Cited by 179Smoking Behavior and CessationBipolar Disorder and TreatmentSubstance Abuse Treatment and Outcomes

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Tobacco smoking behaviors in bipolar disorder: a comparison of the general population, schizophrenia, and major depression

Diaz, Francisco J, James, Danielle, Botts, Sheila, Maw, Lorraine, Susce, Margaret T, De Leon, Jose·2009·Bipolar Disorders

DOI 10.1111/j.1399-5618.2009.00664.x

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Abstract

OBJECTIVES: This study compared the prevalence of tobacco smoking behaviors in patients with bipolar disorder with normal and psychiatric (schizophrenia and major depression) controls. The main goal was to establish that bipolar patients smoke more than normal controls. Differences with psychiatric controls were explored. METHODS: Samples of 424 patients (99 bipolar, 258 schizophrenia and 67 major depression) and 402 volunteer controls were collected in Central Kentucky. Smoking data for Kentucky's general population were available. Odds ratios (ORs) and their 95% confidence intervals (CIs) were used to establish the strength of associations. Logistic regression was used to adjust ORs for confounding variables. RESULTS: Using epidemiological definitions of smoking behaviors and the general population as controls provided bipolar disorder unadjusted ORs of 5.0 (95% CI: 3.3-7.8) for current cigarette smoking, 2.6 (95% CI: 1.7-4.4) for ever cigarette smoking, and 0.13 (95% CI: 0.03-0.24) for smoking cessation. Using a clinical definition and volunteers as controls provided respective bipolar disorder adjusted ORs of 7.3 (95% CI: 4.3-12.4), 4.0 (95% CI: 2.4-6.7), and 0.15 (95% CI: 0.06-0.36). Prevalences of current daily smoking for patients with major depression, bipolar disorder, and schizophrenia were 57%, 66%, and 74%, respectively. CONCLUSIONS: Bipolar disorder was associated with significantly higher prevalences of tobacco smoking behaviors compared with the general population or volunteer controls, independently of the definition used. It is possible that smoking behaviors in bipolar disorder may have intermediate prevalences between major depression and schizophrenia, but larger samples or a combination of multiple studies (meta-analysis) will be needed to establish whether this hypothesis is correct.

