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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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“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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“High nicotine dependence is defined as a total FTND score of ≥6 (78, 79).”
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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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Smoking initiation and schizophrenia: A replication study in a Chinese Han population
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Wang, K.-S., Liu, X., Zhang, Q., & Min De, Z. E. N. G. (2012) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2012.02.003 · Cited by 21
Hamadeh, R. R., Ansari, A., Jahrami, H., & Al-Offi, A. R. (2016) · BMC Research Notes · doi:10.1186/s13104-016-1894-9 · Cited by 19
Personality predicts smoking frequency: An empirical examination separated by sex
Kang, W. (2022) · Personality and Individual Differences · doi:10.1016/j.paid.2022.111843 · Cited by 20
Smoking rates among schizophrenia patients in Japan
Shinozaki, Y., Nakao, M., Takeuchi, T., & Yano, E. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.06.030 · Cited by 18
López-Torrecillas, F., Rueda, M. D. M., López-Quirantes, E. M., Santiago, J. M., & Tapioles, R. R. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-1217 · Cited by 17
“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
de León, J., Gurpegui, M., & Díaz, F. J. (2007) · Journal of Dual Diagnosis · doi:10.1300/j374v03n03_03 · Cited by 18
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
“[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.”
BackgroundSelf-citationPlooy, J.-L. D., Macharia, M., & Verster, C. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-1123-z · Cited by 17
Craving y abstinencia de la nicotina en fumadores españoles en un tratamiento para dejar de fumar
Piñeiro, B., López‐Durán, A., López‐Durán, A., Martínez, Ú., Martínez, Ú., Brandon, T. H., Brandon, T. H., & Becoña, E. (2014) · Adicciones · doi:10.20882/adicciones.4 · Cited by 16
Self-citationYouTube as a source of quit smoking information for people living with mental illness: Table 1
Sharma, R., Lucas, M., Ford, P. J., Meurk, C., & GARTNER, C. E. (2016) · Tobacco Control · doi:10.1136/tobaccocontrol-2015-052713 · Cited by 14
Predictors of Psychiatric Hospitalization in the Navy
Booth‐Kewley, S., & Larson, G. E. (2005) · Military Medicine · doi:10.7205/milmed.170.1.87 · Cited by 14
Neuronal glucose metabolism and schizophrenia: therapeutic prospects?
Dwyer, D. S., Lu, X., & Freeman, A. M. (2003) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.3.1.29 · Cited by 14
Illicit drug use in heavy smokers with and without schizophrenia
Mackowick, K. M., Heishman, S. J., Wehring, H. J., Liu, F., McMahon, R. P., & Kelly, D. L. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2012.04.012 · Cited by 13
“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
Stewart, D. W., Vinci, C., Adams, C. E., Cohen, A. S., & Copeland, A. L. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.11.032 · Cited by 12
“Up to 90% of those with schizophrenia smoke cigarettes (de Leon et al., 2002a; de Leon and Diaz, 2005).”
Gurpegui, M., Díaz, F. J., Ortega, J. M. M., & de León, J. (2004) · Adicciones · Cited by 12
Self-citationTobacco use in first-episode psychosis, a multinational EU-GEI study
Sánchez‐Gutiérrez, T., Rodríguez-Toscano, E., Roldán, L., Ferraro, L., Parellada, M., Calvo, A., López, G., Rapado‐Castro, M., Barbera, D. L., Cascia, C. L., et al. (2023) · Psychological Medicine · doi:10.1017/s0033291723000806 · Cited by 13
“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…”
BackgroundBecoña, E., Nogueiras, L., Flórez, G., Álvarez, S., & Vázquez, D. (2010) · Adicciones · doi:10.20882/adicciones.213 · Cited by 11
Self-citationConsumo de tabaco y psicopatología asociada
Becoña, E., & Míguez, M. C. (2004) · Hispana · doi:10.5209/rev_psic.2004.v1.n1.17190 · Cited by 11
Self-citationA brief measure of high nicotine dependence for busy clinicians and large epidemiological surveys
Díaz, F. J., Jané, M., Saltó, E., et al. (2005) · Australian & New Zealand Journal of Psychiatry · doi:10.1111/j.1440-1614.2005.01538.x · Cited by 10
“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
“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
Metadata
- 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 › Public Health, Environmental and Occupational Health › 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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