The association between high nicotine dependence and severe mental illness may be consistent across countries
Abstract
BACKGROUND: Studies all over the world suggest that severe mental illness, including schizophrenia and mood disorders, is associated with tobacco smoking. This study, combining samples from the United States and Spain, had 3 objectives: (1) to test the hypothesis that severely mentally ill patients who smoke are more likely to have a high nicotine dependence when compared with control smokers, (2) to compare frequencies of high nicotine dependence in controls in both countries, and (3) to compare frequencies of high nicotine dependence in severely mentally ill patients in both countries. METHOD: Scores on the Fagerström Test for Nicotine Dependence (FTND) for 4 samples of current daily smokers were analyzed. The sample sizes of the U.S. and Spanish control groups were 129 and 646 subjects, respectively. The diagnoses for the U.S. patients were DSM-IV schizophrenia, 74% (89/120), and DSM-IV mood disorders, 26% (31/120). The diagnoses for the Spanish patients were DSM-IV schizophrenia, 87% (173/199), and DSM-III-R mood disorders, 13% (26/199). High nicotine dependence (FTND score > or = 6) was the dependent variable in 5 logistic regression analyses. RESULTS: The main findings were that (1) severely mentally ill patients had significantly higher frequencies of high nicotine dependence than controls (odds ratio [OR] = 10.59, 95% CI = 7.31 to 15.34) even after controlling for gender, country, interaction between country and mental illness, and age; (2) U.S. controls had significantly higher frequencies of high nicotine dependence than Spanish controls (OR = 3.18, 95% CI = 2.02 to 5.00); and (3) U.S. and Spanish patients did not have significantly different frequencies of high nicotine dependence. CONCLUSION: New studies, specially designed to test for transcultural differences in nicotine dependence, are needed to verify that nicotine dependence in severely mentally ill patients is consistently high and similar in different countries.
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The results reflect existing epidemiological evidence that schizophrenia patients not only smoke more, but also smoke more heavily.
“our results therefore reflect existing epidemiological evidence demonstrating that schizophrenia patients not only smoke more, but also smoke more heavily (de Leon et al., 2002; de Leon and Diaz, 2005; McClave et al., 2010).”
From DNA methylation meta-analysis reveals cellular alterations in psychosis and markers of treatment-resistant schizophrenia (2021) · cites this paper as de Leon et al., 2002
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“…of dependence or withdrawal, and early relapse back to smoking after a quit attempt, which may result in fewer former smokers in these groups (de Leon et al., 2002; Hagman et al., 2008; Pratt and Brody, 2010), and smoking rates have not gone down in individuals with mental illness (Cook et…”
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“…cs (such as environmental and smoker characteristics) permits more profi table interventions, and as psychiatric patients are known to be heavier smokers than individuals in the general population (de Leon et al., 2002), they might be more open to strategies that reduce smoking than to cessation.”
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López-Torrecillas, F., Nieto-Ruíz, A., Velasco-Ortuño, S., Lara-Fernández, M., López-Quirantes, E. M., & Castillo-Fernández, E. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.06.004 · Cited by 22 · see citing works
“Its factorial structure is consistent [8], and there is a Spanish version of the test [4].”
BackgroundEnemy within? The silent epidemic of substance dependency in GCC countries
Al-Harthi, A., & Al‐Adawi, S. (2002) · Sultan Qaboos University medical journal · doi:10.18295/2075-0528.2591 · Cited by 20 · see citing works
Smoking initiation and schizophrenia: A replication study in a Chinese Han population
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Personality predicts smoking frequency: An empirical examination separated by sex
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Smoking rates among schizophrenia patients in Japan
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“This instrument evaluates the intensity of physical addiction to nicotine and has a consistent factorial structure [35].”
BackgroundEpidemiology of Comorbid Tobacco Use and Schizophrenia: Thinking About Risks and Protective Factors
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Self-citationBecoña, E., López‐Durán, A., del Río, E. F., & Martínez, Ú. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-613 · Cited by 17 · see citing works
“[19], since in our study the increase in psychopathological problems is not related to a rise in nicotine dependence that could explain the poorer treatment outcomes.”
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Craving y abstinencia de la nicotina en fumadores españoles en un tratamiento para dejar de fumar
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Self-citationYouTube as a source of quit smoking information for people living with mental illness: Table 1
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Predictors of Psychiatric Hospitalization in the Navy
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Neuronal glucose metabolism and schizophrenia: therapeutic prospects?
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Illicit drug use in heavy smokers with and without schizophrenia
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“Those with mental illness or substance-use disorders are more susceptible to these diseases because they smoke more cigarettes per day and have more difficulty quitting (Hughes et al., 1986; de Leon, 1996; Dalack et al., 1998; de Leon et al., 2002; Kelly et al., 2011).”
Smoking topography and outcome expectancies among individuals with schizotypy
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“Up to 90% of those with schizophrenia smoke cigarettes (de Leon et al., 2002a; de Leon and Diaz, 2005).”
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Self-citationTobacco use in first-episode psychosis, a multinational EU-GEI study
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“Like cannabis, tobacco is implicated in the pathophysiology of schizophrenia (de Leon et al., 2002; Kelly & McCreadie, 1999; Moore et al., 2007; Zammit et al., 2009) and the shared genetic, environmental, and socioeconomic factors of cannabis and tobacco use make it difficult to address the…”
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Self-citationConsumo de tabaco y psicopatología asociada
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Self-citationA brief measure of high nicotine dependence for busy clinicians and large epidemiological surveys
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“Using this definition in a comparative study, we found that severely mentally ill patients (with schizophrenia and mood disorders) in the US and Spain had similar high nicotine dependence frequencies [29].”
BackgroundSelf-citationPsychosis and smoking cessation: Difficulties in quitting associated with sex and substance abuse
González-Pinto, A. M., Alberich, S., de Azúa, S. R., Martínez‐Cengotitabengoa, M., Fernández, M., Gutiérrez, M., Sáenz-Herrero, M., Besga, A., Galdos, P., & de León, J. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2011.08.005 · Cited by 11 · see citing works
“Although the association between smoking and psychosis in general is consistent between countries (de Leon et al., 2002), differences in the methodology of studies can influence the results of specific smoking behaviors, such as smoking cessation.”
ResultSelf-citationFu, M., Martínez-Sánchez, J. M., Pérez‐Ríos, M., et al. (2009) · Addiction · doi:10.1111/j.1360-0443.2008.02485.x · Cited by 9 · see citing works
- Authors
- de Leon, J., Becona, E., Gurpegui, M., Gonzalez-Pinto, A., & Diaz, F. J.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2002-09-15
- Volume
- 63
- Issue
- 9
- Pages
- 812-816
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W1974462417
- Cited by
- 144
- References
- 0
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 4 · 2018: 5 · 2017: 3 · 2016: 8 · 2015: 9 · 2014: 9 · 2013: 3 · 2012: 10
- FWCI
- 4.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- nicotine dependence, severe mental illness, schizophrenia, mood disorders, smoking, Fagerström Test for Nicotine Dependence, cross-cultural comparison, United States, Spain
- MeSH terms
- Mental Disorders, Cross-Cultural Comparison, Female, Humans, Male, Personality Inventory, Surveys and Questionnaires, Schizophrenia, Schizophrenic Psychology, Severity of Illness Index, Smoking, Spain, Tobacco Use Disorder, United States, Comorbidity, Prevalence, Mood Disorders
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