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“18) on mean change in symptoms of mania [F(1,46) = 2.”
Influential
Genetic Variation of the Mu Opioid Receptor (OPRM1) and Dopamine D2 Receptor (DRD2) is Related to Smoking Differences in Patients with Schizophrenia but not Bipolar Disorder
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Relationship between olfactory function and social cognition in euthymic bipolar patients
Lahera, G., Ruiz-Murugarren, S., Fernández-Liria, A., Saiz-Ruiz, J., Buck, B. E., & Penn, D. L. (2016) · CNS Spectrums · doi:10.1017/s1092852913000382 · Cited by 34
Prevalence and Correlates of Cigarette Smoking among Chinese Schizophrenia Inpatients Receiving Antipsychotic Mono-Therapy
Xu, Y., Chen, H., Li, F., Deng, F., Liu, X.-B., Yang, H., Qi, L.-G., Jin-hong, G., & Liu, T. (2014) · PLoS ONE · doi:10.1371/journal.pone.0088478 · Cited by 34
“Third, the definition of smoking used in the present study is broader, because it defines a current smoker as an ever smoker who currently smokes daily or on some days [81].”
Background
Emotional and affective temperaments and cigarette smoking in a large sample
Bisol, L. W., Soldado, F. A., Albuquerque, C., Lorenzi, T. M., & Lara, D. R. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.04.016 · Cited by 30
“bipolar disorder is higher than general population and close to the prevalence in schizophrenia (Döme et al., 2005; Diaz et al., 2009).”
Background
Lithium use and risk of fracture: a systematic review and meta-analysis of observational studies
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Cannabis use disorder is associated with greater illness severity in tobacco smoking patients with bipolar disorder
Lagerberg, T. V., Icick, R., Andreassen, O. A., Ringen, P. A., Étain, B., Aas, M., Henry, C., Bjella, T. D., Melle, I. S., & Bellivier, F. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.10.023 · Cited by 30
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“Subjective effects were assessed by Modified Cigarette Evaluation Questionnaire (mCEQ) scoring that reported frequency and percent of participants reporting (1) enjoyment of respiratory tract sensations, (2) psychological reward, and (3) satisfaction, among users of e-cigarettes.”
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Pal, A., & Balhara, Y. P. S. (2016) · Tobacco Use Insights · doi:10.4137/tui.s32201 · Cited by 28
Effects of Cigarette Smoking on Neuropsychological Performance in Mood Disorders: A Comparison Between Smoking and Nonsmoking Inpatients
Caldirola, D., Daccò, S., Grassi, M., Citterio, A., Menotti, R., Cavedini, P., Girardi, P., & Perna, G. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12m07985 · Cited by 27
Age-related changes in physiology in individuals with bipolar disorder
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Psychological Issues in Adults with Type 2 Diabetes
Gonzalez, J. S., Esbitt, S. A., Schneider, H. E., Osborne, P. J., & Kupperman, E. (2011) · Springer eBooks · doi:10.1007/978-1-4419-0029-6_2 · Cited by 30
“Individuals with serious mental illnesses such as bipolar disorder or psychotic disorders also have higher rates of tobacco usage than the general population (Diaz et al., 2009; Diwan, Castine, Pomerleau, Meador-Woodruff, & Dalack, 1998).”
Background
E-Cigarette Provision to Promote Switching in Cigarette Smokers With Serious Mental Illness—A Randomized Trial
Pratt, S. I., Ferron, J. C., Brunette, M. F., Santos, M. M., Sargent, J. D., & Xie, H. (2022) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntac082 · Cited by 25
Weighing the Risks: the Management of Bipolar Disorder During Pregnancy
Thomson, M., & Sharma, V. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0882-2 · Cited by 24
Safety and efficacy of first-line smoking cessation pharmacotherapies in bipolar disorders: subgroup analysis of a randomized clinical trial
Heffner, J. L., Evins, A. E., Russ, C., Lawrence, D., Ayers, C. R., McRae, T., Aubin, L. S., Krishen, A., West, R., & Anthenelli, R. M. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.06.008 · Cited by 23
“, 2000) and, among the major psychiatric disorders, is second only to schizophrenia (Diaz et al., 2009; Dickerson et al., 2013).”
Background
Replicated association of the NR4A3 gene with smoking behaviour in schizophrenia and in bipolar disorder
Novak, G., Zai, C. C., Mirkhani, M., Shaikh, S., Vincent, J. B., Meltzer, H., Lieberman, J. A., Strauss, J., Lévesque, D., Kennedy, J. L., et al. (2010) · Genes, Brain and Behavior · doi:10.1111/j.1601-183x.2010.00631.x · Cited by 23
“1986) and bipolar disorder (Diaz et al. 2009), contributing additional morbidity to an already susceptible population.”
Background
Distribution and Correlates of Assertive Community Treatment (ACT) and ACT-Like Programs: Results From the 2015 N-MHSS
Spivak, S., Mojtabai, R., Green, C., Firth, T., Sater, H., & Cullen, B. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201700561 · Cited by 23
Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders
Caponnetto, P., Polosa, R., Robson, D., & Bauld, L. (2020) · Health Psychology Research · doi:10.4081/hpr.2020.9042 · Cited by 24
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Romain, A. J., Bernard, P., Akrass, Z., St‐Amour, S., Lachance, J.-P., Hains-Monfette, G., Atoui, S., Kingsbury, C., Dubois, È., Karelis, A. D., et al. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.05.049 · Cited by 27
Prevalence and correlates of heavy smoking and nicotine dependence in adolescents with bipolar and cannabis use disorders
Heffner, J. L., Anthenelli, R. M., Adler, C. M., Strakowski, S. M., Beavers, J., & DelBello, M. P. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.04.010 · Cited by 22
Maternal smoking during pregnancy and risks of suicidal acts in young offspring
Cnattingius, S., Svensson, T., Granath, F. N., & Iliadou, A. N. (2011) · European Journal of Epidemiology · doi:10.1007/s10654-011-9556-7 · Cited by 22
“Both smoking and suicidal acts are associated with family dysfunction, other life-style habits, psychological problems and psychiatric diseases not requiring in-patient care [3, 14, 29, 30].”
Background
Nicotine intake and smoking topography in smokers with bipolar disorder
Williams, J. M., Gandhi, K. K., Lu, S., Steinberg, M. L., & Benowitz, N. L. (2012) · Bipolar Disorders · doi:10.1111/j.1399-5618.2012.01047.x · Cited by 21
“Cigarette smoking is common in BPD, with prevalence rates of about 60% in various studies (1, 4), and heavy smoking has also been found to be common in patients with this condition (10).”
Background
A Review of Smoking Cessation in Bipolar Disorder: Implications for Future Research
George, T. P., Wu, B. S., & Weinberger, A. H. (2012) · Journal of Dual Diagnosis · doi:10.1080/15504263.2012.671717 · Cited by 21
“7]) for ever smoking, compared to controls (Diaz et al., 2009).”
Background
Elevated Familial Cardiovascular Burden Among Adolescents With Familial Bipolar Disorder
Toma, S., Fıksenbaum, L., Omrin, D. S., & Goldstein, B. I. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00008 · Cited by 20
Cerebral White Matter Lesions and Affective Episodes Correlate in Male Individuals with Bipolar Disorder
Birner, A., Seiler, S., Lackner, N., Bengesser, S., Queissner, R., Fellendorf, F. T., Platzer, M., Ropele, S., Enzinger, C., Schwingenschuh, P., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0135313 · Cited by 19
