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Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults?
Abstract
To investigate associations between social anxiety and smoking behaviour in order to explore whether social anxiety predicts the first onset of cigarette smoking, regular smoking and the development of nicotine dependence. Baseline and four-year follow-up data from the Early Developmental Stages of Psychopathology Study (EDSP), a prospective-longitudinal community study of 3,021 adolescents and young adults, are used. Smoking behaviour and psychopathology were assessed with the M-CIDI and its DSM-IV algorithms. At baseline, 35.7% of the sample were regular smokers, and 18.7% fulfilled criteria for DSM-IV nicotine dependence. Twenty-seven point two percent reported at least one social fear, and 7.2% met criteria for DSM-IV social phobia, most of whom reported first onset of social fear problems clearly prior to smoking initiation. Cross-sectional retrospective baseline analyses based on retrospective reports revealed that social fears and DSM-IV social phobia were both significantly associated with higher rates of nicotine dependence. Prospective-longitudinal analyses that were conducted in an attempt to confirm cross-sectional retrospective results showed that baseline non-users with social fears (OR = 3.85) and baseline non-dependent users with social fears (OR = 1.5) had an increased risk of onset of nicotine dependence during the follow-up period of four years. These findings remained significant even when controlling for co-morbid depressive disorders. Social anxiety was found to be significantly associated with nicotine dependence in both cross-sectional retrospective and prospective-longitudinal analyses. It is suggested that social fears could lead to heavy tobacco use as smoking is a socially acceptable behaviour that relieves anxiety in social situations. Possible differential effects of social anxiety on the early stages of smoking behaviour compared to effects on nicotine dependence are discussed. These findings should stimulate a continued search into potentially causal links between social fear symptoms and the development of tobacco consumption and nicotine dependence in adolescence.
... People with social anxiety experience great fear when they are in social situations; they are worried about not performing well in these situations and, as a result, they tend to feel embarrassed and often avoid social situations (American Psychiatric Association, 2013). Social anxiety is associated with daily smoking and smoking urge/motives and dependence (Buckner, Zvolensky, & Lewis, 2019;Niaura, Shadel, Britt, & Abrams, 2002;Sonntag, Wittchen, Höfler, Kessler, & Stein, 2000), especially in men (Buckner & Vinci, 2013). Smoking may be a socially acceptable strategy to cope with anxiety in social interactions (Sonntag et al., 2000), so that nicotine-dependent individuals who experience high social anxiety tend to smoke to become relaxed and comfortable in social situations, and to reduce anxiety and negative affect (Dahne, Hise, Brenner, Lejuez, & MacPherson, 2015;Watson, DeMarree, & Cohen, 2018;Watson, VanderVeen, Cohen, DeMarree, & Morrell, 2012). ...
... Social anxiety is associated with daily smoking and smoking urge/motives and dependence (Buckner, Zvolensky, & Lewis, 2019;Niaura, Shadel, Britt, & Abrams, 2002;Sonntag, Wittchen, Höfler, Kessler, & Stein, 2000), especially in men (Buckner & Vinci, 2013). Smoking may be a socially acceptable strategy to cope with anxiety in social interactions (Sonntag et al., 2000), so that nicotine-dependent individuals who experience high social anxiety tend to smoke to become relaxed and comfortable in social situations, and to reduce anxiety and negative affect (Dahne, Hise, Brenner, Lejuez, & MacPherson, 2015;Watson, DeMarree, & Cohen, 2018;Watson, VanderVeen, Cohen, DeMarree, & Morrell, 2012). Also, socially anxious individuals who replace cigarettes with social interactions are more likely to be dependent on nicotine because of experiencing anxiety in these interactions (Buckner & Vinci, 2013). ...
... We know that anxiety-inducing social situations and affective responses to these situations increase the likelihood of smoking (Niaura et al., 2002). Socially anxious individuals are more likely to smoke and become dependent on cigarettes than those who are less socially anxious (Sonntag et al., 2000), and in individuals with high anxiety in social situations, smoking is a socially acceptable way to reduce fear and anxiety in these situations (Sonntag et al., 2000). Smokers with high social anxiety, when placed in stressful social situations, tend to use cigarettes to cope with symptoms resulting from social anxiety, and then after smoking they feel relieved of social stress (Watson et al., 2018). ...
Anxiety in social interactions is an important factor in cigarette use and nicotine dependence. Metacognitions about smoking have been found to predict smoking behavior and may help understand the relationship between anxiety in social interactions and nicotine dependence. In the current study, we evaluated the direct effect of anxiety in social interactions on nicotine dependence and its indirect effect through metacognitions (controlling for anhedonia and depression) in nicotine-dependent men (n = 388). Participants completed measures of anxiety in social interactions [the Social Interaction Anxiety Scale (SIAS)], anhedonia [the Snaith HamiltonPleasure Scale (SHAPS)], metacognitions about smoking [e.g., theMetacognitions aboutSmoking Questionnaire (MSQ)] nicotine dependence [the Fagerström Test for Nicotine Dependence (FTND)], and clinical factors related to smoking including depressive symptoms [e.g., the Beck Depression Inventory-II (BDI-II)]. As expected, after controlling for depressive symptoms and anhedonia, anxiety in social interactions indirectly affected nicotine dependence through negative metacognitions about smoking, but not positive metacognitions. These findings are discussed in relation to the metacognitive model of addictive behaviors.
... Several factors are associated with the onset and maintenance of tobacco use, in particular symptoms of anxiety and depression, and the influence of family members (Rondina et al. 2007;Schuck et al. 2012). There is a strong correlation between psychological factors and the consumption of tobacco, as well as other drugs (Sonntag et al. 2000;Rondina et al. 2007;Wand 2008). Clinical investigations have indicated a reduced probability of smoking cessation in smokers diagnosed with depression, and higher chances of relapse in abstinence periods compared with smokers without depression (Rondina et al. 2007). ...
... Recent evidence has demonstrated that the main reason why people use tobacco is to reduce anxiety and induce a relaxed state (Fidler and West 2009;Slopen et al. 2012;Torres and O'Dell 2016). According to Sonntag et al. (2000) individuals with a fear of social interaction have a higher risk of tobacco dependence, and smoking in the presence of a stressor event has been associated with reduced anxiety (Kassel and Shiffman 1997;Sonntag et al. 2000). Kassel and Shiffman (1997) revealed that smoking reduces the focus of attention from stressful thoughts and consequently attenuates anxiety. ...
... Recent evidence has demonstrated that the main reason why people use tobacco is to reduce anxiety and induce a relaxed state (Fidler and West 2009;Slopen et al. 2012;Torres and O'Dell 2016). According to Sonntag et al. (2000) individuals with a fear of social interaction have a higher risk of tobacco dependence, and smoking in the presence of a stressor event has been associated with reduced anxiety (Kassel and Shiffman 1997;Sonntag et al. 2000). Kassel and Shiffman (1997) revealed that smoking reduces the focus of attention from stressful thoughts and consequently attenuates anxiety. ...
Aim Psychological factors play an important role in tobacco dependence. However, few investigations have focused on smokers’
own perception about motivations for tobacco consumption using open-ended questions.
Subject and method In this study, we used the Collective Subject Discourse (CSD) method to investigate the motivations for
tobacco use according to smokers’ own perception in 135 current smokers.
Results The vast majority of patients (83.7%) reported that they smoked cigarettes when seeking relief or emotional comfort.
When asked why they smoked, most declared they smoked due to stress, anxiety, or nervousness. Long-term smokers reporting
using cigarettes to feel pleasure, in contrast to short-term smokers, who mostly reported they smoked because they felt stress or
anxiety (p < 0.001). Most of the patients (71.2%) also reported emotional factors as the reason for increasing the desire to smoke.
Heavy smokers smoked more in moments when they felt alone compared to light smokers (p = 0.034).
Conclusion The smokers’ collective discourses demonstrate that from their own perception, psychological factors are the motivational
basis for their use of cigarettes. Therefore, most smokers are conscious of the impact of emotional factors on smoking
dependence, and this may play a critical role in quit-smoking programs, as well as presenting an important factor for public health.
... Several factors are associated with the onset and maintenance of tobacco use, in particular symptoms of anxiety and depression, and the influence of family members (Rondina et al. 2007;Schuck et al. 2012). There is a strong correlation between psychological factors and the consumption of tobacco, as well as other drugs (Sonntag et al. 2000;Rondina et al. 2007;Wand 2008). Clinical investigations have indicated a reduced probability of smoking cessation in smokers diagnosed with depression, and higher chances of relapse in abstinence periods compared with smokers without depression (Rondina et al. 2007). ...
... Recent evidence has demonstrated that the main reason why people use tobacco is to reduce anxiety and induce a relaxed state (Fidler and West 2009;Slopen et al. 2012;Torres and O'Dell 2016). According to Sonntag et al. (2000) individuals with a fear of social interaction have a higher risk of tobacco dependence, and smoking in the presence of a stressor event has been associated with reduced anxiety (Kassel and Shiffman 1997;Sonntag et al. 2000). Kassel and Shiffman (1997) revealed that smoking reduces the focus of attention from stressful thoughts and consequently attenuates anxiety. ...
... Recent evidence has demonstrated that the main reason why people use tobacco is to reduce anxiety and induce a relaxed state (Fidler and West 2009;Slopen et al. 2012;Torres and O'Dell 2016). According to Sonntag et al. (2000) individuals with a fear of social interaction have a higher risk of tobacco dependence, and smoking in the presence of a stressor event has been associated with reduced anxiety (Kassel and Shiffman 1997;Sonntag et al. 2000). Kassel and Shiffman (1997) revealed that smoking reduces the focus of attention from stressful thoughts and consequently attenuates anxiety. ...
Aim
Psychological factors play an important role in tobacco dependence. However, few investigations have focused on smokers’ own perception about motivations for tobacco consumption using open-ended questions.
Subject and method
In this study, we used the Collective Subject Discourse (CSD) method to investigate the motivations for tobacco use according to smokers’ own perception in 135 current smokers.
Results
The vast majority of patients (83.7%) reported that they smoked cigarettes when seeking relief or emotional comfort. When asked why they smoked, most declared they smoked due to stress, anxiety, or nervousness. Long-term smokers reporting using cigarettes to feel pleasure, in contrast to short-term smokers, who mostly reported they smoked because they felt stress or anxiety (p < 0.001). Most of the patients (71.2%) also reported emotional factors as the reason for increasing the desire to smoke. Heavy smokers smoked more in moments when they felt alone compared to light smokers (p = 0.034).
Conclusion
The smokers’ collective discourses demonstrate that from their own perception, psychological factors are the motivational basis for their use of cigarettes. Therefore, most smokers are conscious of the impact of emotional factors on smoking dependence, and this may play a critical role in quit-smoking programs, as well as presenting an important factor for public health.
... and some anxiety disorders (Burke & Stephens, 1999;Kimbrel, Morissette, Gulliver, Langdon, & Zvolensky, 2014;McCabe et al., 2004;Sonntag, Wittchen, Höfler, Kessler, & Stein, 2000). Although social anxiety is a particularly common psychological problem, and despite the often social nature of smoking, there have been few attempts to find out how these factors are related to the risk of starting cigarette smoking or nicotine dependence. ...
... Tobacco seems to be used to cope with social avoidance in a collectivist cultural context, and to cope with negative affect (i.e. to regulate anxiety) in an individualist cultural context. These findings are consistent with studies suggesting that adults with a high level of social anxiety tend to smoke to relieve the anxiety elicited by social stressors (Kassel, Stroud, & Paronis, 2003;Sonntag et al., 2000). ...
... The present findings suggest that fear of performance in situations generating a strong sense of exposure leads to heavy tobacco use. This is in line with previous research indicating that, in individualist contexts where the self is viewed as independent, smoking is considered by individuals with social anxiety disorder to be a socially acceptable behavior for coping with performance anxiety in social situations (Sonntag et al., 2000). ...
We investigated the role of culture in the relationship between social anxiety and tobacco dependence in a collectivist country (Republic of Moldova) and an individualist Western country (France). More specifically, we examined this relationship among young French (n = 225) and Moldovan (n = 288) adults aged between 18 and 30 years. Moldovan daily smokers had higher fear of performance and fear of social interaction scores than Moldovan non-smokers. Moldovan and French smokers with a low level of cigarette dependence had lower social anxiety scores than those with a medium or high level of cigarette dependence. However, whereas heavy cigarette dependence was mainly associated with avoidance of social interaction in the Moldovan sample, it was mainly associated with performance concerns (fear and avoidance) in the French sample. Cultural context may mediate the co-occurrence of social anxiety and tobacco smoking.
... In the literature, there is a significant increase in nicotine use in the presence of SAD 21,30,41,42 . Potential causal links between social anxiety symptoms and nicotine dependence in adolescence should be investigated 43 . Social anxiety was found to be significantly associated with nicotine dependence in both cross-sectional retrospective and prospective-longitudinal analyses. ...
... Possible differential effects of social anxiety on the early stages of smoking behaviour compared to effects on nicotine dependence are discussed. These findings should stimulate a continued search into potentially causal links between social anxiety symptoms and the development of tobacco consumption and nicotine dependence in adolescence 43 . In our study, it was concluded that having a close friend significantly reduced SAD. ...
Introduction and Aim: Social phobia; It is a public health problem that can lead to failure in working life, major depression and even suicide.The aim of this study was to investigate the prevalence of social phobia and related factors in academicians from Cumhuriyet University. Method: This cross-sectional study was performed in 2017. The universe of the study consists of 1605 academicians working in the health, science and social science fields of Cumhuriyet University. The sample size was determined as 216. A two-part questionnaire was applied to the participants. The first part consists of questions that investigating the sociodemographic characteristics and the variables that we think are related to social phobia. The second part consists of Liebowitz Social Anxiety Scale (LSAS) Results: The frequency of social phobia was found to be 9.0%. While the prevalence of mild and significant social phobia was 3.6%, the prevalence of social phobia was 1.8%. More than half of the academicians show avoidance behavior in situations requiring performance. Conclusion: As a result, it has been found that social phobia has a significant frequency of 9.0%. This situation, which may adversely affect the professional performance and mental health of academicians, is important for public health.
