A Review of Impact of Tobacco Use on Patients with Co-occurring Psychiatric Disorders

Smokers with higher positive or negative urgency have lower rates of smoking cessation success 12 months after a quit attempt

Impulsivity dimensions have been shown to be associated with smoking status and tobacco use disorder severity. However, it is important to determine the specific impulsivity traits associated with smoking relapse. This study aimed at investigating the associations between impulsivity traits and smoking cessation success among adult smokers at 12 months after a quit attempt. Participants were 68 adult smokers enrolled in a 3-month course of simvastatine or placebo associated with behavioral cessation support, with a 9-month follow-up (ADDICSTATINE study). They were classified in 3 groups according to smoking status: abstinent, reduction ≥ 50%baseline or reduction < 50%baseline at 3 and 12 months. Impulsivity traits were assessed using the UPPS-P-scale. At 12 months, abstainers and participants who reduced smoking by 50% or more had significantly lower scores in negative and positive urgency compared to participants who reduced smoking by less than 50% (p = 0.011 and 0.0059). These urgency traits scores at 12 months were significantly and negatively correlated with smoking reduction at 12 months (p = 0.017 and 0.0012). These impulsivity traits were also associated with the smoking cessation success at 3 months. Patients who were abstinent at 3 months had also lower negative and positive urgency (p = 0.017 and 0.0039). Smoking cessation success at 3 and 12 months were not associated with the other impulsivity traits, sensation seeking, lack of premeditation or perseverance. Our findings suggest that positive and negative urgency are associated with smoking cessation success. Proposing better tailored-based-treatment targeting these impulsivity traits in combination with conventional treatment may help improving smoking treatment success.

Burden of anxiety and depression among hospitalized patients with irritable bowel syndrome: a nationwide analysis

BACKGROUND AND AIM

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder that affects patients both physically and mentally. Our study aimed to investigate the burden of psychiatric disorders in IBS patients.

METHODS

We conducted a retrospective analysis of the National inpatient sample (NIS) from 2016 to 2019. We recruited patients admitted with a diagnosis of IBS and determined the prevalence of anxiety, depression, and suicide attempt/ideation.

RESULTS

We found a total of 1,256,325 hospitalizations with a diagnosis of IBS. Among them, 478,515 (38.1%) had anxiety and 344,165 (27.4%) had depression. The prevalence of psychiatric disorders including anxiety (38.1% vs. 15.1%), depression (38.1% vs. 15.1%), bipolar disorder (5.22% vs. 2.38%), suicidal attempt/Ideation (3.22% vs. 2.38%), and eating disorder (0.32% vs. 0.08%) was significantly higher in IBS patient population when compared to general adult population (p < 0.001). Patients with IBS had greater odds of anxiety (AOR 2.88, 95% CI 2.85-2.91, P < 0.001), depression (AOR 2.16, 95% CI 2.14-2.19, P < 0.001) and suicidal attempt/ideation (AOR 1.94, 95% CI 1.88-2.00, P < 0.001) in comparison to general population. IBS subtypes including diarrhea-predominant, constipation-predominant and mixed type were independently associated with increased odds of anxiety, depression, and suicide attempt/ideation. Patients with IBS and a co-diagnosis of anxiety or depression had increased mean length of hospital stay by 0.48 (95% CI 0.43-0.52, P < 0.001) and 0.52 (95% CI 0.06-0.97, P < 0.03) days, respectively.

CONCLUSION

The presence of IBS is associated with an increased associated prevalence of psychiatric disorders such as anxiety, depression, and suicide attempt/ideation.

Development of a Personalized Tobacco Cessation Intervention Package (PTCIP) for Persons with Schizophrenia in India

Background

Among persons with schizophrenia (PwS), tobacco use is higher in comparison to the general population, contributing to greater morbidity and mortality. Pharmacological interventions combined with psychosocial interventions are effective in tobacco cessation. While the effectiveness of extant psychosocial interventions-when used in isolation-seems limited, developing better combinations of interventions could help treatment providers deliver tobacco cessation services to PwS at different stages of motivation to quit. We aimed to develop a personalized tobacco cessation intervention package (PTCIP) for PwS.

Methods

The stage-based intervention package was developed through a systematic review of interventions for tobacco cessation, the authors' clinical experience, and expert validation. The components of the intervention package, developed for PwS visiting the outpatient psychiatric department, were retained, removed, or added based on the content validity ratio (CVR).

