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. Author manuscript; available in PMC: 2015 Jul 1.
Published in final edited form as: Ann Epidemiol. 2014 Apr 28;24(7):493–497. doi: 10.1016/j.annepidem.2014.01.014

Changes in the prevalence of mood and anxiety disorders among male and female current smokers in the United States: 1990 to 2001

Renee D Goodwin 1,2, Melanie M Wall 3,4, Tse Choo 4, Sandro Galea 2, Jonathan Horowitz 1, Yoko Nomura 1,5, Michael J Zvolensky 6,7, Deborah S Hasin 2,3,4
PMCID: PMC4393820  NIHMSID: NIHMS599174  PMID: 24935462

Abstract

Purpose

The present study investigated whether the prevalence of mood and anxiety disorders has increased over time among current smokers, as well as whether these trends differ by gender and in comparison to non-smokers.

Methods

Data were drawn from the National Comorbidity Survey (NCS; 1990) and the National Comorbidity Survey-Replication (NCS-R; 2001), representative samples of the US adult population. Binomial regression analyses were used to determine differences between mood and anxiety disorders among current smokers in 1990 and 2001 and whether these differed by gender and in comparison to those who were former or never current smokers.

Results

Any anxiety disorder, panic attacks, panic disorder, social anxiety disorder and dysthymia were all significantly more common among current smokers in 2001 compared with 1990 and these increases were significantly greater than any trend found in non-smokers. Increases in each of these disorders were more pronounced in female than in male smokers. Major depressive disorder and generalized anxiety disorder were not found to increase over time among smokers.

Conclusions

The prevalence of several anxiety disorders and dysthymia among current smokers appears to have increased from 1990 to 2001. Future studies are needed to determine whether these trends have continued. If so, interventions aimed at moving the prevalence lower may have limited success if mental health problems such as anxiety disorders and certain mood disorders are not considered in the development and dissemination of tobacco control programs.

Keywords: tobacco, depression, anxiety, prevalence

INTRODUCTION

One in five adult deaths in the United States [1] is attributable to cigarette smoking. Even among nonsmokers, smoking presents a substantial health risk; approximately 38,000 nonsmokers die each year from secondhand smoke exposure [2, 3]. Despite the well-known dangers of smoking, it remains common, with a current prevalence of about 21% among U.S. adults [4].

The prevalence of smoking declined substantially in the general US population between 1950–1990 [5]; from 42% in the 1950’s–1960’s to 25%in the 1990’s [6, 7]. The decline in smoking prevalence appears attributable to the effectiveness of public health tobacco control efforts that resulted in increases in smoking cessation [7]. In 2005, the prevalence of smoking was 21.0% [8], suggesting a relatively narrow decline between 1990 and 2005 compared change observed in prior decades. Moreover, quit rates have not increased among adults over this same time period [9]. It is, therefore, possible that the stagnated decline in smoking prevalence is influenced by the stability of quit rates [9]. Accordingly, there is a need to better understand the factors related to quit success among smokers in the general population.

Many smokers with comorbid mental and physical conditions often struggle to quit smoking [10]. There is now broad-based clinical and scholarly recognition that smokers are more likely to have a mental disorder than are nonsmokers and individuals with a mental disorder are significantly more likely to smoke compared to persons without a mental disorder [8, 10–13]. Depression and anxiety disorders are highly prevalent in the general population and highly comorbid with smoking [14–23]. Depression and anxiety disorders have been found in a majority of adults who smoke [24–29]. Moroever, there is robust empirical evidence that depression and anxiety disorders can increase risk of smoking experimentation [30, 31], progression to daily smoking [32], and development of nicotine dependence [33]. Additionally, among current smokers, depression and anxiety disorders often increase risk of smoking cessation failure [34–38].

An increase in the prevalence of depression and anxiety disorders among smokers in the general population could contribute to population-level stagnation of smoking prevalence. Prior studies have shown strong links between depression and anxiety disorders and persistent smoking in community samples [39–41]. Yet, with the exception of one study in Australia which found no significant difference in the strength of the relation between smoking and mental health problems between 1997 and 2007 [42], past research has not examined whether the proportion of smokers with depression and anxiety disorders has actually increased in more recent years. In addition, the decline in smoking has been much more pronounced among men than women [43], who are much more likely than men to have depression and anxiety disorders [44]. As such, gender could be an important factor to consider in better understanding the proportion of smokers with depression and anxiety disorders.

The current study investigated whether and to what degree the prevalence of depression and anxiety disorders has increased among smokers in the US general population over time. Data were drawn from the National Comorbidity Survey (NCS) [45] and the National Comorbidity Survey-Replication (NCS-R) [46], representative samples of the US adult population approximately ten years apart. First, we investigated the prevalence of mood and anxiety disorders among current smokers in 2001 compared to 1990. Second, we examined whether prevalence differ significantly by gender. We also investigated the prevalence of depression and anxiety disorders among non-smokers in 2001, compared with 1990, in an effort to examine whether such changes were specific to smokers.