... One of the factors linked to smoking in adolescence is social anxiety [55]. Studies report that SAD individuals have higher rates of drinking, smoking, and drug use than non-SAD individuals [56,57,58]. Moreover, a recent study in high school students reported association between social anxiety and positive attitudes towards cigarette smoking [59]. ...
... Several studies report that individuals with high anxiety are more likely to smoke [58,61,62,63]. Many factors were accused in this association such as the use of cigarettes as a self-treatment to reduce anxiety and the increased effect of peer pressure in those suffering from anxiety [64,65]. ...
Social anxiety disorder (SAD) is highly prevalent among adolescents but little is known
about its prevalence in Saudi adolescents. Objectives: we aimed to determine the prevalence of SAD and investigate
its associated correlates among Saudi adolescent females. Methods: A cross sectional study design was conducted at
Taif university in the period from January to May 2016. A self-report pre-designed questionnaire was distributed to
the students about personal factors and Social Phobia Inventory (SPIN) which is a reliable and valid psychometric
tool of screening SAD. Results: Data of 957 female students were analyzed and rendered a prevalence of 16.3% for
SAD among them. Most of the affected students had a moderate degree of the disorder in 43.5% of cases. Personal
factors significantly associated with SAD in univariate analysis were obese weight perception (p <0.001), having
body deformities (p = 0.004), insufficient income (p = 0.003), 1st birth order (p = 0.006), parental conflict
(p = 0.003), parental death (p <0.001) and smoking (p <0.001). Conclusion and recommendations: Our results
show there is a high prevalence of SAD among female university students in Taif, Saudi Arabia. Independent
personal factors associated with SAD in our study were smoking, parent death and obese weight perception. Based
on the high prevalence encountered in our study, we recommend early detection and intervention to reduce the
overall burden associated with this psychiatric disorder in the adolescent population as emphasized by the literature.
... 13 A study from Germany in 1995 reported nicotine dependence among 19% of 14-24-year-old regular smokers. 14 Additionally, a study in 2007 in Finland reported 44% of the daily smoking 14-18 years old population being nicotine dependent. 15 Latter two studies used the Heaviness of Smoking Index (HSI). ...
... This estimate falls in between North-American estimates of 63 and 66%, 8,13 44% in Finland, and 19% in Germany. 14,15 The latter study used the Heaviness of Smoking Index (HSI) to quantify nicotine dependence, which includes questions regarding the amount smoked and, therefore, considers consumption an indicator for nicotine dependence. 15 The SDI only measures behavioural changes due to the availability of nicotine. ...
Background:
Nicotine dependence during adolescence increases the risk of continuing smoking into adulthood. The magnitude of nicotine dependence among adolescents in the European Union (EU) has not been established. We aimed to estimate the number of nicotine dependent 15-year-old adolescents in the EU, and identify high-risk groups.
Methods:
The number of nicotine dependent 15-year-olds in the EU was derived combining: (i) total number of 15-year-olds in the EU (2013 Eurostat), (ii) smoking prevalence among 15-year-olds (2013/2014 HBSC survey) and (iii) proportion of nicotine dependent 15-year-olds in six EU countries (2013 SILNE survey). Logistic regression analyses identified high-risk groups in the SILNE dataset.
Results:
We estimated 172 636 15-year-olds were moderately to highly nicotine dependent (3.2% of all 15 years old; 35.3% of daily smokers). In the total population, risk of nicotine dependence was higher in males, adolescents with poor academic achievement, and those with smoking parents or friends. Among daily smokers, only lower academic achievement and younger age of smoking onset were associated with nicotine dependence.
Conclusion:
According to our conservative estimates, more than 172 000 15-year-old EU adolescents were nicotine dependent in 2013. Prevention of smoking initiation, especially among adolescents with poor academic performance, is necessary to prevent a similar number of adolescents getting addicted to nicotine each consecutive year.
... Un facteur de risque de dépendance tabagique largement documenté est la comorbidité avec des troubles psychiatriques, en particulier l'humeur dépressive, l'anxiété, et les troubles de personnalité [77][78][79][80][81]. Des comportements tels que la délinquance, la névrose et la recherche de nouveautés sont également des facteurs de risque de dépendance tabagique [48,74]. ...
... Références citées dans cet article:[3,48,49,52,53,58,59,64,70,[74][75][76][77][78][79][80]114,[139][140][141][142][143][144][145][146][147][148][149][150][151] ...
Contexte - La majorité des fumeurs adultes ont commencé à fumer à l'adolescence et sont devenus dépendants avant l'âge de vingt ans. La plupart des efforts de lutte contre le tabagisme des jeunes se sont centrés sur la prévention de l'initiation et peu sur l'aide au sevrage. Sur ce constat, nous avons proposé de mettre en place une démarche originale de sevrage basée sur une offre de proximité associant le sevrage médicamenteux aux thérapies cognitivo-comportementales. Dans une perspective de réduction des inégalités sociales de santé, nous avons souhaité centrer notre action sur une population particulièrement vulnérable habituellement peu sollicitée, celle des jeunes apprentis. Avant de généraliser une telle intervention, il était important d'en évaluer l'efficacité.Objectif - 1) décrire les caractéristiques du tabagisme dans une population socialement défavorisée, les apprentis 2) puis mettre en évidence les déterminants de la dépendance au tabagisme dans cette population 3) et enfin répondre à l'objectif principal qui est l'évaluation de l'efficacité de l'offre d'un programme de sevrage tabagique au sein de cette population.Méthode - Cette étude quasi-expérimentale, prospective, comparative s'est déroulée au cours des 2 années d'apprentissage. La population était composée de l'ensemble des stagiaires de huit CFA (Centre de Formation des Apprentis) en Lorraine. Le groupe intervention (3 CFA) a bénéficié du programme TABADO, et le groupe témoin (5 CFA) n'a reçu aucune intervention spécifique autre que les services éducatifs généralement disponibles. Résultats - Parmi les 1.814 élèves interrogés (770 dans le groupe intervention, 1044 dans le groupe témoin), 52% étaient fumeurs dont 89,4% de fumeurs quotidiens, et 5,7% ex-fumeurs. L'âge moyen d'initiation au tabagisme était de 12,1 ans (ET=2,1) et celui du début du tabagisme régulier de 13,8 ans (ET=1,6). La consommation actuelle des fumeurs s'élevait en moyenne à 12,8 cigarettes par jour (ET=7,8). Le score moyen de dépendance des adolescents fumeurs interrogés était de 6,1 (ET=2,8), d'après le test du Hooked On Nicotine Checklist (score de 0 à 10= fortement dépendant). Les déterminants de la dépendance mis en évidence étaient : le genre féminin, le tabagisme quotidien, une forte consommation moyenne journalière, la co-consommation de cannabis, un environnement fumeur et un haut score de vulnérabilité perçue. Les facteurs perçus comme incitant à fumer (automatisme du geste, gestion du stress et soutien du moral) étaient également des facteurs de dépendance. Sur les 584 fumeurs à J0 suivis à J0+12 mois, 17% étaient devenus abstinents dans le groupe d'intervention vs. 11,9% dans le groupe témoin (p = 0,08 univariée, p = 0,008 ajusté ; odds ratio [OR] 2,1; 95% intervalle de confiance [IC] 1.2 à 3.6). Conclusion - Notre étude a permis de produire des données originales sur l'efficacité d'une action de sevrage tabagique dans une jeune population socialement défavorisée qui avait été très peu investiguée jusqu'à présent. La combinaison de la proximité de l'action d'information et de soutien psychologique, et d'une offre gratuite de substituts nicotiniques paraît comme une condition du succès. La mise en évidence d'un effet groupe devrait permettre à l'avenir d'élaborer des programmes facilitant cet effet des réseaux sociaux
... One of the factors linked to smoking in adolescence is social anxiety [55]. Studies report that SAD individuals have higher rates of drinking, smoking, and drug use than non-SAD individuals [56,57,58]. Moreover, a recent study in high school students reported association between social anxiety and positive attitudes towards cigarette smoking [59]. ...
... Several studies report that individuals with high anxiety are more likely to smoke [58,61,62,63]. Many factors were accused in this association such as the use of cigarettes as a self-treatment to reduce anxiety and the increased effect of peer pressure in those suffering from anxiety [64,65]. ...
... Particularmente, se ha encontrado una clara asociación entre la elevada prevalencia del consumo de tabaco y ciertos trastornos de ansiedad, como el trastorno de pánico (Amering et al., 1999;Abrams et al., 2008;Feldner et al., 2009;McCabe et al., 2004), el trastorno por estrés postraumático (Feldner, Babson y Zvolensky, 2007;Iruarrizaga, Miguel-Tobal, Cano-Vindel y González-Ordi, 2004;Koenen et al., 2005;Parslow y Jorm, 2006), el trastorno de ansiedad generalizado (Baker-Morissette, Gulliver, Wiegel y Barlow, 2004;Lasser et al., 2000) y la fobia social (Sonntag et al., 2000). La única excepción la constituye el trastorno obsesivo compulsivo (Leal-Carcedo y Cano-Vindel, 2008), cuya comorbilidad con el consumo de tabaco (8-22%) parece ser tan baja (Baker- Morissette et al., 2004;McCabe et al., 2004) debido a las características propias de dicho trastorno (e.g., miedo a la enfermedad, la contaminación, etc.), aunque dicha especulación debería ser rigurosamente examinada en futuras investigaciones. ...
... Sin embargo, la evidencia disponible a favor de esta hipótesis se ha obtenido mayoritariamente a través de estudios sobre el alcohol, no sobre tabaco y, como se ha constatado anteriormente, existe una relación temporal entre tabaco (como variable antecedente) y los trastornos de ansiedad, pero no en sentido opuesto (Breslau, 1995;Breslau, Kilbey y Andreski, 1991), salvo en el caso de la fobia social (Cano-Vindel, Miguel-Tobal et al., 1994). Algunos estudios parecen indicar que la fobia social es un predictor significativo del consumo de tabaco (Sonntag, Wittchen, Hofler, Kessler y Stein, 2000;Wittchen, Stein y Kessler, 1999). Por lo tanto, en el caso del tabaco, no siempre se cumple el primer postulado básico de la hipótesis del mantenimiento. ...
Tobacco use is the first preventable cause of death. This is associated not only with physical illness and a shorter life expectancy, but also with different mental disorders such as anxiety disorders. Given the low risk perception of use, this paper reports a systematic review of the scientific literature on the relationship between anxiety and tobacco from an emotional perspective, including data on smoking prevalence, factors associated with the onset and maintenance of tobacco use, as well as those factors that hamper smoking cessation and increase relapse rates. The high rates of comorbidity between tobacco use and anxiety disorders make necessary the development of new and better tobacco cessation treatments, especially designed for those smokers with high state anxiety or anxiety sensitivity, with the aim of maximizing the efficacy.
... An early start of this substance use predicts later dependence and abuse. For example, youth who start drinking or smoking in early or midadolescence have a higher risk for alcohol use disorder [14] or daily smoking [15,16] later in life than those who start at a later age. Because substance use frequently starts in adolescence and has consequences for later use or even abuse, it seems very important to learn more about factors that facilitate or impede the beginning of these behaviors in this period of life. ...
... In a person's lifetime, social anxiety appears to precede substance use [see review [25]]. In addition, social fears and social anxiety disorder predict later alcohol abuse [25] and nicotine dependency [16]. However, a question that has not yet been answered is why some socially anxious adolescents start smoking, drinking, or using drugs while others do not. ...
The aim of this study was to further our understanding of the link between social anxiety and substance use in adolescents, in particular the role susceptibility to peer pressure plays in this link. The relation between social anxiety and susceptibility to peer pressure was studied in two community samples ( n = 534 and n = 117 ) each consisting of two age groups (12-13 and 15–17 years). The relation of these two variables with substance use was evaluated in the second sample using regression analysis. Social anxiety was related to susceptibility to peer pressure in both groups and not related to substance use in the younger group and negatively related to substance use in the older group. Susceptibility to peer pressure acted as a suppressor in the relation between social anxiety and substance use. Results suggest that socially anxious adolescents basically avoid substance use but, if susceptible, may yield to peer pressure and start using substances. Parents, teachers, and therapists should be aware of this susceptibility to possibly negative peer pressure of socially anxious adolescents.
... For example, among US adults who are nicotine-dependent, the majority also have a comorbid psychiatric disorder (Grant et al. 2004). Nicotine dependence is strongly correlated with depression (Breslau et al. 1991;Grant et al. 2004;Jorm 1999) and anxiety (Breslau et al. 1991;Sonntag et al. 2000). Smokers who experienced more difficulty abstaining and stronger withdrawal symptoms also showed higher scores on depression questionnaires (Pomerleau et al. 2005), and had a greater drop in cortisol levels during quit attempts (Frederick et al. 1998). ...
RationaleCd81 -/- (knockout) mice have previously been reported to have reduced cocaine preference and increased striatal dopamine content and dopamine turnover, but normal learning and memory in the Morris water maze. The effects of Cd81 on other behaviors and drugs of abuse have not been investigated.Objectives and methodsWe measured the effects of Cd81 -/- in a modified two-bottle choice test for nicotine, as well as in somatic signs of nicotine withdrawal, four tests of affective behavior, and tyrosine hydroxylase gene expression assays.ResultsWe found that Cd81 loss-of-function significantly increased voluntary nicotine consumption and somatic signs of nicotine withdrawal. Nicotine consumption of Cd81 -/- female mice increased for 3 weeks and then remained relatively stable for the next 5 weeks, suggesting that their nicotine consumption continued to be limited by aversion to higher nicotine doses. Cd81 -/- also produced a dramatic and significant increase in struggling in the forced swim test and a significant increase in the time spent in the light chamber of the light/dark box. The elevated plus maze and the tail suspension test did not show a main effect of genotype. Therefore, we conclude that Cd81 did not have an overall effect on anxiety- or depression-like behavior. Tyrosine hydroxylase mRNA levels were unchanged.Conclusions
Cd81 knockouts have a strongly increased nicotine preference, plus a proactive response to specific stressful situations. Together with reports of increased striatal dopamine content and anecdotal reports of increased aggressiveness, these provide intriguing parallels to some aspects of post-traumatic stress disorder.