Results

The final components included brief advice, principles of motivational interviewing, psychoeducation, decisional balance matrix, positive reinforcement, offering various treatment options, personalized feedback using a smoking-risk calculator, and prediction of cardiovascular risk using the WHO package of essential noncommunicable disease (PEN). The delivery of the intervention package was refined based on pilot testing in eight participants.

Conclusion

The tailored package was designed to be delivered by a mental health professional as a single comprehensive 40 min to 45 min face-to-face session, integrated with routine follow-up visits, followed by two telephonic conversations in the second and third week of the initial session. The package needs to be tested in a randomized controlled trial for its effectiveness.

Perceived stress and willingness to quit smoking among patients with depressive and anxiety disorders seeking treatment

Rationale and objectives

Little are known about nicotine dependence (ND), perceived stress, and willingness to quit smoking at different treatment stages in patient with affective disorders (AD). This study aimed to evaluate the association between ND and perceived stress among patients with AD presenting with psychiatric treatment at different clinical stages (first visit or follow‐up), and in different nicotine type users (cigarette and waterpipe smokers). We also aimed to evaluate the willingness to quit smoking and its association with barriers to quitting.

Methods

This cross‐sectional mixed‐method study collected quantitative and qualitative data from patients (n = 57) presenting for treatment with AD and ND at different sites in Saudi Arabia. Quantitative validated scales were used to assess the 70 of depression symptoms, anxiety symptoms, perceived stress, and ND. Qualitative questions assessed barriers to quit smoking. We used a linear regression modeling to estimate the association between ND and perceived stress as well as to estimate the association between barrier to quit and willingness to quit.

Results

ND had a statistically significant association with perceived stress (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.20‐3.63). Participants in the follow‐up group had a higher ND score than those in the first‐visit group. One of the most commonly reported barriers to quitting was using nicotine as a stress management (33.3%), which predicted positive willingness to quit (OR: 2.23; 95% CI: 1.48‐3.37; P < .01). Boredom was reported as a barrier in the waterpipe group more than cigarette group.

Conclusion

ND has a significant association with perceived stress regardless of treatment status in patients with AD, indicating the need to evaluate smoking cessation during the early stages of treatment for patients with AD and ND. It will be critical for clinicians to offer patients with AD alternative coping mechanisms to manage stress and boredom.

Burden of depression and anxiety among patients with inflammatory bowel disease: results of a nationwide analysis

PURPOSE

The burden of psychiatric disorders is on a rise in inflammatory bowel disease (IBD) patients which has shown to effect medication compliance and overall clinical outcomes. We studied the prevalence of depression and anxiety in IBD patients when compared to individuals with other chronic medical conditions.

METHODS

This is a retrospective cohort study using the United States national inpatient sample of 2016 to 2018. We identified patient encounters with a diagnosis of IBD. Our primary outcome was prevalence of depression and anxiety in IBD patients when compared to general adult population with other chronic medical conditions. We further studied these outcomes in subgroups of patients with ulcerative colitis and Crohn's disease.

RESULTS

A total of 963,619 patient encounters were identified with the diagnosis of IBD between 2016 and 2018, of them 162,850 (16.9%) had depression and 201,685 (20.9%) had anxiety. The prevalence of depression and anxiety was significantly higher in IBD patients in comparison to general population, (16.9% vs 12.3%) and (20.9% vs 15%) respectively (p < 0.001). Association of depression and anxiety was also higher in IBD patients when compared to patients with other chronic conditions like diabetes, metastatic cancer, and coronary artery disease. Crohn's disease and ulcerative colitis were independently associated with increased odds of depression and anxiety and these results were statistically significant (p < 0.001).

CONCLUSIONS

IBD is associated with increased prevalence of depression and anxiety when compared to general population. Association of these psychiatric illnesses with IBD is significantly higher when compared to other chronic medical conditions.

Prevalence and determinants of tobacco use amongst South African adults with mental illness in the Eastern Cape

Background

Given the physical and mental health consequences of tobacco use amongst individuals with mental illness, it was imperative to assess the burden of tobacco use in this population.

Aim

This study examined the patterns and factors associated with tobacco use in individuals attending the outpatient unit.

Setting

Cecilia Makiwane Hospital Mental Health Department in Eastern Cape province, South Africa.

Methods

Lifetime (ever use) use and current use of any tobacco products were examined in a cross-sectional study of 390 individuals between March and June 2020. A logistic regression was fitted to determine the correlates of lifetime and current use of any tobacco products.

