P Andreski’s research while affiliated with Henry Ford Health System and other places

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. 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. 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. 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.

Epidemiologic surveys in the general population documented a higher rate of posttraumatic stress disorder (PTSD) in women than in men. To date, the finding has received little scientific attention. This study examines the extent to which sex differences in PTSD might be explained by previously identified risk factors and whether the sex difference in PTSD varied by age at exposure to traumatic events. The NIMH-DIS (NIMH Diagnostic Interview Schedule, Version III Revised) was used to measure DSM-IIIR disorders in a random sample of 1007 young adults. Cox proportional hazards models were used to estimate changes in the hazards ratio for PTSD associated with sex when potential risk factors were included. Lifetime prevalence of exposure to traumatic events and number of traumatic events did not vary by sex. The prevalence of PTSD was higher for women than for men exposed to traumatic events (hazards ratio, 2.3; 95% confidence interval, 1.5-3.6). Preexisting anxiety disorders or major depressive disorders played a part in the observed sex difference in PTSD. Family history of anxiety disorder and early separation from parents, although significant risk factors for PTSD in subjects of both sexes, were unrelated to the sex difference in PTSD. The sex difference in PTSD was markedly greater if exposure occurred in childhood than later on. Posttraumatic stress disorder is more likely to develop in females than in males after exposure to a traumatic event. Susceptibility to PTSD in females might be greater in childhood than after age 15 years. Explanations of the sex difference might involve characteristics of individuals and of the traumatic experiences.

Although excessive daytime sleepiness is associated with increased risks for accidents, decreased productivity, and interpersonal difficulties, information on its epidemiology is scarce. This paper examines correlates of and suspected risk factors for daytime sleepiness from a longitudinal epidemiological study of young adults. The sample consisted of 1007 randomly selected young adults from a large health maintenance organization in southeast Michigan. Data were gathered in personal interviews conducted with 97% of the sample 5.5 years after baseline. Information on sleep characteristics in the last 2 weeks, including daytime sleepiness, nocturnal sleep onset, snoring, and hours of sleep, was collected on a self-administered instrument. Psychiatric disorders were measured by the National Institute of Mental Health's Diagnostic Interview Schedule. The average length of nocturnal sleep on weekdays was 6.7 hours. Daytime sleepiness was inversely related to hours of sleep and positively related to the ease of falling asleep at night; it varied significantly by employment and marital status. Snoring was associated with increased daytime sleepiness, as was recent major depression. Factors that might increase daytime sleepiness among young adults include social factors (being single and being employed full time) and pathological conditions (frequent snoring and major depression).

This study examined the likelihood of smoking cessation in smokers with a prior history of alcoholism. Data came from an epidemiologic study of 1007 young adults, randomly selected from those insured in a large health maintenance organization (HMO) in southeast Michigan. Cox proportional hazards models with time-dependent covariates were used to estimate the hazards ratios of quitting in smokers with current and past alcoholism, with smokers with no history of alcoholism as a reference. Sex, race, and education were controlled. Smokers with active alcoholism in the preceding year were 60% less likely to quit than were smokers with no history of alcoholism. In contrast, smokers whose alcoholism had remitted were at least as likely to quit as smokers with no history of alcoholism. Compared with persistent alcoholism, remission of alcoholism was associated with more than a threefold increase in the likelihood of subsequent smoking cessation. The findings suggest that discontinuation of alcoholism might increase the potential for successful smoking cessation.

The authors previously identified suspected risk factors for traumatic events related to posttraumatic stress disorder (PTSD) on the basis of data gathered retrospectively. In this study, they tested that model prospectively. A random sample of 1,200 persons was drawn from all 21- to 30-year-old members of a large health maintenance organization. In 1989, 1,007 of these persons were interviewed, and suspected risk factors were measured. In 1992, 979 were reinterviewed, and the 3-year incidence of exposure to traumatic events was ascertained. Nineteen percent of the sample reported traumatic events during the 3-year follow-up. A history of past exposure to traumatic events signaled an increase in the liability to exposure during follow-up, independent of suspected risk factors. Two predictors of exposure, neuroticism and extroversion, identified retrospectively, also predicted exposure prospectively. The odds for exposure among males and persons with less than a college education were marginally significant. Early misconduct and a family history of psychiatric disorder-predictors of exposure in the retrospective data-were not significant predictors at 3-year follow-up. Blacks had a higher incidence of exposure during follow-up than whites. An exploratory reanalysis suggested that the discrepancy between the retrospective and prospective results may be explained by the inclusion of childhood exposure in the lifetime retrospective inquiry. The assumption that PTSD-related traumatic events are random phenomena was unsupported. Among young adults, those with less education, blacks, and those with high neuroticism and extroversion scores are more likely than others to be exposed to traumatic events and are thus at greater risk for PTSD.