... 43 Sonntag et al found that individuals with social phobia were more likely to also have nicotine dependence. 44 Many individuals may smoke because of the presumed calming effects of nicotine and as a way of managing their anxiety. However, smoking may rather serve to exacerbate symptoms by increasing the heart rate, BP and plasma norepinephrine and epinephrine. ...
Objectives
Anxiety and depression (A&D) are common mental disorders with high economical and health burdens. This study aimed to investigate the prevalence and the incidence rate of A&D symptoms and their relationship with sociodemographic and other risk factors and comorbidities in adults living in southeastern Iran.
Design
A population-based cohort study with random cluster household survey sampling method.
Setting
Second round of Kerman Coronary Artery Disease Risk Factors Study (KERCADRS) (2014–2018) performed in Southeastern, Iran.
Participants
We recruited 9997 participants (15–80 years) in the second round of the study, from whom 2820 persons were the people who also participated in the first round of KERCADRS in 2009–2012. The age-standardised A&D prevalence was measured among all participants, and the 5-year A&D incidence rate was measured in those who were free from A&D in the first round in 2009–2012 and were at risk of A&D in the follow-up. The relationship between A&D and demographic characteristics, smoking, opium use, obesity and physical activity was assessed by logistic regression models.
Results
Overall, the prevalence of anxiety (48.1% to 16.4%, p<0.001) and depression (5.9% to 1.3%, p<0.001) decreased between the two rounds. The highest prevalence of anxiety was among widowed (31.4%), unemployed (21.3%), obese (19.4%), and opium users (17.4%). Young adults, women, those divorced or widowed, and those with obesity and low physical activity had a higher chance of developing anxiety. The 5-year incidence rate (person/1000 person-years) was 15.0 for anxiety and 3.9 for depression.
Conclusion
Despite the overall decrease in the prevalence of A&D symptoms in last 5 years in the area, young adults, women, unemployed, opium users, people with low physical activity and those with obesity had a higher chance of developing anxiety and are in need of more targeted interventions.
... This was consistent with the results of a review study that showed smoking was strongly associated with anxiety disorders and clinical depression [41]. Sonntag et al. found that individuals with social phobia were more likely to also have nicotine dependence [42]. Many individuals may smoke because of the presumed calming effects of nicotine and as a way of managing their anxiety. ...
Background: Anxiety and depression (A&D) are common mental disorders with high economical and health burdens. This study aimed to investigate the prevalence and the incidence rate of A&D and their relationship with socio-demographic and other risk factors and co-morbidities in adults living in southeastern Iran.
Method: We recruited adults (15 to 80 years) in two rounds (2009-2012, 2014-2018) of a population-based cohort study called Kerman coronary artery disease risk factors study (KERCADRS) in Kerman, Iran. The age-standardized A&D prevalence was measured among all participants (n=9996) and the five-year A&D incidence rate was measured in those who were free of A&D in the first round (n = 2813). The relationship between A&D and demographic characteristics, smoking, opium use, obesity and physical activity was assessed by logistic regression models.
Results: Overall, the prevalence of anxiety (48.1% to 16.4%, P-value <0.001) and depression (5.9% to 1.3% P-value <0.001) decreased between the two rounds. The highest prevalence of anxiety was among people who were unemployed (%?), smokers (%?), and opium users (%?). Young adults, women, those divorced or widowed, and those with obesity and low physical activity had a higher chance for anxiety. The five-year incidence rate (person/1000 person-years) was 15.0 for anxiety and 3.9 for depression.
Conclusion: Despite the overall decrease in the prevalence of A&D, certain groups such as young adults, women, unemployed and those who smoke cigarettes or opium, people with low physical activity and obesity are in need of more targeted interventions.
... Research investigating the association of child and adolescent anxiety disorders with risk factors for CVD has focused primarily on participation in unhealthy lifestyle behaviours (eg, cigarette smoking, alcohol use, dietary patterns). Studies on the association of adolescent anxiety disorders with future nicotine dependence/heavy cigarette smoking have yielded conflicting results, with most, [70][71][72] but not all, 73 studies reporting that anxiety disorders confer increased risk of future smoking. In the general population, anxiety disorders among adolescents are associated with increased risk of alcohol use and alcohol use disorders. ...
This narrative review, emphasizing children and adolescents, addresses the link between five psychiatric disorders and cardiovascular risk: attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, anxiety disorders, depression, and bipolar disorders. The evidence regarding cardiovascular risk factors, non-invasive measures of early atherosclerosis, and cardiovascular disease prevalence and/or mortality is summarized. Whereas multiple studies have examined stimulant treatment of ADHD in relation to cardiovascular death, and autonomic-vagal function in autism spectrum disorders, little is known regarding atherosclerotic cardiovascular disease in these conditions. For anxiety disorders, there is a gap in knowledge regarding cardiovascular risk in clinical samples of youth. In contrast to the adult literature, there are few studies regarding depression diagnoses, as opposed to self-reported symptoms, in relation to cardiovascular risk in youth. For bipolar disorder, youth studies focusing on epidemiologic samples and various mood-stabilizing medications are warranted. General recommendations for future research include: larger samples, prospective repeated-measures studies, and the integration of clinical and biological mediators with non-invasive measures of early atherosclerosis. Overall, the potential implications of cardiovascular risk factors are multiplied in youth with psychiatric conditions, as these risk factors are relevant not only to cardiovascular disease but to mental health and cognitive function. A shift in thinking regarding treatment paradigms for youth with psychiatric disorders is warranted. Pending changes in clinical practice guidelines and care delivery models, patients, families, clinicians, and policy makers can act on currently available information to reduce cardiovascular risk among children and adolescents with psychiatric disorders.
... This was consistent with the results of a review study that showed smoking was strongly associated with anxiety disorders and clinical depression [40]. Sonntag et al. found that individuals with social phobia were more likely to also have nicotine dependence [41]. Many individuals may smoke because of the presumed calming effects of nicotine and as a way of managing their anxiety. ...
Background: Anxiety and depression (A&D) are very common disorders and among the important causes of morbidity. This study aimed to investigate the prevalence and the incidence rate of these mental disorders and their relationship with socio-demographic and coronary artery disease risk factors in the adult population in southeastern Iran.
Method: In a population based cohort study (KERCADRS phase2), the prevalence and five-year incidence rate of A&D and associated variables were studied on 9996 adults, 2820 of whom had also participated in phase1 of the study.
Results: The prevalence for A&D was 41.6% (30.6% men, 48.9% women) and 16.0% (10.0% men, 19.9% women), respectively. The prevalence of A&D showed a decreasing trend with increase of education and age. The highest prevalence of A&D was observed among the unemployed, smokers, and opium users. The chance of having A&D symptoms also significantly increased in young people, the female gender, divorced or widowed women, obese individuals, and those with low physical activity (LPA). In phase2, A&D were significantly lower than they were in phase1 in all age groups and in both genders. The five-year incidence rate (per 1000 person-years) was 30.7 for anxiety and 9.8 for depression.
Conclusion: Although there are some promising signs of reduction in the prevalence of A&D symptoms in the last five years, their higher prevalence in young people and females, along with their association with unemployment, smoking, opium use, LPA and obesity means that more effective interventions and strategies are needed to reduce the deleterious consequences of these disorders.
... The need for early identification of risk for anxiety disorder is evident. Childhood anxiety symptoms are associated with significant impairment in familial, social, and academic domains (Duchesne et al., 2010) and are frequently comorbid with other internalizing symptoms, particularly depression (Essau, Conradt, & Petermann, 1999;Sonntag, Wittchen, Höfler, Kessler, & Stein, 2000). For example, anxiety symptoms have pervasive negative effects on children including declines in academic performance , lower social competence (Pine & Klein, 2008), greater likelihood of peer rejection (Flanagan, Erath, & Bierman, 2008), concurrent depression , and increased risk of substance use/abuse (Wolitzky-Taylor, Bobova, Zinbarg, Mineka, & Craske, 2012). ...
Identifying early risk factors for the development of social anxiety symptoms has important translational implications. Accurately identifying which children are at the highest risk is of critical importance, especially if we can identify risk early in development. We examined continued risk for social anxiety symptoms at the transition to adolescence in a community sample of children ( n = 112) that had been observed for high fearfulness at age 2 and tracked for social anxiety symptoms from preschool through age 6. In our previous studies, we found that a pattern of dysregulated fear (DF), characterized by high fear in low threat contexts, predicted social anxiety symptoms at ages 3, 4, 5, and 6 years across two samples. In the current study, we re-evaluated these children at 11–13 years of age by using parent and child reports of social anxiety symptoms, parental monitoring, and peer relationship quality. The scores for DF uniquely predicted adolescents’ social anxiety symptoms beyond the prediction that was made by more proximal measures of behavioral (e.g., kindergarten social withdrawal) and concurrent environmental risk factors (e.g., parental monitoring, peer relationships). Implications for early detection, prevention, and intervention are discussed.
... Moreover, individuals with PTSD demonstrate greater difficulty maintaining nicotine abstinence (Lasser et al., 2000;Hapke et al., 2005) and are more likely to relapse following cessation attempts (Beckham et al., 2012). A bidirectional relationship between nicotine dependence and AD has also been identified in individuals with panic disorders(Cosci et al., 2010;Goodwin et al., 2005), phobias (Schumann et al., 2004;Sonntag et al., 2000), and generalized anxiety disorder (Moylan et al., 2012). Therefore, while nicotine use may attenuate symptoms of anxiety short-term (Robinson et al., 2009), it may also predispose individuals to AD by enhancing baseline symptom severity over time (.Although different AD are characterized by distinct symptoms, exaggerated fear responses are common across AD subtypes (Lissek et al., 2005;Shin & Liberzon, 2009). ...
Although considerable progress has been made, we do not fully understand the neuropsychological properties of nicotine that drive nicotine dependence. The present body of work provides an original investigation of the effects of nicotine on behavioral and physiological responding for rewarding and aversive stimuli in humans, which arises from considerable nonhuman investigations of nicotine’s complex interactions in conditioned learning. In order to accomplish this goal, three distinct studies were conducted. Given evidence that nicotine enhances operant responding for nonpharmacological reinforcers, Study 1 assessed the ability of nicotine to enhance food reward sensitivity using a virtual reality conditioned place preference paradigm. Acute administration of nicotine prior to conditioning resulted in partial reward enhancement in that nicotine-treated participants demonstrated place preferences by spending significantly more time in the previously rewarded context, while the placebo group did not. However, we did not observe significant differences between treatment groups. Study 2 explored differences in reward responding between nicotine users and non-users. Research suggests that nicotine users assign enhanced motivational salience to nicotine rewards; however, discrepancies exist as to whether this enhanced salience modulates the reward value of non-drug cues. Using physiological measures and explicit pleasurability ratings of affectively rewarding stimuli and drug-related cues, we found that nicotine users attributed enhanced incentive salience to nicotine rewards relative to non-users. However, we found little evidence of hyporeactivity to non-nicotine rewards among nicotine users. We also examined the effects of acute nicotine administration on these measures of reward processing but found no effect of nicotine in our nondependent sample. Finally, to extend nonhuman findings that nicotine particularly facilitates hippocampal-dependent fear learning, Study 3 measured the effects of acute nicotine on conditioned fear using a novel virtual reality fear conditioning paradigm. We observed nicotine-enhanced contextual fear learning but found no enhancement of trace fear. Hypotheses generated by these data provide insight into the mechanisms that underlie nicotine dependence and anxiety disorder comorbidity, as well as risks for the development and maintenance of nicotine use, and risks for relapse following cessation. Ongoing research may aid in the development of behavioral and pharmacological interventions and treatments for nicotine dependence.
... European data estimated that SAD cost €7277 million in direct health care costs in 2010, while indirect costs, factoring in absenteeism from work and early pension, amounted to €4806 million [6]. People affected by SAD reported impaired occupational productivity due to emotional problems and increased absences [7][8], and studies have found that they achieve lower educational attainment and earn wages 10% lower than a nonclinical population [9][10]. The core feature of SAD is a marked fear or anxiety about social interactions and performance situations in which one is exposed to possible evaluation by others, as described in the Diagnostic and Statistical Manual of Mental Disorders -5th edition [11]. ...
Background: Exposure therapy is highly effective for social anxiety disorder. However, there is room for improvement.
Objective: This is a first attempt to examine the feasibility of an arousal feedback–based exposure therapy to alleviate social
anxiety symptoms in an analogue adult sample.
Methods: A randomized, pilot, proof-of-concept trial was conducted to evaluate the acceptability, safety, and preliminary
efficacy of our treatment program. Sessions were administered once a week for 4 weeks (1 hour each) to an analogue sample of
50 young adults who reported at least minimal social anxiety symptoms. Participants in both intervention and waitlist control
groups completed assessments for social anxiety symptoms at the baseline, week 5, and week 10.
Results: Most participants found the intervention acceptable (82.0%, 95% CI 69.0%-91.0%). Seven (14.9%, 95% CI 7.0%-28.0%)
participants reported at least one mild adverse event over the course of study. No moderate or serious adverse events were reported.
Participants in the intervention group demonstrated greater improvements on all outcome measures of public speaking anxiety
from baseline to week 5 as compared to the waitlist control group (Cohen d=0.61-1.39). Effect size of the difference in mean
change on the overall Liebowitz Social Anxiety Scale was small (Cohen d=0.13).
Conclusions: Our results indicated that it is worthwhile to proceed to a larger trial for our treatment program. This new medium
of administration for exposure therapy may be feasible for treating a subset of social anxiety symptoms. Additional studies are
warranted to explore its therapeutic mechanisms.