Results

The rates of ever use and current use of tobacco products were 59.4% and 44.6%, respectively. Of the participants interviewed, lifetime tobacco use was more prevalent amongst individuals with schizophrenia (67.9%) and cannabis-induced disorders (97.3%) and lower in those with major depressive disorders (36.1%) and bipolar and related disorders (43.5%). Men were six times more likely to have ever used or currently use tobacco products in comparison to women. Also, those who had a salaried job or owned a business were over three times more likely to have ever used or currently use tobacco products compared with those receiving government social grants.

Conclusions

The prevalence of tobacco use in this study was significantly higher than the general population in the Eastern Cape. Therefore, smoking prevention and cessation interventions targeted at the general population should target this often neglected sub-population in the region.

Tobacco Use Trajectories in Young Adults: Analyses of Predictors Across Systems Levels

INTRODUCTION

Research is needed to examine trajectories of tobacco use beyond cigarette smoking, particularly during emerging middle young adulthood, and to identify distinct multilevel influences of use trajectories.

AIMS AND METHODS

We examined (1) tobacco use trajectories over a 2-year period among 2592 young adult college students in a longitudinal cohort study and (2) predictors of these trajectories using variables from a socioecological framework, including intrapersonal-level factors (eg, sociodemographics, psychosocial factors [eg, adverse childhood experiences, depressive symptoms, and attention-deficit hyperactivity disorder symptoms], early-onset substance use), interpersonal factors (eg, social support, parental substance use), and community-level factors (eg, college type, rural vs. urban).

RESULTS

About 64.5% were female and 65.0% were white. From age 18 to 26, 27%-31% of participants reported past 30-day use of any tobacco product. We identified four trajectory classes: Abstainers/Dabblers who never or infrequently used (89.2%); Adult users who began using frequently around age 20 and continued thereafter (5.9%); College Smokers who began using before 19 but ceased use around 25 (2.5%); and Teenage users who used during their teenage years but ceased use by 22 (1.9%). Multinomial regression showed that, compared to Abstainers/Dabblers, significant predictors (p < .05) of being (1) Adult users included being male, earlier onset marijuana use, attending public universities or technical colleges (vs. private universities), and living in urban areas; (2) College users included being male, earlier onset marijuana use, and parental alcohol or marijuana use; and (3) Teenage users included only earlier onset marijuana use.

CONCLUSION

Distinct prevention and intervention efforts may be needed to address the trajectories identified.

IMPLICATIONS

Among young adult college students, the largest proportion of tobacco users demonstrate the risk of continued and/or progression of tobacco use beyond college. In addition, specific factors, particularly sex, earlier onset marijuana use, parental use of alcohol and marijuana, and contextual factors such as college setting (type of school, rural vs. urban) may influence tobacco use outcomes. As such, prevention and cessation intervention strategies are needed to address multilevel influences.

A study on tobacco use in women with major mental illnesses- schizophrenia, bipolar disorder and recurrent depression

About 14.2% of women in the general Indian population and 4.8% in Delhi use tobacco but its use among women with Major Mental Illness (MMI) in developing countries has not been adequately studied. We assessed tobacco use in women with MMI in a tertiary care psychiatry outpatient department through a cross-sectional, observational study, with sample size of at least n= 77 each for schizophrenia-SZ, bipolar disorder-BD and Recurrent Depressive Disorder-RDD. Fagerstrom Test for Nicotine Dependence (FTND) both for smoke and smokeless tobacco were applied along with a subset of questions from Global Adult Tobacco Survey 2016. After diagnosis and referral by the treating psychiatrist and written informed consent, in our total sample of 321 women participants, lifetime use of tobacco was reported by 14.64%. Of all those who had ever used tobacco, 12.14% used it currently as well. As for diagnosis, those with BD (16.25%) used tobacco most frequently followed by SZ (14.18%) and RDD (6%). The FTND score was higher for schizophrenia indicating greater dependence. Tobacco use among women with MMI was thrice as common as women in general population of Delhi State, with smoke and smokeless tobacco use being equally prevalent, a grave cause for concern and intervention.

Tobacco smoking in three “left behind” subgroups: indigenous, the rainbow community and people with mental health conditions

Purpose

This paper aims to investigate the extent to which three subgroups – people with mental health conditions, people belonging to sexual minority and gender groups and Indigenous peoples – have been “left behind” by countries implementing the World Health Organization’s Framework Convention on Tobacco Control.

Design/methodology/approach

A general review of electronic bibliographical databases to provide an overview of smoking prevalence among the three groups and interventions designed specifically to reduce their smoking rates.

