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Smoking, But Not Smokeless Tobacco, Associated with Past-Year Psychiatric Disorders

Posted Feb 20 2013 10:10pm

Compared with the general population, smokers have elevated rates of psychiatric problems, and affected smokers tend to consume more cigarettes, inhale more deeply and quit less often (evidence here , here and here ).  A new study confirming this link concludes that “smokeless tobacco is not significantly associated with psychiatric morbidity…”

The principal investigator of the study, which was published in Social Psychiatry and Psychiatric Epidemiology (abstract here ), is Nicholas Peiper, a doctoral student in epidemiology at the University of Louisville; I am honored to be a co-author. 

Peiper analyzed data from the 2005 to 2008 National Survey on Drug Use and Health (NSDUH).  In addition to detailed information on tobacco use, the survey also measures past-year serious psychological distress and major depressive episodes using clinically validated instruments, and past-year anxiety disorder with proxy items.  Results were adjusted for other potential factors for these disorders, including age, race/ethnicity, education, income, marital status, diabetes and other illnesses, substance/alcohol abuse and pregnancy. 

Odds Ratios For Serious Pyschological Distress (SPD), Major Depressive Episode (MDE) and Anxiety Disorder (AD) Among Current Smokers, Smokeless Tobacco Users and Dual Users, NSDUH 2005-2008
SmokersSmokeless UsersDual Users
SPD1.14 (0.99 – 1.31)0.71 (0.55 – 0.91)0.86 (0.65 – 1.14)
MDE1.21 (0.99 – 1.48)0.88 (0.66 – 1.19)1.15 (0.82 – 1.63)
AD1.53 (1.17 – 2.00)1.21 (0.79 – 1.87)1.73 (1.13 – 2.65)
SPD1.60 (1.45 – 1.77)0.95 (0.51 – 1.77)2.24 (1.10 – 4.58)
MDE1.43 (1.26 – 1.63)0.38 (0.13 – 1.10)1.68 (0.71 – 3.98)
AD1.83 (1.56 – 2.14)0.99 (0.35 – 2.81)2.76 (1.09 – 7.00)

Both male and female smokers were more likely than never tobacco users to have experienced past-year serious psychological distress, major depressive episodes or anxiety disorders.  Smokeless users were less likely to experience psychological distress (statistically significant in men) and depressive episodes.  Female and male dual users were significantly more likely to experience anxiety; female dual users also experienced more psychological distress.

It is evident that tobacco harm reduction can be an effective adjunct to the management of patients with psychological problems.  We conclude: “considerable efforts should focus on addressing differential tobacco risks in treatment settings, as those with psychiatric morbidity suffer a disproportionate share of smoking-attributable morbidity and mortality.” 

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