Trial Registration: ClinicalTrials.gov NCT02493010; https://clinicaltrials.gov/ct2/show/NCT02493010
... While the relationship between SAD and other behavioral/psychological difficulties is well-noted (Grant et al., 2005), studies also have demonstrated linkages between elevated SA symptoms below diagnostic threshold, and negative outcomes typically associated with formal diagnosis (Fehm, Beesdo, Jacobi, & Fiedler, 2008). Elevated SA is linked with a host of negative outcomes in addition to experience of symptoms themselves (Beesdo et al., 2007), including emotional distress (Bruch, 1989;Storch et al., 2005), difficulties with intimacy in friendships (Vernberg, Abwender, Ewell, & Beery, 1992), increased risk for substance use problems (Essau et al., 1999;Sonntag, Wittchen, H€ ofler, Kessler, & Stein, 2000), depression (Stein et al., 2001), suicidality (Katzelnick et al., 2001;Nelson et al., 2000;Thibodeau, Welch, Sareen, & Asmundson, 2013), and impairments to overall functioning (Dell'Osso et al., 2003). ...
This study examined the extent to which social anxiety (SA) differed by dimensions of sexual identity, attraction, romantic and sexual history. Participants were 1133 emerging adults, 635 of whom endorsed a non-heterosexual identity and/or some same gender attraction or history. Individuals who reported a minority sexual identity, any same-gender attraction or experience reported greater SA compared to majority peers, particularly those with experience with/attraction to multiple genders. Differences are discussed in terms of implications/recommendations for mental health research and the need for research on nonbinary and intersectional identities.
... Sonntag et al. [39] have highlighted through a longitudinal study on 3021 adolescents and young adults, an association between social phobia, and anxiety disorders and the occurrence of a nicotinic dependency. The recognition of the importance played by the negative emotions in the smoking behavior has led some authors to suggest the use of antidepressants and anxiolytics as a treatment for tobacco dependence [40]. ...
Background:
Smokers with comorbid anxio-depressive disorders are more prone to progress to a more severe level of dependence and to experience more severe nicotine withdrawal symptoms than smokers without anxio-depressive disorders.
Aim of the study:
To determine the relationship between tobacco dependence and anxio-depressive disorders as well as assessing their impact on the withdrawal.
Methods:
We conducted a cross-sectional study among attendees of the smoking cessation clinic of Sahloul University Hospital, Sousse, Tunisia, from December 2009 to May 2015. The monitoring of the attendees was performed through retrieving the records until May 2016 in order to verify their smoking cessation status at 1 year.
Results:
Overall, 534 smokers were included. We identified 315 smokers (59%) presenting an anxio-depressive disorder. Based on the HAD scale, we found 231 patients (43.4%) with anxiety disorders, 200 (37.6%) patients with depressive disorders, and 116 (21.8%) patients with anxio-depressive disorder. In multivariate analysis, only a high number of consultation was associated with a better rate of tobacco cessation at 6 months. However, no factor was found linked to the relapse at 1 year.
Conclusion:
According to our results, only a high number of consultation was revealed as an independent factor of withdrawal for anxio-depressed smokers. It is necessary to simultaneously use the nicotinic substitutions and anxio-depressive treatment to ensure the tobacco cessation.
... General population factors associated with smoking include depression, general anxiety, social anxiety, low self-esteem, impulsivity, trauma, stress, alcohol use, poor academic performance and low socioeconomic status (SES) (Balk, Lynskey, & Agrawal, 2009;Johnson & Hoffmann, 2000;Kushner, Menary, Maurer, & Thuras, 2012;Leventhal et al., 2012;Leventhal & Zvolensky, 2015;Liu, 2003;Lynch, Kaplan, & Salonen, 1997;O'Loughlin, Dugas, O'Loughlin, Karp, & Sylvestre, 2014;Otten, Bosma, & Swinkels, 1999;Patton et al., 1998;Sonntag, Wittchen, Hofler, Kessler, & Stein, 2000). ...
Aim
To evaluate the role of tobacco use in the development of psychosis in individuals at clinical high risk.
Method
The North American Prodrome Longitudinal Study is a 2‐year multi‐site prospective case control study of persons at clinical high risk that aims to better understand predictors and mechanisms for the development of psychosis. The cohort consisted of 764 clinical high risk and 279 healthy comparison subjects. Clinical assessments included tobacco and substance use and several risk factors associated with smoking in general population studies.
Results
Clinical high risk subjects were more likely to smoke cigarettes than unaffected subjects (light smoking odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9‐5; heavy smoking OR = 4.8, 95% CI = 1.7‐13.7). In both groups, smoking was associated with mood, substance use, stress and perceived discrimination and in clinical high risk subjects with childhood emotional neglect and adaption to school. Clinical high risk subjects reported higher rates of several factors previously associated with smoking, including substance use, anxiety, trauma and perceived discrimination. After controlling for these potential factors, the relationship between clinical high risk state and smoking was no longer significant (light smoking OR = 0.9, 95% CI = 0.4‐2.2; heavy smoking OR = 0.3, 95% CI = 0.05‐2.3). Moreover, baseline smoking status (hazard ratio [HR] = 1.16, 95% CI = 0.82‐1.65) and categorization as ever smoked (HR = 1.3, 95% CI = 0.8‐2.1) did not predict time to conversion.
Conclusion
Persons at high risk for psychosis are more likely to smoke and have more factors associated with smoking than controls. Smoking status in clinical high risk subjects does not predict conversion. These findings do not support a causal relationship between smoking and psychosis.
... El control de la ansiedad ayuda a conseguir la cesación del consumo. El consumo severo de tabaco en adolescentes produce un riesgo 8 veces mayor de trastornos por ansiedad, entre ellos 5 veces más de trastorno de ansiedad generalizada, 7 de agorafobia y 15 de trastorno de pánico; además en los adolescentes con fobia social las posibilidades de pasar a ser dependientes de nicotina son 4 veces mayores [151][152][153] . ...
El tabaquismo es una enfermedad adictiva, reconocida como tal en los principales sistemas de clasificación de enfermedades. Nuestro estudio pretende conocer las variables principales y características epidemiológicas de esta enfermedad, así como su tratamiento.
Además se pretende hacer un estudio farmacoeconómico en el entorno de Castilla. La Mancha.
Nuestras conclusiones principales son:
1- El tratamiento antitabáquico es eficaz siendo el éxito global de un 16,4% y de un 32,27% si se incluyen sólo los que siguieron el tratamiento.
2- Los pacientes se distribuyeron entre ambos géneros de forma muy parecida, aunque predominaron ligeramente los hombres. Tenían 46 años, su dependencia fue moderada y su motivación, también moderada. Tuvieron importantes comorbilidades, entre las que destacó, además de la respiratoria y cardiovascular, la psiquiátrica.
3- El tratamiento antitabáquico en pacientes psiquiátricos fue efectivo y se consiguió completar el tratamiento farmacológico en una proporción igual en ambos grupos.
4- Se utilizaron los tratamientos de primera línea junto con la terapia cognitivo-conductual. A lo largo de los años se incrementó el uso de la vareniclina, disminuyendo la utilización del bupropion y la nicotina.
5- El éxito fue similar en ambos géneros. Hubo diferencias en ciertas comorbilidades, como las respiratorias, en las que el hecho de tenerlas fue perjudicial. Influyeron en el éxito completar el tratamiento y el tipo del mismo, mejor para bupropion y vareniclina, sin olvidar el psicológico.
6- Casi el 50% de los pacientes de la muestra abandonó el tratamiento antes de empezarlo, sin encontrar ninguna causa que lo justifique. El fracaso fue menor en los pacientes que completaron el tratamiento y, además, influyó el tipo de tratamiento.
7- El tratamiento antitabáquico es eficiente. Todos los tratamientos empleados son coste-efectivos en el entorno clínico.
... (Levinson et al., 2007), where some individuals only smoke solely in the context of social interactions. In one study, researchers found that fear and anxiety in social settings are likely to exacerbate smoking and addiction to nicotine in adolescents and young adults, even when controlling for frequently comorbid depressive disorders (Sonntag, Wittchen, H€ ofler, Kessler, & Stein, 2000). Identifying social smokers by the affective state (i.e., social fear or anxiety) leading to non-daily and social smoking helps to characterize previously unexplained variance in smoking motivation in the smoking population, and can therefore better inform smoking cessation intervention strategies targeting this unique group of social smokers. ...
Cigarette smoking is the leading preventable cause of death in the United States. The number of new smokers, specifically among adolescents, has risen rapidly in recent years. Thus, understanding the role of social influences on patterns of nicotine and tobacco use is important. Clinical studies have addressed the impact social relationships such as family members and peers have on smoking acquisition and susceptibility. As well, preclinical animal models have examined the impact of social factors on drug intake, acquisition, maintenance, and relapse. For example, environmental enrichment (EE) is a multi-faceted model that includes social factors, exercise, and novelty, among others. This model has elucidated addiction-related neurobehavioral effects of these different factors. However, there is a dearth of literature examining the impact of social partners on nicotine addiction and underlying neural mechanisms. Here we discuss the importance of social factors on nicotine addiction vulnerability, and propose new directions for addiction research that integrate social aspects of nicotine use.
... General population factors associated with smoking include depression, general anxiety, social anxiety, low self-esteem, impulsivity, trauma, stress, alcohol use, poor academic performance and low socioeconomic status (SES) (Balk, Lynskey, & Agrawal, 2009;Johnson & Hoffmann, 2000;Kushner, Menary, Maurer, & Thuras, 2012;Leventhal et al., 2012;Leventhal & Zvolensky, 2015;Liu, 2003;Lynch, Kaplan, & Salonen, 1997;O'Loughlin, Dugas, O'Loughlin, Karp, & Sylvestre, 2014;Otten, Bosma, & Swinkels, 1999;Patton et al., 1998;Sonntag, Wittchen, Hofler, Kessler, & Stein, 2000). ...
Background:
Most studies of neurocognitive functioning in Clinical High Risk (CHR) cohorts have examined group averages, likely concealing heterogeneous subgroups. We aimed to identify neurocognitive subgroups and to explore associated outcomes.
Methods:
Data were acquired from 324 participants (mean age 18.4) in the first phase of the North American Prodrome Longitudinal Study (NAPLS-1), a multi-site consortium following individuals for up to 2 1/2 years. We applied Ward's method for hierarchical clustering data to 8 baseline neurocognitive measures, in 166 CHR individuals, 49 non-CHR youth with a family history of psychosis, and 109 healthy controls. We tested whether cluster membership was associated with conversion to psychosis, social and role functioning, and follow-up diagnosis. Analyses were repeated after data were clustered based on independently developed clinical decision rules.
Results:
Four neurocognitive clusters were identified: Significantly Impaired (n = 33); Mildly Impaired (n = 82); Normal (n = 145) and High (n = 64). The Significantly Impaired subgroup demonstrated the largest deviations on processing speed and memory tasks and had a conversion rate of 58%, a 40% chance of developing a schizophrenia spectrum diagnosis (compared to 24.4% in the Mildly Impaired, and 10.3% in the other two groups combined), and significantly worse functioning at baseline and 12-months. Data clustered using clinical decision rules yielded similar results, pointing to high convergent validity.
Conclusion:
Neurocognitive profiles vary substantially in their severity and are associated with diagnostic and functional outcome, underscoring neurocognition as a predictor of illness outcomes. These findings, if replicated, are a first step toward personalized treatment for individuals at-risk for psychosis.
... Thus, the research of Sonntag et al. (2000) [35] find that in social phobia, which is the most common pathology among anxiety disorders, smoking is twice as common and often associated with alcohol. Moreover, comorbidity, between cannabis use and anxiety symptoms, has been found in several epidemiological and clinical studies in adolescents. ...
Adolescence is a period of pivotal change in brain development. It accompanied by profound cognitive-behavioral, somatic and psychic changes with increased vulnerability to risk taking. This work explores the current state of consumption of the main psychoactive substances (PAS), (tobacco, cannabis, alcohol) among schoolchildren, their interrelationships and the possible links with psychological suffering of anxious or depressive type. The study is a descriptive and analytical transversal type, carried out by a self-questionnaire and two neuropsychological tests evaluating depressive symptomatology: Adolescent Depression Rating Scale (ADRS) patient version in 10 items, and The Hospital Anxiety and Depression Scale (HADS), among 714 high school students aged 15 to 21 years, in Kenitra, Morocco. The results show that the population of adolescents who use psychoactive substances appears to be more depressed and more anxious than non-users. The prevalence of regular consumption of the three psychoactive substances is significant between girls and boys (p < 0.000), and shows that for: tobacco is 16.38% (14.52% girls, 85.47% boys); cannabis is 6.72% (1.7% girls, 95.83% boys); and alcohol is 5.88% (2.56% girls, 92.86% boys). These results encourage an emphasis on the school’s role in early detection of adolescent-specific pathologies such as anxiety and depression. As well as the development of strategy of prevention of consumption of the PAS, and the care of the pupils presenting anxious or depressive symptomatology. In addition, further longitudinal studies would be needed to establish causal links among anxiety, depression, and PAS use.
... Reported rates of smoking were highest among individuals with panic-related problems and other anxiety disorders where panic attacks are common (e.g., social phobia, posttraumatic stress disorder [PTSD], generalized anxiety disorder; Lasser et al., 2000). Similar findings have been found by others (Hapke et al., 2005;Sonntag, Wittchen, Hofler, Kessler, & Stein, 2000). Moreover, the observed association between smoking and anxiety psychopathology does not appear to be due to sociodemographic characteristics, other psychiatric comorbidities, or symptom overlap in diagnostic criteria for anxiety disorders and nicotine dependence (Zvolensky & Schmidt, 2003). ...