Findings

Although explanations and specific rates differ, two trends are consistent across all three groups. First, information reported in the past two decades suggests that smoking prevalence is disproportionately high among people with mental health conditions, and in the rainbow and indigenous communities. Second, most cessation programmes are targeted at majority politically dominant groups, missing opportunities to reduce smoking rates in these minority communities.

Research limitations/implications

There is a general dearth of data preventing detailed analysis. Better data collection efforts are required. Trials to identify effective smoking reduction interventions for marginalised groups are needed.

Social implications

It is socially unjust that these groups are being systematically ignored by tobacco control initiatives. A failure to equitably reduce tobacco harms among all groups across society has contributed to the perceived concentration of smoking in some subgroups. The increasing stigmatisation of people who smoke then adds a marginality, compounding the negative effects associated with belonging to a marginalised group. Ongoing marginalisation of these groups is an important determinant of smoking.

Originality/value

Cross-case analysis of neglected subgroups with disproportionately high smoking rates suggests social marginalisation is a shared and important determinant of smoking prevalence.

Associations between polygenic risk for tobacco and alcohol use and liability to tobacco and alcohol use, and psychiatric disorders in an independent sample of 13,999 Australian adults

BACKGROUND

Substance use, substance use disorders (SUDs), and psychiatric disorders commonly co-occur. Genetic risk common to these complex traits is an important explanation; however, little is known about how polygenic risk for tobacco or alcohol use overlaps the genetic risk for the comorbid SUDs and psychiatric disorders.

METHODS

We constructed polygenic risk scores (PRSs) using GWAS meta-analysis summary statistics from a large discovery sample, GWAS & Sequencing Consortium of Alcohol and Nicotine use (GSCAN), for smoking initiation (SI; N = 631,564), age of initiating regular smoking (AI; N = 258,251), cigarettes per day (CPD; N = 258,999), smoking cessation (SC; N = 312,273), and drinks per week (DPW; N = 527,402). We then estimated the fixed effect of these PRSs on the liability to 15 phenotypes related to tobacco and alcohol use, substance use disorders, and psychiatric disorders in an independent target sample of Australian adults.

RESULTS

After adjusting for multiple testing, 10 of 75 combinations of discovery and target phenotypes remained significant. PRS-SI (R² range: 1.98%-5.09 %) was positively associated with SI, DPW, and with DSM-IV and FTND nicotine dependence, and conduct disorder. PRS-AI (R²: 3.91 %) negatively associated with DPW. PRS-CPD (R²: 1.56 %-1.77 %) positively associated with DSM-IV nicotine dependence and conduct disorder. PRS-DPW (R²: 3.39 %-6.26 %) positively associated with only DPW. The variation of DPW was significantly influenced by sex*PRS-SI, sex*PRS-AI and sex*PRS-DPW. Such interaction effect was not detected in the other 14 phenotypes.

CONCLUSIONS

Polygenic risks associated with tobacco use are also associated with liability to alcohol consumption, nicotine dependence, and conduct disorder.

Cigarette use trajectories in young adults: Analyses of predictors across system levels

BACKGROUND

Cigarette smoking escalates most in early to middle young adulthood. However, little research has examined a range of multilevel factors in relation to smoking trajectories during this time.

METHODS

We examined: 1) trajectories of cigarette smoking among 2967 US college students (aged 18-25) in a two-year, six-wave longitudinal study (using growth mixture modeling); and 2) intrapersonal- (i.e., other substance use, depressive symptoms, ADHD symptoms,); interpersonal- (i.e., adverse childhood events, social support, parental tobacco and marijuana use), and community-level (i.e., type of college, rural vs. urban setting) predictors of differing trajectories (using multinomial logistic regression).

RESULTS

We identified three trajectory classes: 1) Dabblers, who used cigarettes at one point in their life or not at all (85.6%); 2) College Onset Smokers, who began smoking regularly during the college years (6.2%); and 3) Later Onset Smokers, who began smoking during the mid- to late-20 s (8.2%). Multinomial regression (with Dabblers as the reference group) showed that predictors of being College Onset Smokers included being male (p = .031); Asian (p = .001) but not Black (p = .008; Ref: White); early onset smokers (i.e., initiation before age 15; p = .006); past 30-day users of little cigars/cigarillos (p = .024), alcohol (p < .001), and marijuana (p = .008); children of tobacco users (p = .050); and public (p = .031) or a technical college students (p < .001; Ref: private college); predictors of being Later Onset Smokers were being male (p = .019) and technical college students (p = .005).

CONCLUSIONS

Despite some young adults' smoking initiating/escalating in middle young adulthood, few risk factors were documented. This understudied period warrants greater examination to inform intervention.