In a previous article the authors reported associations between nicotine dependence and psychiatric disorders in a community sample of young adults. Increased lifetime rates of major depression and anxiety disorders were found in persons with DSM-III-R nicotine dependence but not in nondependent smokers. The purpose of the present study was to examine the associations of nicotine dependence with four measures of psychologic vulnerability to nonpsychotic psychiatric disorders. A randomly chosen group of 1,007 21- to 30-year-old members of a large health maintenance organization were interviewed with the National Institute of Mental Health Diagnostic Interview Schedule, revised for DSM-III-R diagnoses. Self-ratings of neuroticism, negative affect, hopelessness, and general emotional distress were obtained. Nicotine dependence, but not nondependent smoking, was associated with higher scores on all four measures of vulnerability to psychopathology. With one exception the associations between nicotine dependence and these psychologic measures remained significant when the variables current smoking status, history of major depression or anxiety disorders, alcohol and drug use disorders, race, and level of education were controlled; the association of nicotine dependence with general emotional distress was not significant. Neuroticism and the correlated psychologic vulnerabilities may commonly predispose to nicotine dependence and major depression or anxiety disorders.

We examined prospectively the association between nicotine dependence and major depression (MDD). The following questions were addressed: (1) Are smokers with a history of MDD at increased risk for progression to nicotine dependence and more severe levels of dependence? (2) Are persons with a history of nicotine dependence at increased risk for MDD? A sample of 995 young adults were interviewed in 1989 and reinterviewed in 1990, 14 months later. The revised National Institute of Mental Health-Diagnostic Interview Schedule was used to ascertain DSM-III-R nicotine dependence and other substance use and psychiatric disorders. A history of MDD increased the risk for progression to nicotine dependence or more severe levels of dependence (odds ratio, 2.06; 95% confidence interval, 1.21 to 3.49). In addition, persons with a history of nicotine dependence had a higher rate of first-incidence MDD during the follow-up period than persons with no history of nicotine dependence (7.5% vs 3.2%; odds ratio, 2.45; 95% confidence interval, 1.17 to 5.15). The prospective data suggest that the association between nicotine dependence and MDD, observed previously in cross-sectional studies, might be either causal, with influences flowing in both directions, or, more probably, noncausal, reflecting the effects of common factors that predispose to both disorders.

Earlier, the authors reported on the association of nicotine dependence with major depression and anxiety disorders in a group of young adults. This report describes the occurrence of withdrawal symptoms and their sociodemographic and psychiatric correlates in persons in that group who tried unsuccessfully to abstain from smoking. A random sample of 1,007 members of a health maintenance organization, 21-30 years old, were interviewed with a revised version of the NIMH Diagnostic Interview Schedule. Data on nicotine withdrawal came from a subset of 239 smokers who had tried unsuccessfully to quit or cut down on smoking. With two exceptions, each of the DSM-III-R nicotine withdrawal symptoms was reported by more than one-half of these smokers. Withdrawal symptoms were more severe in white than in black smokers but were unrelated to sex, educational level, or marital status. Persons with histories of major depression or any anxiety disorder reported more severe withdrawal symptoms than persons with neither of these disorders. Severity of withdrawal, or any specific symptom, did not account for the association between major depression and continued smoking. Furthermore, severity of withdrawal was unrelated to continued smoking. While the long-term clinical significance of nicotine withdrawal is unclear, the evidence indicates that in the general population, abstinence from smoking is associated with a variety of disturbances, including a craving for cigarettes, dysphoria, and symptoms of irritability or nervousness. In this study disturbances were more severe in persons with histories of major depression or anxiety disorders.