Disproportionately more smokers report low-income and mental health problems relative to non-smokers. Low-income smokers may use smoking to alleviate negative emotional states resulting from exposure to multiple stressors. Yet, little work has been devoted to elucidating mechanisms that may explain the association between negative emotional states and smoking-related processes among low-income smokers. The present study sought to address this gap by examining anxiety sensitivity, a transdiagnostic factor related to both anxiety and smoking, as a potential mediator for the influence of anxiety symptoms on smoking-related processes, including threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), perceived barriers for cessation, and problems experienced during past quit attempts. Participants included treatment-seeking daily cigarette smokers (n=101; 68.3% male; Mage=47.1; SD=10.2). Results indicated that anxiety symptoms exerted a significant indirect effect through anxiety sensitivity for threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), perceived barriers for cessation, and problems experienced during past quit attempts. The present results provide empirical support that anxiety sensitivity may be an underlying mechanism that partially explains the relation between anxiety symptoms and smoking processes among low-income treatment-seeking smokers. Findings broaden current theoretical understanding of pathways through which anxiety symptoms contribute to maladaptive smoking processes and cognitions among socioeconomically disadvantaged smokers.
... Individuals suffering from social anxiety often experience impairment in various functional domains such as employment or interpersonal relationships (Schneier et al., 1994;Stein, Torgrud, & Walker, 2000). Further, social anxiety is often related to other detrimental conditions including suicidal ideation, substance-related impairment, and depression (Buckner, Bernert, Cromer, Joiner, & Schmidt, 2008a;Buckner et al., 2008b;Davidson et al., 1993;Kessler et al., 1997;Sonntag, Wittchen, Höfler, Kessler, & Stein, 2000). ...
Background:
Social anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to social anxiety in predominantly White samples are related to social anxiety among historically underrepresented groups.
Design:
We tested whether one such vulnerability factor, post-event processing (PEP; detailed review of social event that can increase state social anxiety) was related to social anxiety among African-American (AA; n = 127) persons, who comprise one of the largest underrepresented racial groups in the U.S. Secondarily, we tested whether AA participants differed from non-Hispanic White participants (n = 127) on PEP and social anxiety and whether race moderated the relation between PEP and social anxiety.
Method:
Data were collected online among undergraduates.
Results:
PEP was positively correlated with social anxiety among AA participants, even after controlling for depression and income, pr = .30, p = .001. AA and White participants did not differ on social anxiety or PEP, β = -1.57, 95% CI: -5.11, 1.96. The relation of PEP to social anxiety did not vary as a function of race, β = 0.00, 95% CI: -0.02, 0.02.
Conclusions:
PEP may be an important cognitive vulnerability factor related to social anxiety among AA persons suffering from social anxiety.
... Epidemiological studies estimated about 1.1 billion daily smokers worldwide with 81% male smokers (Jha, Ranson, Nguyen, & Yach, 2002;World Health Organization, 2011) and an annual death rate of approximately 5 to 6 million people globally (Mathers & Loncar, 2006;World Health Organization, 2014). Smoking plays a role in regulating negative mood and emotions (Gilbert, 1995;Leung, Gartner, Dobson, Lucke, & Hall, 2011)supporting a high prevalence of nicotine dependence among individuals with emotional dysfunctions (Capron et al., 2012;Langdon et al., 2013;Luk & Tsoh, 2010;Sonntag, Wittchen, Hofler, Kessler, & Stein, 2000). Specifically, higher rates of smoking have been found among individuals diagnosed with anxiety disorders Grover, Goodwin, & Zvolensky, 2012;Ziedonis et al., 2008). ...
Background and objectives:
Both chronic smoking and trait anxiety have been associated with dysregulations in psychobiological stress response systems. However, these factors have not been studied in conjunction. We expected trait anxiety and smoking status to attenuate stress reactivity. Furthermore, we expected an allostatic load effect resulting in particularly attenuated stress reactivity in high-anxious smokers. In addition, high-anxious smokers were expected to exhibit increased urges to smoke in response to stress.
Methods:
115 smokers and 37 nonsmokers, aged 18-64 years, completed a laboratory session including mental stressors such as evaluated public speaking and mental arithmetic. Trait anxiety was assessed using Spielberger's State-Trait Anxiety Inventory. Cardiovascular autonomic indices, salivary cortisol, and the desire to smoke were measured at baseline, during stressors, and at recovery.
Results:
Regression analyses showed that smokers exhibited attenuated cardiovascular stress responses in comparison to nonsmokers. Higher trait anxiety predicted attenuated systolic blood pressure responses to stress. No interaction effect of smoking status and trait anxiety was found in stress response measures. Higher trait anxiety predicted an increased desire to smoke in response to stress among smokers.
Conclusion:
Results indicate that both smoking status and trait anxiety are associated with blunted sympatho-adrenal cardiovascular stress reactivity. Elevated urges to smoke in response to stress found among smokers with high trait anxiety suggest an important role of anxiety in smoking propensity and relapse.
... But mood and cognitive disorders appear to confer vulnerability to nicotine abuse according to dissociable processes more related to 'coping' or self-medication strategy, to regulate affective or cognitive symptoms (Gehricke et al. 2007). This is particularly well documented for high anxiety (Baker et al. 2004;Kushner et al. 2012;Picciotto et al. 2002;Salin-Pascual et al. 2003;Sonntag et al. 2000;Wong et al. 2013). Here, we demonstrate that both α5 gene deletion and targeted α5SNP expression lead to decreased rearing and increased anxietylike behaviour. ...
Rationale
Evidence links alterations in α5-containing nicotinic receptors (α5*-nAChRs) to nicotine addiction. Notably, the rs16969968 polymorphism in the α5 gene (α5SNP) increases the risk for heavy smoking and impairs nicotine-rewarding properties in mice. Additional work is needed to understand how native and polymorphic α5*-nAChRs contribute to processes associated with the risk for nicotine addiction.
Objectives
We aimed at understanding the contribution of α5*-nAChRs to endophenotypes like increased responses to novelty and anxiety, known to promote vulnerability to addiction, and to the response of the dopamine and serotonin systems to nicotine.
Methods
Behavioural phenotypes were investigated in mice lacking the α5 gene (α5−/−). Nicotine injections were performed to test the consequences of nicotine exposure on the phenotypes identified. Dopamine and serotonin signalling were assessed using in vivo microdialysis and electrophysiology. We used lentiviral vectors to compare the consequences of re-expressing either the α5 wild-type allele or the α5SNP in specific brain areas of α5−/− mice.
Results
α5−/− mice did not exhibit high responses to novelty but showed decreased novelty-induced rearing behaviour together with high anxiety. Exposure to high doses of nicotine rescued these phenotypes. We identified altered spontaneous and nicotine-elicited serotonin and dopamine activity in α5−/− mice. Re-expression of α5 in the ventral tegmental area and hippocampus rescued rearing and anxiety levels in α5−/− mice, respectively. When expressing the α5SNP instead, this resulted in a knockout-like phenotype for both behaviours.
Conclusions
We propose that altered α5*-nAChR cholinergic signalling contributes to emotional/behavioural impairments that may be alleviated by nicotine consumption.
Genetic vulnerability contributes significantly to the individual variability observed in nicotine dependence. Selective breeding for sensitivity to a particular effect of abused drugs has produced rodent lines useful for studying genetic vulnerability to drug addiction. Previous research showed that anxiety-related personality traits are associated with nicotine dependence. Therefore, we examined the differences in anxiety-like behavior between a high nicotine-preferring rat line and their controls. At the beginning of the study, all rats, naïve to any drug, were exposed sequentially to open field arena, marble-burying and elevated plus-maze paradigms. In the second step, all rats received nicotine in drinking water for 7 weeks. Behavioral tests were rerun on the final 2 weeks of chronic nicotine treatment. Elevated plus-maze testings under basal condition and during chronic nicotine treatment showed that the time spent on the open arms, preference for being in the open arms, and the latency to enter the closed arms were higher, whereas open arm avoidance index was lower in nicotine-preferring rats compared to the controls. In the open field test, nicotine-preferring rats spent longer time in the central zone and excreted less fecal pellets; they buried less marbles in the marble-burying test. These findings indicate a lower level of anxiety-like behavior in nicotine-preferring rat line under basal conditions and during chronic nicotine treatment. We conclude that lower anxiety level in nicotine-preferring rat line is consistent with novelty-seeking personality type and may increase vulnerability to nicotine dependence in this rat line.
Background:
The use of e-cigarette among Korean adolescents is spreading with alarming rapidity, but it has not been studied along with the severity level of GAD-7. This study aims to identify adolescents' e-cigarette use and its associated factors among four different anxiety groups using the problem behavioral theory (PBT).
Methods:
A cross-sectional secondary dataset was retrieved from the 2020 Korea Youth Risk Behavior Survey. Of the total sample of 54,948, four anxiety groups were formed: minimal (score 0-4; n = 36,711), mild (score 5-9; n = 12,138), moderate (score 10-14; n = 4143), and severe (score above 15; n = 1965). A total of 11 variables were selected based on the PBT domains. Descriptive analysis, Chi-square, ANOVA, univariate analysis and multiple linear regression analysis were performed.
Results:
E-cigarette use was the highest in the order of severe, mild, moderate, and minimal. While cigarette use was associated with vaping in all anxiety groups, adolescents with minimal or mild anxiety levels were more likely to be influenced by tobacco accessibility and other behavior system factors such as sexual intercourse, alcohol use, and smartphone addiction. Secondhand smoke exposure was a significant factor in all anxiety groups except for those with moderate anxiety levels.
Limitation:
Due to the nature of cross-sectional dataset, the study could not make causal links between vaping and other identified factors, include all the necessary PBT components.
Conclusion:
These findings underscore the need to consider different levels of anxiety when intervening the problems related to vaping among Korean adolescents.
Objective
The aim of this study was to determine the effect of social phobia and peer pressure on substance use among adolescent.
Methods
The study was conducted in three high schools in the city of Van/Turkey between November 2015-July 2017. The descriptive study was conducted with 1996 adolescents using face-to-face data collection method. Data were collected using a sociodemographic questionnaire, Social Phobia Scale for Children and Adolescents (SPSCA), and Peer Pressure Scale (PPS). The data were collected face to face in the classroom environment. All ethical principles were observed in the study.
Results
It was determined that the SPSCA and PPS mean scores of adolescents were at a low level. The mean PPS and SPSCA scores of adolescent were found to be positively and weakly correlated (p < .05). It was concluded that there was a statistically significant difference between the mean SPSCA and PPS scores of adolescent who smoke tobacco and drink alcohol (p < .001).
Conclusion
As the result of the research, it is identified that substance use among adolescents is at a considerable level. It is observed that several sociodemographic variables are effective in substance use on peer pressure and social phobia perceived by adolescents. It is recommended that school health nurses include the topic “the effect of social phobia and peer pressure on substance use” in training programs.
E-cigarette use is prevalent, and rates of use continue to increase. Although e-cigarettes are often used to help combustible users quit or reduce smoking, some use e-cigarettes in the absence of combustible cigarettes, increasing risk for smoking combustible cigarettes. Yet, little research has examined individual vulnerability factors implicated in transitioning from exclusive e-cigarettes use to dual use of combustible cigarettes. Social anxiety may be one such factor given it is related to a variety of negative smoking-related outcomes. Thus, the current study tested whether social anxiety was related to using e-cigarettes before smoking combustibles among 226 current undergraduate dual users (use both e-cigarettes and combustible cigarettes). Most dual users reported initiating with e-cigarettes (67%). Those who initiated with e-cigarettes reported statistically significantly greater negative reinforcement (d = 0.59) and weight control expectancies (d = 0.37) and greater social anxiety (d = 0.37) than those who initiated with combustibles. Social anxiety was indirectly related to e-cigarette initiation via negative and weight control expectancies. Findings add to a growing literature that dual users initiated with e-cigarettes and extend understanding of this phenomenon by identifying that socially anxious persons may be especially vulnerable to doing so, at least partially due to expectations regarding e-cigarette’s ability to manage negative affect and/or weight.
Tobacco addiction is highly co-morbid with a variety of mental health conditions, including schizophrenia, mood and anxiety disorders. Nicotine, the primary psychoactive compound in tobacco-related products is known to functionally modulate brain circuits that are disturbed in these disorders. Nicotine can potently regulate the transmission of various neurochemicals, including dopamine (DA), γ-amino-butyric acid (GABA) and glutamate, within various mesocorticolimbic structures, such as the ventral tegmental area (VTA), nucleus accumbens (NAc) and prefrontal cortex (PFC), all of which show pathologies in these disorders. Many neuropsychiatric diseases have etiological origins during neurodevelopment, typically occurring during vulnerable periods of adolescent or pre-natal brain development. During these neurodevelopmental periods, exposure to extrinsic drug insults can induce enduring and long-term pathophysiological sequelae that ultimately increase the risk of developing chronic mental health disorders in later life. These vulnerability factors are of growing concern given rising rates of adolescent nicotine exposure via traditional tobacco use and the increasing use of alternative nicotine delivery formats such as vaping and e-cigarettes. A large body of clinical and pre-clinical evidence points to an important role for adolescent exposure to nicotine and increased vulnerability to developing mood and anxiety disorders in later life. This review will examine current clinical and pre-clinical evidence that pinpoints specific mechanisms within the mesocorticolimbic circuitry and molecular biomarkers linked to the association between adolescent nicotine exposure and increased risk of developing mood and anxiety-related disorders.
This article is part of the special issue on ‘Vulnerabilities to Substance Abuse’.
Now-a-days Anxiety, Depression, Stress and Suicide has become one of the most common causes of the death. The purpose of this study is to explore Why Anxiety, Depression, Stress and after that Commit Suicide in India. Now-a-days suicidal gesture, attempted suicide & well successful suicide cases are seen in the society often on. This study attempts to provide a theoretical work/information regarding Why Anxiety, Depression, Stress and after that Commit Suicide? and why people try to end their lives? Mental health issues affect many people across the country. While there's a 25 times greater risk of suicide, even during the recovery process, the American Association of Suicidology reports that treatment for depression is effective 60 to 80 percent of time. These types of challenges are not new and have been around for a long time.
Resumen
Objetivo
La asociación entre el consumo de cigarrillos y los trastornos psiquiátricos está claramente establecida en adultos. Sin embargo, sólo un número limitado de estudios ha investigado si la edad de inicio del consumo diario de tabaco (TD) en adolescentes se asocia con enfermedades psiquiátricas y viceversa.