“Additionally, smoking behavior and obesity/metabolic syndrome differentially affect individuals with BD [20, 21].”
Background
Nicotine dependence vs. daily smoking as a meaningful variable: Implications for clinical and epidemiological psychiatric studies
Martínez-Ortega, J. M., Jurado, D., & Manuel Gurpegui, A. (2008) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2008.09.015 · Cited by 19
Update on Smoking Cessation: E-Cigarettes, Emerging Tobacco Products Trends, and New Technology-Based Interventions
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Temporal sequencing of nicotine dependence and bipolar disorder in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
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“In particular, individuals with bipolar disorder (BD) as compared to the general population are more likely to have a lifetime history of smoking (Diaz et al., 2009; Gonzalez-Pinto et al., 1998; Lasser et al., 2000), current smoking (Diaz et al.”
BackgroundInfluential
Factors Associated With Staff Engagement in Patients’ Tobacco Treatment in a State Psychiatric Facility
Okoli, C. T. C., Otachi, J. K., Kaewbua, S., Woods, M. A., & Robertson, H. E. (2017) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390317704045 · Cited by 17
“Moreover, in 2009, rates of smoking among hospitalized patients with MI in Kentucky were as high as 74% for individuals with schizophrenia as compared to 31% in the state (Diaz et al., 2009).”
Methylphenidate in mania project (MEMAP): study protocol of an international randomised double-blind placebo-controlled study on the initial treatment of acute mania with methylphenidate
Kluge, M., Hegerl, U., Sander, C., Dietzel, J., Mergl, R., Bitter, I., Demyttenaere, K., Gusmão, R. M., González-Pinto, A. M., Pérez, V., et al. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-71 · Cited by 16
“Withdrawal of vigilance-stabilising drugs, such as nicotine, can trigger mania [17,18] and a high smoking prevalence has been reported in bipolar disorder [19].”
Background
One size doesn’t fit all: A trial of individually tailored skills training.
Pratt, S. I., Mueser, K. T., Wolfe, R. S., Santos, M. M., & Bartels, S. J. (2017) · Psychiatric Rehabilitation Journal · doi:10.1037/prj0000261 · Cited by 17
“This early mortality disparity reflects a variety of preventable health conditions including greater rates of obesity and tobacco use (Daumit et al., 2003; Diaz et al., 2009; Dickerson et al., 2006; Lasser et al., 2000), as well as poor access to primary health care (Druss, Bradford, Rosenheck, Radford, & Krumholz, 20…”
Background
Chronic obstructive pulmonary disease in severe mental illness: A timely diagnosis to advance the process of quitting smoking
Jaén‐Moreno, M. J., Feu, N., del Pozo, G. I., Gómez, C., Carrión, L., Chauca, G. M. C., Guler, I., Montiel, F. J., Sánchez, M. D., Alcalá, J. A., et al. (2021) · European Psychiatry · doi:10.1192/j.eurpsy.2021.12 · Cited by 17
Assessing treatment response to prophylactic lithium use in patients with bipolar disorder
Silva, L. F. D. A. L. E., Loureiro, J. C., Franco, S. C. R., Santos, M. D. L., Secolin, R., Lopes‐Cendes, Í., Dantas, C. D. R., & Banzato, C. E. M. (2016) · Jornal Brasileiro de Psiquiatria · doi:10.1590/0047-2085000000097 · Cited by 14
Healthy lifestyle intervention for people with severe mental disorders
Baker, A., KAY‐LAMBKIN, F. J., RICHMOND, R. L., Filia, S., Castle, D. J., Williams, J. M., & Thornton, L. K. (2011) · Mental Health and Substance Use · doi:10.1080/17523281.2011.555086 · Cited by 16
“The majority of people with schizophrenia and bipolar disorder smoke (Diaz et al., 2009), thereby increasing their risk of CVD.”
Background
Diabetes mellitus and first episode mania associated with cardiovascular diseases in patients with older-age bipolar disorder
Chen, P., Chang, C.-K., Chiang, S.-J., Lin, Y., Tsai, S., & Huang, S. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.004 · Cited by 13
Treating Smoking in Adults With Co-occurring Acute Psychiatric and Addictive Disorders
Das, S., Hickman, N. J., III, & Prochaska, J. J. (2017) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000320 · Cited by 13
“In treatment settings, over half of patients smoke; methadone maintenance programs and inpatient psychiatry units generally have the highest rates, in the range of 75% to 95% (Kleber et al., 2007; Diaz et al., 2009).”
Smoking is Associated with Greater Symptom Load in Bipolar Disorder Patients
Saiyad, M., & El-Mallakh, R. S. (2012) · Annals of Clinical Psychiatry · doi:10.1177/104012371202400409 · Cited by 13
A cross‐sectional analysis of factors associated with the intention to engage in tobacco treatment among inpatients in a state psychiatric hospital
Okoli, C. T. C., Otachi, J. K., Manuel, A., & Woods, M. A. (2017) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12435 · Cited by 13
Smoking cessation and serious mental illness: a service evaluation of a drop‐in stop smoking clinic on an acute in‐patient unit
Robson, D., Cole, F., Jalasi, S., Boojharut, B., Smith, S. M. R., Thompson, S., Jones, M., & Haddad, M. (2012) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2012.04222.x · Cited by 14
“The prevalence of daily smoking for patients with major depression, bipolar disorder and schizophrenia is estimated to be 57, 66 and 74%, respectively (Diaz et al. 2009).”
Background
Genetic Variation of the Mu Opioid Receptor (OPRM1) and Dopamine D2 Receptor (DRD2) is Related to Smoking Differences in Patients with Schizophrenia but not Bipolar Disorder
Hirasawa-Fujita, M., Bly, M. J., Ellingrod, V. L., Dalack, G. W., & Domino, E. F. (2014) · Clinical Schizophrenia & Related Psychoses · doi:10.3371/csrp.mhmb.061314 · Cited by 12
The prevalence and associated clinical correlates of hyperuricemia in patients with bipolar disorder
Li, S., Lu, X., Chen, X., Huang, Z., Zhou, H., Li, Z., & Ning, Y. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.998747 · Cited by 12
“According to previous studies, BPD patients have higher rates of smoking (Diaz et al., 2009) and drinking habits (Liberopoulos et al.”
Method
Presence of an interaction between smoking and being overweight increases risks of hypertension, diabetes, and cardiovascular disease in outpatients with mood disorders
Nishiyama, M., Kimijima, M., Muto, T., & Kimura, K. (2011) · Environmental Health and Preventive Medicine · doi:10.1007/s12199-011-0250-x · Cited by 12
“In studies investigating lifestyle among psychiatric inpatients and outpatients [15, 16], alcohol consumption and unhealthy dietary habits were suggested to be risk factors for depression [15], and a diagnosis of bipolar disorder was found to be independently related to smoking status [15, 17, 18] and being overweight…”
Background
Effects of smoking on health outcomes in bipolar disorder with a special focus on suicidal behavior
Döme, P., Gonda, X., & Rihmer, Z. (2012) · Neuropsychiatry · doi:10.2217/npy.12.51 · Cited by 11
Is Mania the Hypertension of the Mood? Discussion of A Hypothesis
Rihmer, Z., Gonda, X., & Döme, P. (2017) · Current Neuropharmacology · doi:10.2174/1570159x14666160902145635 · Cited by 11
“d) Prevalence of smoking is also markedly increased both in bipolar patients [134, 135] and in hypertension [136].”
Background

