The association between smoking and depression from adolescence to adulthood

Tjora, Tore; Hetland, Jørn; Aarø, Leif Edvard; Wold, Bente; Wiium, Nora; Øverland, Simon

doi:10.1111/add.12522

Cited by 67 publications

(46 citation statements)

References 31 publications

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“…Smoking is a major risk factor for lung cancer, cardiovascular and respiratory diseases making it the leading cause of preventable death worldwide 1 . In developed nations, smoking is more common amongst individuals with mental health conditions [2][3][4][5] , in particular schizophrenia 6 and depression [7][8][9] . In the UK, estimates suggest that up to 45% of individuals with schizophrenia, and 31% of individuals with depression smoke 6 , compared to around 15% of the general population 10 .…”

Section: Introductionmentioning

confidence: 99%

Causal effects of lifetime smoking on risk for depression and schizophrenia: Evidence from a Mendelian randomisation study

Stuijfzand

et al. 2018

Preprint

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250 words). Background. Smoking prevalence is higher amongst individuals with schizophrenia and depression compared to the general population. Mendelian randomisation (MR) can examine whether this association is causal using genetic variants identified in genome-wide association studies (GWAS).Methods. We conducted a GWAS of lifetime smoking behaviour (capturing smoking duration, heaviness and cessation) in a sample of 462,690 individuals from the UK Biobank, and validated the findings via two-sample MR analyses of positive control outcomes (e.g., lung cancer). Having established the validity of our instrument, we used bi-directional twosample Mendelian randomisation to explore its effects on schizophrenia and depression.Outcomes. There was strong evidence to suggest smoking is a causal risk factor for both schizophrenia (OR = 2.27, 95% CI = 1.67 -3.08, P < 0.001) and depression (OR = 1.99, 95% CI = 1.71 -2.32, P < 0.001). We also found some evidence that genetic risk for both schizophrenia and depression cause increased lifetime smoking (β = 0.022, 95% CI = 0.005 -0.038, P = 0.009; β = 0.091, 95% CI = 0.027 -0.155, P = 0.005).Interpretation. These findings suggest that the association between smoking, schizophrenia and depression is due, at least in part, to a causal effect of smoking, providing further evidence for the detrimental consequences of smoking for mental health.Evidence before this study: The association between smoking and mental health (especially schizophrenia and depression) is often assumed to be the result of selfmedication (for example, to alleviate symptoms). However, more recent evidence has suggested that smoking might also be a risk factor for schizophrenia and depression. This alternative direction of effect is supported by meta-analyses and previous prospective observational evidence using related individuals to control for genetic and environmental confounding. However, observational evidence cannot completely account for confounding or the possibility of reverse causation. One way to get around these problems is Mendelian randomisation (MR). Previous MR studies of smoking and mental health have not shown an effect of smoking on depression and are inconclusive for the effects of smoking on schizophrenia. However, these studies have only looked at individual aspects of smoking behaviour and some studies required stratifying participants into smokers and non-smokers, reducing power. Added value of this study:We have developed a novel genetic instrument for lifetime smoking exposure which can be used within a two-sample MR framework, using publiclyavailable GWAS summary statistics. We were therefore able to test the bi-directional association between smoking with schizophrenia and depression to see if the effects are causal. We found strong evidence to suggest that smoking is a causal risk factor for both schizophrenia and depression. There was some evidence to suggest that risk of schizophrenia and depression increases lifetime smoking (consistent with the selfmedication hypothesis) but t...

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Section: Introductionmentioning

confidence: 99%

Causal effects of lifetime smoking on risk for depression and schizophrenia: Evidence from a Mendelian randomisation study

Stuijfzand

et al. 2018

Preprint

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“…These bidirectional associations between adolescent smoking and anxiety in early adulthood do not prove causality. The same applies to other disorders, such as ADHD [52] and depression [53]. In any case, these studies do not show that any increased risk of cognitive impairments and mood disorders can be attributed to nicotine as distinct from other constituents of tobacco smoke.…”

Section: Effects Of Nicotine Inhalation By the E-cigarette Usermentioning

confidence: 60%

A critique of the US Surgeon General’s conclusions regarding e-cigarette use among youth and young adults in the United States of America

Polosa

Russell²,

Nitzkin³

et al. 2017

Harm Reduct J

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Background: In December 2016, the Surgeon General published a report that concluded e-cigarette use among youth and young adults is becoming a major public health concern in the United States of America. Methods: Re-analysis of key data sources on nicotine toxicity and prevalence of youth use of e-cigarettes cited in the Surgeon General report as the basis for its conclusions. Results: Multiple years of nationally representative surveys indicate the majority of e-cigarette use among US youth is either infrequent or experimental, and negligible among never-smoking youth. The majority of the very small proportion of US youth who use e-cigarettes on a regular basis, consume nicotine-free products. The sharpest declines in US youth smoking rates have occurred as e-cigarettes have become increasingly available. Most of the evidence presented in the Surgeon General's discussion of nicotine harm is not applicable to e-cigarette use, because it relies almost exclusively on exposure to nicotine in the cigarette smoke and not to nicotine present in ecigarette aerosol emissions. Moreover, the referenced literature describes effects in adults, not youth, and in animal models that have little relevance to real-world e-cigarette use by youth. The Surgeon General's report is an excellent reference document for the adverse outcomes due to nicotine in combination with several other toxicants present in tobacco smoke, but fails to address the risks of nicotine decoupled from tobacco smoke constituents. The report exaggerates the toxicity of propylene glycol (PG) and vegetable glycerin (VG) by focusing on experimental conditions that do not reflect use in the real-world and provides little discussion of emerging evidence that e-cigarettes may significantly reduce harm to smokers who have completely switched. Conclusions: The U.S. Surgeon General's claim that e-cigarette use among U.S. youth and young adults is an emerging public health concern does not appear to be supported by the best available evidence on the health risks of nicotine use and population survey data on prevalence of frequent e-cigarette use. Nonetheless, patterns of e-cigarettes use in youth must be constantly monitored for early detection of significant changes. The next US Surgeon General should consider the possibility that future generations of young Americans will be less likely to start smoking tobacco because of, not in spite of, the availability of e-cigarettes.

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“…Training mental health and social services providers to incorporate tobacco dependence treatment into daily practice may also be beneficial 9. Our findings, in conjunction with accumulating evidence of the bidirectional association between smoking and mental illness,10 should motivate tobacco control advocates, healthcare providers and the broader public health community to prioritise identifying and treating these co-occurring conditions.…”

Section: Discussionmentioning

confidence: 81%

Trends in smoking among adults with serious psychological distress during comprehensive tobacco control in New York City, 2003–2012: Table 1

et al. 2014

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The association between smoking and depression from adolescence to adulthood

Abstract: The inter-relationship between depression and smoking seems to be due to the reciprocal causal effects between smoking and depression that are established in early adolescence and maintained into adulthood.

Cited by 67 publications

References 31 publications

Causal effects of lifetime smoking on risk for depression and schizophrenia: Evidence from a Mendelian randomisation study

Causal effects of lifetime smoking on risk for depression and schizophrenia: Evidence from a Mendelian randomisation study

A critique of the US Surgeon General’s conclusions regarding e-cigarette use among youth and young adults in the United States of America

Trends in smoking among adults with serious psychological distress during comprehensive tobacco control in New York City, 2003–2012: Table 1

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