Métodos
Se recogieron datos de 508 adolescentes ingresados en un hospital psiquiátrico. Se usó el modelo de riesgo proporcional de Cox para comparar la iniciación del TD en adolescentes con y sin abuso de sustancias (AS) y otros trastornos psiquiátricos.
Resultados
Las tasas de TD eran altas en todas las categorías diagnósticas. Los chicos comenzaron a fumar con menos edad (media 12,4 años) que las chicas (13 años). Tanto los chicos como las chicas diagnosticados de trastornos de conducta oposicionista y desafiante (TCOD) y también las chicas con AS comenzaron a fumar habitualmente antes que las chicas sin estos trastornos. El TCOD fue previo a la iniciación del TD en chicos. Los AS, los trastornos psicóticos y depresivos (DEP) fueron secundarios al TD en ambos sexos.
Conclusiones
El TD en la adolescencia está relacionado con el AS posterior. El TCOD se asocia con la iniciación posterior del TD en chicos. El lapso de tiempo entre la iniciación del tabaquismo y el TCOD es más corto en chicas. La diferencia de sexos desempeña un papel en la asociación de TD y DEP. La iniciación de TD en muy temprana edad debería alertar a los profesionales médicos del posible desarrollo posterior de psicopatologías, sobre todo, AS.
Individuals with mental health problems smoke at far higher rates than their peers, and have done for decades. This paper explores a potential explanation: smoking as a means to cope with distress. The proposed “coping response” framework is assessed by analyzing how adolescents respond to two events known to trigger acute mental distress: violent crime victimization and death of a non-family member the respondent felt close to. Consistent with a coping response, these shocks yield statistically significant increases in first cigarette use, recent smoking, and daily smoking, with greater initiation responses among those who are depressed at baseline, and dampened responsiveness among those facing higher cigarette taxes. Back-of-the-envelope estimates suggest that differential responsiveness to adverse events by baseline depression explains 5% of first cigarette use in this sample, and almost a third of the gap in adolescent smoking initiation between those in the highest and lowest tercile of depression scores.
Aim: In this study, we aimed to investigate the relationship between the anxiety sensitivity levels and nicotine dependence and smoking cessation outcomes in patients referred to the Smoking Cessation Policlinics.Methods: This retrospective study included 286 patients referred to a smoking cessation policlinic between January 2017 and July 2017. Socio-demographic characteristics, Fagerström Test for Nicotine Dependence (FTDN) scores, depression scores measured by the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Anxiety Sensitivity Index-3 (ASI) scale scores were retrospectively retrieved from patient medical files. All patients were contacted and the instant smoking status of the patients was recorded.Results: Of the participants, 19.5% (n=56) (including those who did not come to follow-up) had quit smoking and were abstinent at least six months after the quitting date. The mean scores of anxiety sensitivity were significantly higher in moderate/high nicotine dependent patients than in mild nicotine dependent patients (p=0.001 and p<0.001, respectively). The mean scores of anxiety sensitivity and all its subscales were significantly higher in current smokers than ex-smokers (p<0.001 for each).Conclusion: It has been determined that anxiety sensitivity may be a severe barrier to smoking cessation success. Therewithal, anxiety sensitivity is significantly associated with high nicotine dependence. It is essential to evaluate the anxiety sensitivity, anxiety, and depression levels from the first days of patients who are planning to stop smoking. High anxiety sensitivity smokers should be carefully monitored, and treatments should be applied to reduce their anxiety sensitivities to increase quit rates
Despite the negative health consequences associated with smoking, most smokers find it difficult to quit. This is especially true for smokers with elevated social anxiety. One factor that may play a role in maintaining smoking with elevated anxiety is false safety behavior (FSB), behaviors geared toward decreasing anxiety short-term but that maintain or increase anxiety long-term. The present study tested whether FSB explained the relation of social anxiety severity with smoking among 71 current smokers. Avoidance-related FSB was the only type of FSB related to cigarettes smoked per day (CPD) and it was robustly related to more CPD. Further, social anxiety was related to CPD indirectly via FSB-Avoidance. Findings suggest that more frequent use of avoidance behaviors to manage anxiety may maintain smoking and may partially explain the high rates of smoking among those with elevated social anxiety. Thus, FSB may be a promising target in smoking cessation interventions, especially among those with elevated social anxiety.
Amaç: Sigara bağımlılığı tüm dünyada ve ülkemizde en
önemli halk sağlığı sorunlarındandır. Sigara kullanımına bağlı ortaya çıkan
sağlık sorunları nedeniyle her saniyede bir kişi hayatını kaybetmektedir.
Sigara bağımlılarında anksiyete, depresyon, çocukluk çağı travmaları ve
dürtüsellik çalışılmış olmakla birlikte D Tipi kişilik örüntüsü
araştırılmamıştır. Literatürdeki bu eksikliği gidermek için bu çalışma
planlanmıştır. Materyal ve Metot: Çalışmamıza sigara bağımlısı olan 151 kişi ve 100
kontrol olmak üzere toplam 251 kişi alınmıştır. Olgulara Sosyodemografik Veri
Formu, Hamilton Depresyon Ölçeği, Hamilton Anksiyete Ölçeği, D Tipi Kişilik
Ölçeği, Çocukluk Çağı Travmaları Ölçeği, Barratt Dürtüsellik Ölçeği
uygulanmıştır. Bulgular: Sosyodemografik verilere bakıldığında hasta grubu ile kontrol
grubu arasında anlamlı fark tespit edilmemiştir. Gruplar karşılaştırıldığında
Hamilton Depresyon Ölçeği, Hamilton Anksiyete Ölçeği, D Tipi Kişilik Ölçeği,
Çocukluk Çağı Travmaları Ölçeği, Barratt Dürtüsellik Ölçeği puanları açısından
anlamlı fark bulunmuştur. Ayrıca sigara içmenin yordayıcılarının dürtüsellik, D
tipi kişilik, depresyon ve anksiyete olduğu gösterilmiştir.Sonuç: Sigara bağımlılarında D tipi kişilik, depresyon, anksiyete,
dürtüsellik, çocukluk çağı travmaları daha yüksektir. Ayrıca dürtüsellik, D
tipi kişilik, depresyon ve anksiyete sigara bağımlılığını yordamaktadır.
Im ersten Kapitel werden einleitend verschiedene Formen sozialer Angst sowie die Abgrenzung normaler Ängste zu klinisch bedeutsamen Ängsten beschrieben. Soziale Ängste sind schon immer Teil der Menschheitsgeschichte und in allen Kulturen bekannt. Im individuellen Lebensverlauf können sich Ängste das ganze Leben über zeigen, wenngleich sich Befürchtungen und Inhalte der Ängste mit dem Alter ändern können. Abschließend gehen wir auf mögliche Konsequenzen ein, die entstehen, wenn soziale Ängste sich ausprägen und klinisch bedeutsam werden.
Dalla Pianificazione Regionale alla Programmazione Aziendale di interventi di prevenzione e cura sul tabagismo e gli altri stili di vita Guida per operatori mAGGio 2014 Reti e Comunità La guida Reti e Comunità è stata realizzata nell'ambito del progetto ministeriale CCM "Soste-gno alle iniziative di controllo al tabagismo: dalla pianificazione regionale, alla pianificazione aziendale", con il contributo delle Regioni capofila Emilia-Romagna, Il progetto a forte valenza interregionale è stato realizzato con il coordinamento didattico del Centro di Formazione delle Regione Emilia-Romagna Luoghi di Prevenzione e ha previsto inter-venti di sperimentazione nei territori sulle seguenti aree: • monitoraggio e controllo dei servizi di disassuefazione al fumo e stesura di protocolli operativi per target speciali: giovani, pazienti psichiatrici, pazienti ospedalizzati e pazienti esposti a dop-pio fattore di rischio; • programmi di prevenzione dell'abitudine al fumo rivolti ai giovani e valutazione qualitativa e quantitativa dell'efficacia degli interventi nella fascia di età dei 14-15 anni con un trial randomiz-zato; • criteri per la costituzione di una rete competente e efficace di operatori impegnati nel contrasto al tabagismo; • sperimentazione di interventi di prevenzione, cura e controllo del tabagismo in un contesto di comunità; • interventi di contrasto al tabagismo nei luoghi di lavoro; • collaborazione con le Università per l'inserimento nella formazione delle specialità mediche di percorsi di sostegno al cambiamento dei comportamenti a rischio. Il volume può rappresentare un utile strumento di lavoro per chi ha compiti di pianificazione di interventi di promozione della salute su fumo di sigaretta, alcol, alimentazione, attività fisica. Ap-profondisce nello specifico la trasformazione dei progetti in processi come risultato delle azioni di rete, la valutazione di efficacia degli interventi di Prevenzione e il ruolo della formazione a distanza per l'acquisizione e supervisione delle competenze professionali degli operatori.
Background:
In adolescence and young adults, inconsistence of the association between anxiety and smoking remains to be investigated and clarified. The aim of this study is investigated and clarified the association between anxiety and smoking stages in adolescence and young adults.
Methods:
The data on the causal influence of anxiety on smoking in adolescents and young adults aged 14 to 25 years old was retrieved from electronic databases.
Results:
Nineteen of 668 articles were subjected to a systematic review. Definitional differences with respect to smoking stages constrained homogeneity across the nineteen analyzed reports. Anxiety appears to play a more consistent risk role for nicotine dependent (ND) smokers than for non-nicotine dependent (non-ND) regular or daily smokers. Anxious non-ND smokers are at higher risk to become nicotine dependent.
Conclusions:
A ununified definition of smoking stages is responsible for the production of inconsistent results. The analysis reinforced anxiety as a significant risk factor for smoking in one's lifetime. Anxious non-ND smokers are the key target for interventions aimed at preventing nicotine dependence and smoking-related health problems.
Background:
Alcohol and substance use disorders are important predictors for suicidal behavior. However, the role of individual substances as proximal risk factors for suicidal behavior and the mechanisms through which substance use affect risk are not entirely clear. We examine whether the frequency of substance use and whether biological markers in the HPA axis and inflammatory pathways are associated with clinical risk factors of suicidal behavior of aggression, impulsivity, hopelessness, and poor sleep.
Methods:
The sample consisted of psychiatric inpatients, aged 15-30 years, admitted for suicide attempt (n = 38), suicidal ideation (n = 40); and healthy controls (n = 37). We measured hair cortisol concentrations, glucocorticoid receptor (GR) sensitivity, stimulated production of interleukin- or IL-6, C-reactive protein, and mRNA expression of GR, SKA2, FKBP5, TNF-α, and IL-1β.
Results:
Smoking was associated with increased aggression [β = 2.9, 95% CI (-0.03, 6), p = 0.05], impulsivity [β = 3.1, 95% CI (1.6, 4.6), p < 0.001], and poor sleep [β = 0.5, 95% CI (0.03, 0.95), p = 0.04] even after controlling for demographics and group. Similarly, TNF-α mRNA was associated with impulsivity [β = 0.07, 95% CI (0.01, 0.1), p = 0.02] and hopelessness [β = 0.03, 95% CI (0.004, 0.05), p = 0.03]. Smoking tobacco (r = 0.32, p < 0.001) was positively associated with TNF-α mRNA.
Limitations:
Study limitations include the cross-sectional design, retrospective assessment, and relatively small sample size.
Conclusions:
Future longitudinal studies are needed to test whether inflammatory markers mediate the relationships between smoking, clinical risk factors, and suicidal behavior; and to examine whether smoking cessation could reduce the risk for suicidal behavior in at-risk patients.
Background and objectives:
Despite clear associations between social anxiety (SA), high prevalence of smoking, and cessation failure, little is known about factors contributing to these relationships. Moreover, the extent to which smokers with moderate SA represent an at-risk group of smokers is also unknown. This study examined the extent to which established risk factors for poor cessation (eg, sociodemographic, smoking history, mental health comorbidity) are prevalent among smokers with low, moderate, and high levels of SA.
Methods:
Participants (N = 2,637) were adult smokers from a web-based smoking cessation trial. Nineteen characteristics considered risk factors for poor cessation outcomes were assessed at baseline. Those associated with social anxiety were subsequently compared by SA level.
Results:
Regression models indicated that 10/19 risk factors were associated with SA. Compared to smokers with low SA, those with moderate and high SA endorsed 4/10 and 10/10 risk factors as more prevalent or severe, respectively. Compared to smokers with low SA, High SA was associated with greater sociodemographic risk factors, while both moderate and high SA was associated with more severe mental health symptoms.
Conclusions and scientific significance:
Smokers with moderate and high levels of SA endorse more risk factors for poor cessation outcomes than those with low levels of SA, particularly mental health symptoms. These factors may help explain the differential smoking outcomes of socially anxious smokers. Results suggest that smokers with both moderate and high levels of SA would likely benefit from cessation interventions that address and consider these risk factors. (Am J Addict 2017;XX:1-7).
Objectives:
Although social anxiety is associated with higher prevalence of smoking and lower cessation rates, little is known about the underlying mechanisms of these relationships. Research suggests that socially anxious smokers have higher levels of smoking-specific experiential avoidance and are inclined to smoke to avoid internal smoking cues. However, it is unknown which types of internal smoking cues they avoid. Thus, this study aimed to address this gap in the literature.
Methods:
Participants (N = 450) were adult smokers from a group-based trial for smoking cessation. Bivariate correlations and hierarchical linear regression models examined relationships between baseline levels of social anxiety and acceptance of internal smoking cues-physical sensations, emotions, and cognitions.
Results:
Social anxiety was associated with lower levels of acceptance of thoughts, sensations, and emotions that cue smoking. After controlling for levels of nicotine dependence, depression, generalized anxiety, and post-traumatic stress disorder (PTSD), social anxiety still explained unique variability in overall acceptance of internal smoking cues and in acceptance of physical sensations and emotions that serve as smoking cues. Social anxiety no longer explained unique variability in acceptance of thoughts that trigger smoking.