Authors: Diaz, F. J., James, D., Botts, S., Maw, L., Susce, M. T., & De Leon, J.
Affiliations: University of Kentucky (US)
ORCID: Botts, Sheila
Venue: Bipolar Disorders
Publisher: Wiley
Published: 2009-02-25
Volume: 11
Issue: 2
Pages: 154-165
ISSN: 1398-5647 (ISSN-L)
1399-5618
DOI: 10.1111/j.1399-5618.2009.00664.x
OpenAlex: W1979173012
Cited by: 179
References: 49
Citations by year: 2026: 6 · 2025: 2 · 2024: 2 · 2023: 5 · 2022: 12 · 2021: 6 · 2020: 10 · 2019: 8 · 2018: 6 · 2017: 12 · 2016: 6 · 2015: 20 · 2014: 6 · 2013: 12 · 2012: 24
FWCI: 14.36
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Bipolar Disorders (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords: smoking, bipolar disorder, schizophrenia, major depressive disorder, smoking prevalence, smoking cessation, psychiatric comorbidity
MeSH terms: Adult, Bipolar Disorder, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Schizophrenia, Schizophrenic Psychology, Smoking, Prevalence, Confidence Intervals, Odds Ratio, Population Groups

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Tobacco smoking behaviors in bipolar disorder: a comparison of the general population, schizophrenia, and major depression

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