature that has prospectively examined this relationship in population studies using validated diagnostic criteria. The most consistent evidence supports smoking and nicotine dependence as increasing the risk of panic disorder and generalized anxiety disorder. The literature assessing anxiety disorders increasing smoking and nicotine dependence is inconsistent. Potential issues with the current literature are discussed and directions for future research are suggested.

SUBMITTER: Moylan S

PROVIDER: S-EPMC3523047 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Publications

Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological studies.

Moylan Steven S Jacka Felice N FN Pasco Julie A JA Berk Michael M

BMC medicine 20121019

<h4>Background</h4>Multiple studies have demonstrated that rates of smoking and nicotine dependence are increased in individuals with anxiety disorders. However, significant variability exists in the epidemiological literature exploring this relationship, including study design (cross-sectional versus prospective), the population assessed (random sample versus clinical population) and diagnostic instrument utilized.<h4>Methods</h4>We undertook a systematic review of population-based observationa ...[more]

PMID: 23083451

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Project description:BackgroundWhile the heritability of cigarette smoking and nicotine dependence (ND) is well-documented, the contribution of specific genetic variants to specific phenotypes has not been closely examined. The objectives of this study were to test the associations between 321 tagging single-nucleotide polymorphisms (SNPs) that capture common genetic variation in 24 genes, and early smoking and ND phenotypes in novice adolescent smokers, and to assess if genetic predictors differ across these phenotypes.MethodsIn a prospective study of 1294 adolescents aged 12-13 years recruited from ten Montreal-area secondary schools, 544 participants who had smoked at least once during the 7-8 year follow-up provided DNA. 321 single-nucleotide polymorphisms (SNPs) in 24 candidate genes were tested for an association with number of cigarettes smoked in the past 3 months, and with five ND phenotypes (a modified version of the Fagerstrom Tolerance Questionnaire, the ICD-10 and three clusters of ND symptoms representing withdrawal symptoms, use of nicotine for self-medication, and a general ND/craving symptom indicator).ResultsThe pattern of SNP-gene associations differed across phenotypes. Sixteen SNPs in seven genes (ANKK1, CHRNA7, DDC, DRD2, COMT, OPRM1, SLC6A3 (also known as DAT1)) were associated with at least one phenotype with a p-value <0.01 using linear mixed models. After permutation and FDR adjustment, none of the associations remained statistically significant, although the p-values for the association between rs557748 in OPRM1 and the ND/craving and self-medication phenotypes were both 0.076.ConclusionsBecause the genetic predictors differ, specific cigarette smoking and ND phenotypes should be distinguished in genetic studies in adolescents. Fifteen of the 16 top-ranked SNPs identified in this study were from loci involved in dopaminergic pathways (ANKK1/DRD2, DDC, COMT, OPRM1, and SLC6A3).ImpactDopaminergic pathways may be salient during early smoking and the development of ND.

Project description:IntroductionThe number of cigarettes smoked per day (CPD) is a component of commonly used nicotine dependence measures and often used as a smoking cessation treatment outcome. Yet relighting (ie, smoking used cigarette butts) is not usually considered when CPD is assessed, which may underestimate nicotine dependence and result in an inaccurate picture of smoking behaviors.Aims and methodsData from a randomized controlled trial of a smoking cessation intervention were used. Fagerström Test for Cigarette Dependence (FTCD), CPD, and the frequency of smoking (number of smoking episodes/day) assessed at baseline and 3-month follow-up were used.ResultsParticipants were 49 adults with mood disorders who smoke daily receiving outpatient psychiatric treatment. At baseline, 27 (55.1%) participants reported relighting cigarettes, and 6 (27.3%) of those who did not report relighting at baseline reported relighting at 3-month follow-up. Replacing CPD with the frequency of smoking to recalculate the total FTCD score increased the score for 21 participants (43%). The mean FTCD scores increased from 4.61 to 5.16, from a classification of low to medium dependence, and 16 participants (33%) moved up in the dependence classification. Of the 31 participants who reported a >=50% reduction in CPD at 3-month follow-up, 5 (16%) did not achieve the outcome of >=50% reduction in the frequency of smoking per day.ConclusionsIn this sample of adults with mood disorders who smoke, over half reported relighting cigarettes. Results underscore the importance of incorporating the frequency of smoking/relighting when assessing nicotine dependence and patterns of smoking behaviors in high-risk populations.ImplicationsThis is the first study to investigate the patterns of relighting behavior and its impact on nicotine dependence and smoking cessation treatment outcome measures among treatment-seeking adults with mood disorders who smoke. The majority were relighting, and over a quarter of those who did not report relighting at baseline subsequently reported relighting in the context of a quit attempt. The findings demonstrate that overlooking relighting may underestimate nicotine dependence and overestimate the rates of those who have made meaningful changes in smoking behavior. Incorporating the frequency of smoking/relighting may help to more accurately capture nicotine dependence and patterns of smoking behavior among high-risk populations.

Project description:BackgroundMany studies report a positive association between smoking and mental illness. However, the literature remains mixed regarding the direction of this association. We therefore conducted a systematic review evaluating the association of smoking and depression and/or anxiety in longitudinal studies.MethodsStudies were identified by searching PubMed, Scopus, and Web of Science and were included if they: (1) used human participants, (2) were longitudinal, (3) reported primary data, (4) had smoking as an exposure and depression and/or anxiety as an outcome, or (5) had depression and/or anxiety as the exposure and smoking as an outcome.ResultsOutcomes from 148 studies were categorized into: smoking onset, smoking status, smoking heaviness, tobacco dependence, and smoking trajectory. The results for each category varied substantially, with evidence for positive associations in both directions (smoking to later mental health and mental health to later smoking) as well as null findings. Overall, nearly half the studies reported that baseline depression/anxiety was associated with some type of later smoking behavior, while over a third found evidence that a smoking exposure was associated with later depression/anxiety. However, there were few studies directly supporting a bidirectional model of smoking and anxiety, and very few studies reporting null results.ConclusionsThe literature on the prospective association between smoking and depression and anxiety is inconsistent in terms of the direction of association most strongly supported. This suggests the need for future studies that employ different methodologies, such as Mendelian randomization (MR), which will allow us to draw stronger causal inferences.ImplicationsWe systematically reviewed longitudinal studies on the association of different aspects of smoking behavior with depression and anxiety. The results varied considerably, with evidence for smoking both associated with subsequent depression and anxiety, and vice versa. Few studies supported a bidirectional relationship, or reported null results, and no clear patterns by gender, ethnicity, clinical status, length to follow-up, or diagnostic test. Suggesting that despite advantages of longitudinal studies, they cannot alone provide strong evidence of causality. Therefore, future studies investigating this association should employ different methods allowing for stronger causal inferences to be made, such as MR.

Dataset Information

Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological studies.

Background

Methods

Results

Conclusions

Publications

Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological studies.

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