Conclusions:
Smokers with high levels of social anxiety are less accepting of internal smoking cues. For physical and emotional cues, this effect was independent of level of dependence and mental health comorbidity. Results help explain why smokers with social anxiety are less likely to quit and can inform the development of targeted cessation treatments for smokers with social anxiety.
Im ersten Kapitel werden einleitend verschiedene Formen sozialer Angst sowie die Abgrenzung normaler Ängste zu klinisch bedeutsamen Ängsten beschrieben. Soziale Ängste sind schon immer Teil der Menschheitsgeschichte und in allen Kulturen bekannt. Im individuellen Lebensverlauf können sich Ängste das ganze Leben über zeigen, wenngleich sich Befürchtungen und Inhalte der Ängste mit dem Alter ändern können. Abschließend gehen wir auf mögliche Konsequenzen ein, die entstehen, wenn soziale Ängste sich ausprägen und klinisch bedeutsam werden.
Individual differences in psychopathology, personality, and nicotine responsitivity and their biological bases are evaluated as mechanisms potentially mediating smoking heritability. Smokers are more likely to be high in neurotic traits (e.g., depression, anxiety, anger) and in social alienation (psychoticism, impulsivity, unsocialized sensation-seeking, low conscientiousness, low agreeableness) and low in achievement/socioeconomic status. Psychological and biological mechanisms putatively mediating these associations are reviewed. It is concluded that a number of relatively indirect and complex processes, as well as more direct (e.g., self-medication for psychopathology, nicotine sensitivity), mediate the inheritance of smoking behavior.
We administered the Center for Epidemiological Studies Depression (CES-D) Scale to 547 San Francisco Latinos as part of a random digit dialing telephone survey to evaluate smoking behavior. Both men and women current smokers had the highest mean CES-D levels (9.7 and 14.3, respectively). Logistic regression analysis adjusting for gender, acculturation, education, age, and employment showed that current smokers had an odds ratio of 1.7 (95% CI = 1.3, 2.2) for significant depressive symptoms compared to former smokers (OR = 1.1;95% CI = .8, 1.6) and never smokers (OR = 1).
The authors examined the incidence and predictors of major depression following successful smoking cessation treatment, with special attention to the influence of past major depression.
Three-month follow-up data were obtained from 126 subjects who successfully completed a 10-week smoking cessation program.
The 3-month incidence of new major depression following treatment for nicotine dependence was 2%, 17%, and 30% among subjects with histories of no major depression, single major depression, and recurrent major depression, respectively. A history of major depression and persistent withdrawal symptoms independently predicted posttreatment major depression.
Continued patient care beyond the 2-4-week period associated with the nicotine withdrawal syndrome is indicated when abstinence is attempted by smokers with prior major depression.
Background:
Recent epidemiologic studies have revealed that social phobia is more prevalent than has been previously believed. An unresolved issue is the extent to which public-speaking fears constitute a recognizable form of social phobia in a community sample and, moreover, to what extent these fears are associated with functional morbidity.Methods:
To examine the prevalence and impact of public-speaking fears and their relationship to social phobia in a community sample, we conducted a randomized telephone survey of 499 residents of Winnipeg, Manitoba, a medium-sized midwestern metropolitan area.Results:
One third of the respondents reported that they had excessive anxiety when they spoke to a large audience. The onset of fears was early (ie, 50%, 75%, and 90% by the ages of 13, 17, and 20 years, respectively). Anxious cognitions about public speaking included the following fears: doing or saying something embarrassing (64%), one's mind going blank (74%), being unable to continue talking (63%), saying foolish things or not making sense (59%), and trembling, shaking, or showing other signs of anxiety (80%). In total, 10% (n=49) of the respondents reported that public-speaking anxiety had resulted in a marked interference with their work (2%), social life (1%), or education (4%), or had caused them marked distress (8%). Twenty-three persons (5%) had public-speaking anxiety in isolation (ie, without evidence of additional kinds of social fears).Conclusions:
These data support the inclusion of severe forms of public-speaking fears within the social phobia construct and, furthermore, suggest that publicspeaking anxiety may have a detrimental impact on the lives of many individuals in the community.
Standard large-sample confidence intervals about a maximum likelihood estimator θ ^ are two-thirds robust; i.e. when the parametric model is imperfect θ ^ often remains consistent and asymptotically normal. The confidence intervals are invalidated only because the third necessary condition, consistency of the variance estimator, fails. The ’delta method’ provides a simple alternative variance estimator which remains consistent under more general conditions and provides robust large-sample confidence intervals.
Background
Epidemiologic studies have reported an association between major depression and smoking. This prospective study examines the role of depression in smoking progression and cessation, and the role of smoking in first-onset major depression.
Methods
Data are from a 5-year longitudinal epidemiologic study of 1007 young adults. Incidence and odds ratios (ORs) are based on the prospective data. Hazards ratios are based on the combined lifetime data and estimated in Cox proportional hazards models with time-dependent covariates.
Results
Based on the prospective data, history of major depression at baseline increased significantly the risk for progression to daily smoking (OR, 3.0; 95% confidence interval, 1.1-8.2), but did not decrease significantly smokers' rate of quitting (OR, 0.8; 95% confidence interval, 0.4-1.6). History of daily smoking at baseline increased significantly the risk for major depression (OR, 1.9; 95% confidence interval, 1.1-3.4). These estimates were reduced somewhat when history of early (ie, before age 15 years) conduct problems was controlled. Estimates based on lifetime data were consistent with these results.
Conclusions
The observed influences from major depression to subsequent daily smoking and smoking to major depression support the plausibility of shared etiologies. Separate causal mechanisms in each direction might also operate, including self-medication of depressed mood as a factor in smoking progression and neuropharmacologic effects of nicotine and other smoke substances on neurotransmitter systems linked to depression.
This paper compares diagnoses of the DSM-IV algorithms of the computer-assisted version of the Munich-Composite International Diagnostic Interview (M-CIDI) with clinical diagnoses made by treating physicians using the standard LEAD procedure. A random sample of 68 patients being treated in three psychiatric and one neurological ward of the Max Planck Institute of Psychiatry were first examined with the CIDI, using the M-CIDI/DSM-IV algorithms. Diagnostic findings were then compared with lifetime and cross-sectional diagnoses assigned by the treating physician, who was blind to the CIDI findings, taking into account all available symptom and diagnostic information from current and previous charts as well as his own assessments. Clinicians were encouraged to use the DSM-IV manual to assign multiple lifetime diagnoses and not to focus exclusively on primary diagnoses. To explore agreements and disagreements further, all discrepant cases were subsequently discussed with the treating physicians. There was generally good concordance between clinicians and interview DSM-IV diagnoses, with the exception of psychotic disorders (kappa: 0.21), dysthymia (0.54) and somatoform disorders (0.50), with kappa values for the remaining categories ranging from 0.63 (any panic disorder) to 0.96 (any depressive episode). It is concluded that the M-CIDI, in clinical cases, provides valid diagnoses for almost all non-psychotic disorders and is sensitive for all disorders but might have reduced specificity and predictive value in some anxiety and somatoform disorders. Copyright © 1998 Whurr Publishers Ltd.
This paper reports the results of methodological studies carried out in conjunction with the US National Comorbidity Survey (NCS) to evaluate Version 1.0 of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). These studies relied on recent survey data collection methodology literature to investigate problems regarding question comprehension, instruction comprehension, respondent motivation to report accurately, and regarding the limits of respondent ability to report accurately. Insights and strategies developed by survey methodologists were used to modify the CIDI in an effort to address these problems. The paper describes these strategies and methodological studies that evaluated their effects, including a clinical reappraisal study and a field experiment that evaluated the impact of question modifications on prevalence estimates. The paper closes with a discussion of remaining methodological problems with the CIDI and potentially useful future studies that might be able to develop solutions to these problems. Copyright © 1998 Whurr Publishers Ltd. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/34217/1/33_ftp.pdf
To determine whether nicotine dependence, classified by level of severity, was associated with other substance dependence, major depression, and anxiety disorders, we studied a random sample of 1007 young adults in the Detroit (Mich) area using the National Institute of Mental Health Diagnostic Interview Schedule, revised according to DSM-III-R. The systematic coverage of DSM-III-R criteria of nicotine dependence provides an unprecedented opportunity to separate persons with nicotine dependence from the larger class of persons with a history of smoking and to examine the prevalence of psychiatric disorders among persons with nicotine dependence and among nondependent smokers. The lifetime prevalence of nicotine dependence was 20%. Nicotine dependence was associated with alcohol, cannabis, and cocaine dependence. Controlling for the effects of other substance dependencies, persons with nicotine dependence had higher rates of major depression and anxiety disorders. The strength of these associations varied by level of severity of nicotine dependence. Nondependent smokers had higher rates of other substance dependencies, but not of major depression or anxiety disorders.
A relationship between cigarette smoking and major depressive disorder was suggested in previous work involving nonrandomly selected samples. We conducted a test of this association, employing population-based data (n = 3213) collected between 1980 and 1983 in the St Louis Epidemiologic Catchment Area Survey of the National Institute of Mental Health. A history of regular smoking was observed more frequently among individuals who had experienced major depressive disorder at some time in their lives than among individuals who had never experienced major depression or among individuals with no psychiatric diagnosis. Smokers with major depression were also less successful at their attempts to quit than were either of the comparison groups. Gender differences in rates of smoking and of smoking cessation observed in the larger population were not evident among the depressed group. Furthermore, the association between cigarette smoking and major depression was not ubiquitous across all psychiatric diagnoses. Other data are cited indicating that when individuals with a history of depression stop smoking, depressive symptoms and, in some cases, serious major depression may ensue.
Recent epidemiologic studies have revealed that comorbidity of psychiatric disorders is far more pervasive than previously suspected. Strong associations have been reported between specific substance use disorders and between any mental disorder and any substance use disorder. This report focuses on comorbidity of nicotine dependence, a substance use disorder on which little epidemiologic information is available. Data come from an epidemiologic study of approximately 1000 young adults in southeast Michigan, in which the NIMH-DIS, revised according to DSM-III-R, was used. Lifetime prevalence of nicotine dependence was 20%. Males and females with nicotine dependence had increased odds for alcohol and illicit drug disorders, major depression, and anxiety disorders, compared with nondependent smokers and nonsmokers combined. Major depression and any anxiety disorder were associated specifically with nicotine dependence. Increased odds for alcohol or illicit drug disorders were observed also in nondependent smokers, compared to nonsmokers. History of early conduct problems increased the odds for nicotine dependence among smokers. Potential mechanisms in the comorbidity of nicotine dependence are discussed.
This paper reviews reliability and validity studies of the WHO - Composite International Diagnostic Interview (CIDI). The CIDI is a comprehensive and fully standardized diagnostic interview designed for assessing mental disorders according to the definitions of the Diagnostic Criteria for Research of ICD-10 and DSM-III-R. The instrument contains 276 symptom questions many of which are coupled with probe questions to evaluate symptom severity, as well as questions for assessing help-seeking behavior, psychosocial impairments, and other episode-related questions. Although primarily intended for use in epidemiological studies of mental disorders, it is also being used extensively for clinical and other research purposes. The review documents the wide spread use of the instrument and discusses several test-retest and interrater reliability studies of the CIDI. Both types of studies have confirmed good to excellent Kappa coefficients for most diagnostic sections. In international multicenter studies as well as several smaller center studies the CIDI was judged to be acceptable for most subjects and was found to be appropriate for use in different kinds of settings and countries. There is however still a need for reliability studies in general population samples, the area the CIDI was primary intended for. Only a few selected aspects of validity have been examined so far, mostly in smaller selected clinical samples. The need for further procedural validity studies of the CIDI with clinical instruments such as the SCAN as well as cognitive validation studies is emphasized. The latter should focus on specific aspects, such as the use of standardized questions in the elderly, cognitive probes to improve recall of episodes and their timing, as well as the role of order effects in the presentation of diagnostic sections.
We describe the epidemiology of nicotine dependence and its association with other substance use and psychiatric disorders. Data came from a random sample of young adults, 21-30 years of age, in the Detroit, Michigan metropolitan area. The NIMH Diagnostic Interview Schedule was used to ascertain DSM-III-R disorders. Lifetime prevalence of nicotine dependence was 20%. Higher rates were observed in whites, persons with low education and persons who were separated or divorced. Males and females with nicotine dependence had significantly increased odds for alcohol and illicit drug disorders, major depression and one or more anxiety disorder, as compared to non-dependent smokers and non-smokers combined. Among smokers, lifetime prevalence of illicit drug disorders other than marijuana alone, major depression and any anxiety disorder were significantly higher in dependent than non-dependent people. Major depression was associated specifically with nicotine dependence, an association explained in part by neuroticism. This finding suggests that the personality trait of neuroticism might constitute a common predisposition for major depression and nicotine dependence.
The goal of this study was to gain a broader perspective on social anxiety in the community than has been achieved by epidemiologic surveys to date.
The authors conducted a telephone survey of social anxiety among 526 randomly selected respondents in a medium-sized Canadian city.
Sixty-one percent of the respondents reported being much or somewhat more anxious than other people in at least one of the seven social situations surveyed. Speaking to a large audience (i.e., public speaking) was the most frequently feared situation (endorsed by 55.0% of the respondents), followed by speaking to a small group of familiar people (24.9%), dealing with people in authority (23.3%), attending social gatherings (14.5%), speaking to strangers or meeting new people (13.7%), and eating (7.1%) or writing (5.1%) in front of others. When the threshold for caseness was systematically modified--by altering the required level of psychosocial interference or distress or by including or excluding subjects with pure public speaking phobia--the rate of "social anxiety syndrome" in the community varied from 1.9% to 18.7%; 7.1% was the prevalence when the criteria were set to conform with DSM-III-R.
Social anxiety is common in the community, but precise delineation of the prevalence of "social phobia" depends heavily on where the diagnostic threshold is set. If DSM-III-R criteria had been applied in previous epidemiologic studies, it is likely that those studies would have documented prevalences of social phobia that are several times as high as the currently accepted rates.
