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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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de Leon, J., & Diaz, F. J. (2005) · Schizophrenia Research · doi:10.1016/j.schres.2005.02.010 · Cited by 1,276
Self-citationTobacco use and cessation in psychiatric disorders: National Institute of Mental Health report
Ziedonis, D., Hitsman, B., Beckham, J. C., Zvolensky, M., Adler, L. E., Audrain-McGovern, J., Breslau, N., Brown, R. A., George, T. P., Williams, J., et al. (2008) · Nicotine & Tobacco Research · doi:10.1080/14622200802443569 · Cited by 735
Serious mental illness and physical health problems: A discussion paper
Robson, D., & Gray, R. (2007) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2006.07.013 · Cited by 411
“Epidemiological studies that have established international prevalence rates of smoking in people with schizophrenia and bi-polar disorder range from 58% to 88%, up to three times higher than the general population (Hughes et al., 1986; de Leon et al., 2002).”
BackgroundHannon, E., Dempster, E., Viana, J., Burrage, J., Smith, A. R., Macdonald, R., St Clair, D., Mustard, C., Breen, G., Therman, S., et al. (2016) · Genome Biology · doi:10.1186/s13059-016-1041-x · Cited by 349
“Across the full sample, DNA methylation-derived smoking scores were significantly higher in patients with schizophrenia compared to controls (Mann – Whitney P = 1.51 × 10 − 41 ; Additional file 1: Figure S3), consistent with epidemiological data [25 – 27] and the results of our initial EWAS.”
InfluentialWaters, F., Collerton, D., ffytche, D. H., Jardri, R., Pins, D., Dudley, R., Blom, J. D., Mosimann, U. P., Eperjesi, F., Ford, S., et al. (2014) · Schizophrenia Bulletin · doi:10.1093/schbul/sbu036 · Cited by 325
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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