Smoking and mental health - NCSCT

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Smoking and mental health Relative risk (RR) Relative risk (RR) Study or subgroup IV, random, 95% Cl IV, random, 95% Cl Initiation or use Burke 2001 1.89 [1.02, 3.50] Burke 2007 (Grade 1) 1.14 [0.96, 1.36] Burke 2007 (Grade 7) 1.35 [1.16, 1.57] Elkins 2007 1.56 [1.12, 2.18] Galéra 2010 (females) 1.41 [0.66, 3.03] Galéra 2010 (males) 1.87 [1.05, 3.34] Niemelä 2009 (heavy) 1.20 [1.02, 1.41] Subtotal (95% CI) 1.30 [1.17, 1.44] Heterogeneity, tau 2 = 0.00; chi 2 = 7.33, df = 6 (p = 0.29); I 2 = 18% Test for overall effect: Z = 4.79 (p < 0.0001) Daily or regular smoking Agrawal 2005 1.53 [1.36, 1.72] Brook 2008 2.45 [1.28, 4.68] Galéra 2005 (females) 1.75 [0.92, 3.35] Galéra 2005 (males) 2.95 [1.36, 6.39] Lynskey 1995 1.16 [0.99, 1.36] Subtotal (95% CI) 1.58 [1.22, 2.04] Heterogeneity, tau 2 = 0.04; chi 2 = 14.53, df = 4 (p = 0.006); I 2 = 72% Test for overall effect: Z = 3.48 (p = 0.0005) Lifetime smoking Galéra 2005 (females) 3.27 [1.52, 7.04] Galéra 2005 (males) 2.00 [0.97, 4.11] Subtotal (95% CI) 2.52 [1.49, 4.25] Heterogeneity, tau 2 = 0.00; chi 2 = 0.84, df = 1 (p = 0.36); I 2 = 0% Test for overall effect: Z = 3.45 (p = 0.0006) 0.2 0.5 1 2 5 Test for subgroup differences: chi 2 = 7.39, df = 2 (p = 0.02); I 2 = 72.9% CD reduces risk CD increases risk Fig 4.3 Conduct disorder (CD) and the onset of smoking. onset of daily smoking in individuals with conduct disorder (RR = 3.8, p
Epidemiology of the association between smoking and mental disorders 4 significant association between smoking and the incidence of bipolar disorder in adults (IRR = 6.45, 95% CI 0.55–75.65), 3 but numbers were small with only nine incident cases in the cohort. Conflicting results were seen for the impact of bipolar disorder on onset of smoking in adolescence, where one study showed a significant sevenfold increase in the onset of heavy smoking in adolescents (OR = 7.1, 95% CI 1.9–25.9), 27 but no significant association with onset of light/moderate smoking in adolescents (OR = 0.9, 95% CI 0.3–2.7). Furthermore, no significant association was seen between the impact of bipolar disorder on the onset of smoking in adults in two studies (OR = 0.3, 95% CI 0–3.3; 27 magnitude of effect was not reported, 3 except p >0.05). 4.6 Smoking and schizophrenia Five cohort or longitudinal studies of the association between smoking and schizophrenia were identified in our literature search, and these are summarised in Table A3. Two of these are large cohort studies of young male army recruits, from Israel and Sweden, and report conflicting results. 28,29 The study from Israel reported an almost twofold increase in the risk of incidence schizophrenia among smokers (OR = 1.94), 29 but the Swedish study, which involved a much larger sample (48,772 vs 14,248) and number of incident cases of schizophrenia (350 vs 44), found no excess risk (OR = 0.80). 28 Another study demonstrated that the time between initiation of smoking and the onset of the mental health illness was much shorter for schizophrenia than for other psychoses. 30 A more recent prospective study 31 in Danish women found that being a smoker increased the risk of developing schizophrenia spectrum disorder by about 40% (OR = 1.42, 95% CI 1.12–1.80), with some evidence that risk increased with the number of cigarettes smoked per day. The study also reported an increased risk of affective spectrum disorder in those who smoked (OR = 1.40, 95% CI 1.05–1.86). One further study recruited 48 participants aged 12–30 years with prodromal symptoms (and thus at risk of developing schizophrenia) who participated in the Cognitive Assessment and Risk Evaluation (CARE) programme. 32 The study demonstrated that nicotine use was significantly associated with the development of schizophrenia (p = 0.005, Fisher’s exact test). 32 Due of the lack of prospective studies, we examined an existing systematic review of schizophrenia and smoking, based on 42 cross-sectional studies from 20 countries, by de Leon and Diaz. 33 The combined OR for current smoking among those with schizophrenia, compared with the general population, was 7.2 (95% CI 6.1–8.3) and 3.3 (95% CI 3.0–3.6) among males and females, respectively, but few studies had adjusted for confounding. Combining these pooled estimates with three results reported subsequently in four published studies 34–37 produces an OR of 4.62 (95% CI 2.15–9.92, p
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PDF not for circulation Smoking and
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Contents Members of the Tobacco Adv
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Contents 4.4.3 Attention deficit hy
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Contents 6.4.3 Staff knowledge 122
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Contents 10.5 Tobacco policy and me
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Contributors Anthony Aclet - Specia
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Contributors Jill Williams - Associ
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1 Mental disorders 1.1 What is a me
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Mental disorders 1 1.3 Common menta
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Mental disorders 1 1.4.4 Somatisati
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Mental disorders 1 In addition to s
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Mental disorders 1 not diagnosed un
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Mental disorders 1 Similar to many
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Mental disorders 1 12 Chang CK, Hay
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Mental disorders 1 52 Young S, Toon
Page 31 and 32: Smoking among people with mental di
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Population strategies to prevent sm
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Smoking and mental disorders: speci
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The economic cost of smoking in peo
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Ethical and legal aspects 9 pose co
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Ethical and legal aspects 9 less an
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Ethical and legal aspects 9 patient
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10 Summary and conclusions 10.1 Smo
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Summary and conclusions 10 10.4 Smo
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Summary and conclusions 10 although
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11 Key conclusions and recommendati
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Key conclusions and recommendations
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