Smoking and mental health - NCSCT

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Smoking and mental health Relative risk Relative risk Study or subgroup IV, random, 95% Cl IV, random, 95% Cl Breese McCoy 2006 2.20 [1.18, 4.10] Breese McCoy 2008 2.42 [1.26, 4.65] Rubio 2008 (Cohort 1) 1.36 [0.64, 2.91] Rubio 2008 (Cohort 2) 2.31 [1.21, 4.39] Total (95% CI) 2.08 [1.50, 2.91] Heterogeneity, tau 2 = 0.00; chi 2 = 1.54, df = 3 (p = 0.67); I 2 = 0% Test for overall effect: Z = 4.34 (p < 0.0001) 0.2 0.5 Smoking reduces risk 1 2 5 Smoking increases risk Fig 4.6 Smoking and onset of postpartum depression. Relative risk Relative risk Study or subgroup IV, random, 95% Cl IV, random, 95% Cl Ajdacic-Gross 2009 i 6.00 [1.93, 18.70] Ajdacic-Gross 2009 ii 1.60 [0.57, 4.50] Breslau 1998 3.00 [1.10, 8.19] Brown 1996a 2.04 [1.16, 3.60] Fleming 2002 2.57 [1.30 5.07] Goodman 2000 1.72 [0.78, 3.81] Lam 2005 1.48 [1.07, 2.05] Otten 2009 1.44 [1.14, 1.82] Van Gool 2003 1.34 [0.14, 12.45] Wang 1999 (adolescent) 0.98 [ 0.89, 1.08] Wang 1999 (adult) 1.15 [0.99, 1.33] Wu 1999 1.06 [0.74, 1.51] Total (95% CI) 1.43 [1.17, 1.74] Heterogeneity, tau 2 = 0.06; chi 2 = 38.41, df = 11 (p < 0.0001); I 2 = 71% 0.05 0.2 Test for overall effect: Z = 3.55 (p = 0.0004) Depression reduces risk 1 5 20 Depression increases risk Fig 4.7 Depression and the onset of smoking. Relative risk Relative risk Study or subgroup IV, random, 95% Cl IV, random, 95% Cl Breslau 1998 1.91 [1.09, 3.36] Brook 2004 1.00 [0.78, 1.28] Kang 2010 1.00 [0.98 1.02] McKenzie 2010 1.70 [0.85, 3.40] Otten 2009 1.98 [1.31, 3.00] Park 2009a 0.89 [0.50, 1.60] Park 2009b 2.41 [1.13, 5.14] Rohde 2004 1.48 [1.00, 2.19] Sihvola 2008 2.14 [1.33, 3.45] Wang 1999 (adolescent) 1.22 [1.07, 1.39] Wang 1999 (adult) 1.29 [1.05, 1.59] Total (95% CI) 1.34 [1.13, 1.58] Heterogeneity, tau 2 = 0.04; chi 2 = 49.81, df = 10 (p < 0.0001); I 2 = 80% Test for overall effect: Z = 3.46 (p = 0.0006) 0.1 0.2 0.5 Depression reduces risk 1 2 5 10 Depression increases risk Fig 4.8 Depression and the risk of daily/regular smoking. 74 © Royal College of Physicians 2013
Epidemiology of the association between smoking and mental disorders 4 between per unit increase in depression score at baseline and the transition to daily smoking 1 year later (OR = 1.01, 95% CI 0.99–1.02). 93 4.10 Smoking and dementia In 2007, Anstey et al reported a review and meta-analysis of 19 studies published before June 2005 with at least 12 months of follow-up, including data from over 26,000 participants followed from 2 years to 30 years with respect to incident dementia and/or cognitive decline. 95 The pooled relative risk for developing dementia was estimated as 1.27 (95% CI 1.02–1.60, two studies) in current smokers compared with never smokers, and corresponding relative risks of incident Alzheimer’s disease and vascular dementia were 1.79 (95% CI 1.43–2.23, four studies) and 1.78 (95% CI 1.28–2.47, two studies), respectively. A second systematic review and meta-analysis published in 2008 was conducted in parallel with the first review, but included more contemporary studies written in English language and published up to November 2007. 96 The second review reported essentially similar findings, with a pooled ratio for current smoking and incident Alzheimer’s disease of 1.59 (95% CI 1.15–2.20, eight studies). The four larger studies found positive associations between current smoking and incident dementia (or subtypes), and include a 4-year follow-up of 1,064 participants aged 65 years and over, 97 a 2-year follow-up of 2,820 participants aged 60 years and over, 98 a follow-up of 6,870 people aged at least 55 years over an average period of 2.1 years, 99 and an association between mid-life smoking and late-life Alzheimer’s disease in 3,734 men with a mean age of around 77 years. 100 Of these, two reported exposure-related effects, where the risk of dementia increased with increasing cigarette consumption. 98,100 However, the large studies that found no association between smoking and an increased risk of dementia include the Canadian Study of Health and Aging (RR = 0.82, 95% CI 0.57–1.17) 101 and the MRC Cognitive Function and Ageing Study (RR = 0.90, 95% CI 0.50–1.50). 102 The reason for this heterogeneity is unclear, although both studies involved relatively long follow-up periods and findings from the Rotterdam cohort study have suggested a diminution of risk ratio for all dementia from 2.2 at approximately 2 years 99 to 1.5 at approximately 7 years; 103 it is therefore possible that longer follow-up periods in panel survey designs obscure the effect because of selective attrition. Relevant studies published since the systematic reviews mentioned above include two that report positive associations between smoking and dementia hospitalisation or healthcare contacts, 104,105 and one reporting a strong association between mid-life smoking status and late-life dementia risk in 1449 people aged 65–79 years. 106 A recent review also concluded that studies with tobacco industry affiliation were more likely to report a protective effect and less likely to report a risk effect than studies without such affiliation. 107 © Royal College of Physicians 2013 75
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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
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Smoking among people with mental di
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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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