Recent epidemiologic studies have revealed that social phobia is more prevalent than has been previously believed. An unresolved issue is the extent to which public-speaking fears constitute a recognizable form of social phobia in a community sample and, moreover, to what extent these fears are associated with functional morbidity.
To examine the prevalence and impact of public-speaking fears and their relationship to social phobia in a community sample, we conducted a randomized telephone survey of 499 residents of Winnipeg, Manitoba, a medium-sized midwestern metropolitan area.
One third of the respondents reported that they had excessive anxiety when they spoke to a large audience. The onset of fears was early (ie, 50%, 75%, and 90% by the ages of 13, 17, and 20 years, respectively). Anxious cognitions about public speaking included the following fears: doing or saying something embarrassing (64%), one's mind going blank (74%), being unable to continue talking (63%), saying foolish things or not making sense (59%), and trembling, shaking, or showing other signs of anxiety (80%). In total, 10% (n = 49) of the respondents reported that public-speaking anxiety had resulted in a marked interference with their work (2%), social life (1%), or education (4%), or had caused them marked distress (8%). Twenty-three persons (5%) had public-speaking anxiety in isolation (ie, without evidence of additional kinds of social fears).
These data support the inclusion of severe forms of public-speaking fears within the social phobia construct and, furthermore, suggest that public-speaking anxiety may have a detrimental impact on the lives of many individuals in the community.
To examine cross-sectionally and prospectively relationships of cigarette smoking with major depressive disorder (MDD), controlling for comorbidity in a community sample of adolescents.
A representative sample of 1,709 adolescents (aged 14 through 18 years) was assessed by using semistructured diagnostic interviews on two occasions, approximately 1 year apart. Logistic regression analyses were used to examine cross-sectionally and prospectively the relationships between smoking and each psychiatric disorder, while statistically controlling for the other disorders.
Cross-sectional analyses revealed significant relationships of drug abuse/dependence and disruptive behavior disorders with adolescent smoking, even after the co-occurrence of all other disorders was controlled. Prospectively, smoking was found to increase the risk of developing an episode of MDD and drug abuse/dependence, after adjusting for other disorders. Finally, only lifetime prevalence of MDD remained a significant predictor of smoking onset, after controlling for other disorders. Gender did not moderate any of the relationships between psychopathology and smoking.
The results suggest important relationships between cigarette smoking and psychiatric disorders among adolescents, particularly with regard to MDD, drug abuse/dependence, and disruptive behavior disorders. These findings have important clinical implications, both for psychiatric care and for smoking prevention and cessation efforts with adolescents.
As part of a longitudinal study, prevalence findings of DSM-IV disorders are presented for a random sample of 3021 respondents aged 14 to 24, with response rate 71%.
Assessment included various subtypes of disorders, subthreshold conditions and disorders that have only rarely been studied in other epidemiological surveys. The computer-assisted Munich-Composite International Diagnostic Interview (M-CIDI) was used to derive DSM-IV diagnoses.
Substance disorders were the most frequent (lifetime 17.7%; 12-month 11.4%), with abuse being considerably more frequent than dependence. Other mental disorders had a lifetime prevalence of 27.5% (12-month, 17.5%) with depressive disorders (16.8%) being more frequent than anxiety disorders (14.4%). Eating disorders (3.0%) and threshold somatoform disorders (1.2%) were rare disorders. Subthreshold anxiety and somatoform disorders, however, were more frequent than threshold disorders. Prevalence of disorders was equally high for males and females, although specific disorder prevalence varied significantly by gender. The co-occurrence of disorders (co-morbidity) was substantial and was significantly related to greater reductions in work productivity and increased rates of professional helpseeking behaviour.
Findings underline that mental disorders in young adults are frequent and impairing, limiting work and education ability and social interaction. Given the fact that adolescents and young adults are in a key phase of socialization in terms of professional career and interpersonal relationships, our findings indicate a considerable risk potential for an accumulation of complicating factors and future chronicity. This paper is the first report of this ongoing longitudinal study about early developmental conditions of mental disorders.
This article presents epidemiologic data on the distinction between social phobia characterized by pure speaking fears and that characterized by other social fears.
The data come from the National Comorbidity Survey (N = 8,098). Social phobia was assessed with a revised version of the Composite International Diagnostic Interview.
Latent class analysis showed that the brief set of social fears assessed in the survey can be disaggregated into a class characterized largely by speaking fears and a second class characterized by a broader range of social fears. One-third of the people with lifetime social phobia exclusively reported speaking fears, while the other two-thirds also had at least one of the other social fears assessed. The vast majority of the latter had multiple social fears including, in most cases, both performance and interactional fears. The two subtypes were similar in age at onset distribution, family history, and certain sociodemographic correlates. However, the social phobia characterized by pure speaking fears was less persistent, less impairing, and less highly comorbid with other DSM-III-R disorders than was social phobia characterized by other social fears.
Further general population research assessing more performance and interaction fears is needed to determine whether social phobia subtypes can be refined and whether the subtypes are better conceptualized as distinct disorders. In the meantime, people who have social phobia with multiple fears, some of which are nonspeaking fears, appear to have the most impairment and should be the main focus of prevention and intervention efforts.
Ths paper describes the distribution of dependence criteria and diagnoses in a sample of 14- to 24-year-olds from Munich, Germany (n = 3,021; 71% response rate), evaluates differences between nondependent and dependent smokers and examines associations of smoking with other substances, affective and anxiety disorders. Assessment was made using the M-CIDI. The lifetime prevalence of DSM-IV nicotine dependence in the total sample is 19%, rising to 52% among regular smokers. No gender differences were seen in the progression from regular smoking to nicotine dependence, although men were more likely than women to initiate regular use. Analysis of daily cigarette use identified a significant dose-response relationship with the number of endorsed DSM-IV dependence criteria with unsuccessful cut-backs being the most prevalent criterion. As compared to nondependent smokers, dependent smokers were more likely to associate negative health effects with smoking and to have a desire to change and attempt a change in their pattern of use. Regular use of nicotine was found to be significantly associated with other substance and nonsubstance disorders, although dependent regular use was more strongly associated with these disorders than nondependent regular use. These results indicate that daily smoking is a behavior which is resistant to change despite an expressed desire and repeated cut-back attempts. Although initiation of regular smoking among nonsmokers does not occur frequently after the early twenties, the risk for dependent smoking among regular users persists into adulthood and is associated with a range of mental disorders.
After reviewing currently available diagnostic assessment instruments for substance use disorders this paper describes the format and structure of the Munich-Composite International Diagnostic Interview (M-CIDI) substance disorder section. In addition, the test-retest reliability of diagnoses and criteria for nicotine, alcohol, illegal and prescription drugs, is reported. Findings obtained in community sample of adolescents and young adults indicate that the substance section is acceptable for almost all types of respondents, efficient in terms of time and ease of administration as well as reliable in terms of consistency of findings over time. The test-retest reliability over a period of an average of 1 month, as examined by two independent interviewers indicates good-to-excellent kappa values for all substance disorders assessed, with significant kappa values ranging between 0.55 for drug abuse and 0.83 for alcohol abuse. There was also fairly consistently high agreement for the assessment of single DSM-IV diagnostic criteria for abuse and dependence as well as the M-CIDI quantity-frequency and time-related questions. To conclude, although - unlike previous studies - this study was conducted in a community sample and not in patients and used considerably longer time intervals of more than a month between investigations, our M-CIDI reliability findings are at least as high as those from previous studies.
The primary and secondary objectives of the Early Developmental Stages of Substance Abuse Study (EDSP) are described along with a detailed description of the overall design, special design features and instruments used. The EDSP is a 5-year prospective study with three waves of assessments. Special design features are the linkages with family genetic investigations as well as neuroendocrinological stress tests in high-risk subjects. Overall, 3,021 adolescents and young adults aged 14-24 years are included. The response rate for the baseline investigation was 71%. Diagnostic assessments were made by using a modified lifetime (baseline) and 12-month change version of the WHO-CIDI, adjusted for DSM-IV. Modifications refer to a more detailed quantitative assessment of symptoms and substance use variables as well as the inclusion of questions to assess course of disorders and subthreshold diagnostic conditions.
The structure and content of the Munich-Composite International Diagnostic Interview (M-CIDI) for the assessment of DSM-IV symptoms, syndromes, and diagnoses is described along with findings from a test-retest reliability study. A sample of 60 community respondents were interviewed twice independently by trained interviewers with an average time interval of 38 days between investigations. Test-retest reliability was good for almost all specific DSM-IV core symptom questions and disorders examined, with kappa values ranging from fair for two diagnoses--bulimia (kappa 0.55) and generalized anxiety disorder (kappa 0.45)--to excellent (kappa above 0.72) for all other anxiety disorders and alcohol use disorders. Test-retest reliability for age of onset and time-related questions was fairly consistently high (intra-class correlation values of 0.79 or above), with one notable exception: the assessment of disorders with onset before puberty. We concluded that the M-CIDI is acceptable for respondents, efficient in terms of time needed for and ease of administration, and reliable in terms of consistency of findings over time periods of at least 1 month.
Epidemiological studies have identified two subtypes of social phobia: speaking-only social phobia which is characterized by the fear of public speaking situations and complex social phobia which is characterized by the fear of multiple social situations. Speaking-only social phobia most closely corresponds to the DSM-IV's 'nongeneralized social phobia' while complex social phobia resembles 'generalized social phobia'. In contrast to the speaking-only social phobia, the complex form is usually more disabling, familial and longer-lasting. In addition, the complex form has a lower chance of spontaneous recovery and carries a higher risk of comorbidity and impairment. Overall, both types of social phobia tend to be underdiagnosed and under-treated. Effective treatments which can manage not only complex social phobia, but also its spectrum of comorbid conditions, are required.
The paper describes prevalence, impairments, patterns of co-morbidity and other correlates of DSM-IV social phobia in adolescents and young adults, separating generalized and non-generalized social phobics.
Data are derived from the baseline investigation of the Early Developmental Stages of Psychopathology Study (EDSP), a prospective longitudinal community study of 3021 subjects, aged 14-24. Diagnoses were based on the DSM-IV algorithms of an expanded version of the Composite International Diagnostic Interview.
Lifetime prevalence of DSM-IV/CIDI social phobia was 9.5% in females and 4.9% in males, with about one-third being classified as generalized social phobics. Twelve-month prevalence was only slightly lower, indicating considerable persistence. Respondents with generalized social phobia reported an earlier age of onset, higher symptom persistence, more co-morbidity, more severe impairments, higher treatment rates and indicated more frequently a parental history of mental disorders than respondents with non-generalized social phobia.
History of DSM-IV social phobia was found to be quite prevalent in 14-24 year-olds. The generalized subtype of social phobia was found to have different correlates and to be considerably more persistent, impairing and co-morbid than non-generalized social phobia. Although generalized social phobics are more likely than non-generalized social phobics to receive mental health treatments, the treatment rate in this sample was low despite the fact that mental health services are free in Germany.
Social phobia is increasingly recognized as a prevalent and socially impairing mental disorder. However, little data is available regarding the general and disease-specific impairments and disabilities associated with social phobia. Furthermore, most studies have not controlled for the confounding effects of comorbid conditions.
This study investigates: (a) the generic quality of life; (b) work productivity; and, (c) various other disorder-specific social impairments in current cases with pure ( n = 65), comorbid ( n = 51) and subthreshold ( n = 34) DSM-IV social phobia as compared to controls with no social phobia (subjects with a history of herpes infections).
Social phobia cases reported a mean illness duration of 22.9 years with onset in childhood or adolescence. Current quality of life, as assessed by the SF-36, was significantly reduced in all social phobia groups, particularly in the scales measuring vitality, general health, mental health, role limitations due to emotional health, and social functioning. Comorbid cases revealed more severe reductions than pure and subthreshold social phobics. Findings from the Liebowitz self-rated disability scale indicated that: (a) social phobia affects most areas of life, but in particular education, career, and romantic relationship; (b) the presence of past and current comorbid conditions increases the frequency and severity of disease-specific impairments; and, (c) subthreshold social phobia revealed slightly lower overall impairments than comorbid social phobics. Past-week work productivity of social phobics was significantly diminished as indicated by: (a) a three-fold higher rate of unemployed cases; (b) elevated rates of work hours missed due to social phobia problems; and (c) a reduced work performance.
Overall, these findings underline that social phobia in our sample of adults, whether comorbid, subthreshold, or pure was a persisting and impairing condition, resulting in considerable subjective suffering and negative impact on work performance and social relationships. The current disabilities and impairments were usually less pronounced than in the past, presumably due to adaptive behaviors in life style of the respondents. Data also confirmed that social phobia is poorly recognized and rarely treated by the mental health system.
To present data on the incidence of cannabis use at follow-up, and its progression, stability, abuse and dependence in a representative sample of adolescents (N = 1228), aged 14-17 years at "baseline"--the outset of the study--in Munich, Germany.
The study employed a prospective longitudinal design using a representative population sample. The mean follow-up time was 19.7 months. The Composite International Diagnostic Interview (M-CIDI) was used to assess patterns of use, abuse and dependence according to DSM-IV criteria.
(1) In our sample, 34.8% of males and 30.2% of females had tried cannabinoids at least once. (2) Of those who used cannabis repeatedly (two or four times) at baseline, 26.1% stopped using by follow-up; the majority went on to regular use in the follow-up period. Similarly, only 17.7% of the regular users at the outset stopped using cannabis completely; 74.2% continued their pattern of regular use. Thus, the higher the baseline use pattern, the higher was the probability of continued or heavier use during follow-up. (3) Although the cumulative life-time incidence for DSM-IV cannabis abuse (3.5%) in this age group was low, it is noteworthy that complete diagnostic remissions were relatively rare (31.7% for dependence, 41.1% for abuse). (4) There was considerable concurrent use of other drugs.
Cannabis use was almost as widespread in this sample of adolescents in Germany as in similar age groups in metropolitan areas of North America. There was a relatively low spontaneous remission rate among regular and repeated users. Cannabis use in adolescence appears to be less transient than many people would believe.
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