METHODS

Sample I

The National Comorbidity Survey (NCS) is based on a national probability sample (n = 8,098) of individuals aged 15 to 54 in the non-institutionalized United States population [47]. Fieldwork was carried out between September 1990 and February 1992. There was an 82.4% response rate. The data were weighted for differential probabilities of selection and non-response. A weight was also used to adjust the sample to approximate the cross-classification of the population distribution on a range of sociodemographic characteristics. Weighting and a full description of study methodology are described in detail elsewhere [48, 49]. Only 18–54 year olds were included in the present analyses to ensure consistency with the 2001 survey. Questions about smoking in the NCS were restricted to a random subsample who participated in the in the NCS Tobacco Supplement (n = 4, 411). Written informed consent was obtained from each participant after the survey had been fully explained. The study was approved by the IRB of the University of Michigan.

Diagnostic Assessment

Psychiatric diagnoses were generated from a modified version of the World Health Organization (WHO) Composite International Diagnostic Interview [50], a structured interview designed for use by trained lay interviewers. WHO field trials [51] and NCS clinical reappraisal studies documented acceptable reliability and validity of all diagnoses [52, 53]. Psychiatric disorders examined in the current analyses included past 12-month panic attacks, panic disorder, post-traumatic stress disorder (PTSD), specific phobia, social anxiety disorder, generalized anxiety disorder (GAD), major depressive disorder, dysthymia, bipolar I and II.

Smoking

All participants in the in the NCS Tobacco Supplement (n = 4,411, n= 4,149 between 18–54) were asked a series of questions about cigarette smoking, that allowed for the categorization of current, former, and never smokers. The initial question was “Have you ever (smoked/used) for a month or more?” Participants answering “No” to this question were designated as “Never a Smoker.” Those answering “Yes” were asked “When was the last time you (smoked/used) fairly regularly – in the past month, past six months, past year, or more than a year ago?” Participants who answered “More than a year ago” were designated as “Former Smokers.” Those who selected any of the three other answers were considered “Current Smokers.”

Sample II

The National Comorbidity Survey-Replication (NCS-R) is a nationally representative sample (n = 9,882) of English-speaking individuals aged 18 and older living in US households between February 2001 and December 2004 [54]. Part I of the NCS-R survey, which comprised of core diagnostic assessment, was administered to all respondents, Part II was administered to only those individuals who met lifetime criteria for a Part I disorder and a probability sample of other respondents [55]. Analyses were carried out on the sample that completed both Parts I and II (n= 6,706). The data were weighted to adjust for the sampling scheme of the NCS-R. Only 18–54 year olds were included in the current analyses to be consistent with the 1990 sample. The NCS-R received human subjects consent approval from Harvard Medical School and the University of Michigan.

DSM-IV mental disorders

The WHO Composite International Diagnostic Interview (CIDI) Version 3.0 was used to assess major depression and anxiety disorders. The CIDI is a structured diagnostic interview which is administered by lay interviewers who are specifically trained in CIDI administration [56]. Clinical re-appraisal studies have shown good concordance between CIDI diagnoses and diagnoses made with the research version of the Structured Clinical Interview for DSM-IV (SCID) [57, 58]. These analyses included past 12-month panic attacks, panic disorder, PTSD, specific phobia, social anxiety disorder, and GAD, major depressive disorder, dysthymia, bipolar I and II.

Smoking

Participants were asked “Are you a current smoker, ex-smoker, or have you never smoked?” Those answering current were coded as “Current smokers”, those answering ex-smoker were coded as “Former smokers” and those answering “Only a few times” (an additional response category) or “Never” were considered “Never a Smoker”.

Statistical Analyses

The prevalence of depression and anxiety disorders by each smoking group (current, former, never) were calculated in 1990 and 2001. Binomial regression with a linear link of each disorder as the outcome regressed on year, smoking group, and the interaction of year and group was used to obtain risk differences (RDs) and 95% confidence intervals representing the increase or decrease in the prevalence of the disorder across time within the particular group. Differential time trends across smoking groups were tested by the interaction term. Then using only current smokers, a similar set of binomial regression models tested for differences in time trends across gender. Analyses incorporated sampling weights available for NCS and NCS-R rescaled to sum to the sample size.

RESULTS

Prevalence of depression and anxiety disorders by smoking status in 1990 vs. 2001

In 1990 the prevalence of all depression and anxiety disorders were significantly higher among current smokers than they were in never smokers. This was also found in 2001.

When examining trends over time, the prevalence of panic attacks, panic disorder, social phobia and dysthymia were statistically significantly higher among current smokers in 2001 compared with 1990 (see Table 1). Furthermore, with the exception of social phobia the increases over time among current smokers were significantly greater than the respective changes over time in the never smokers. The most prominent increase in current smokers was among panic attacks. Post-traumatic stress disorder showed an increase from 1990 to 2001 among former smokers that was significantly greater than the change over time of never smokers (who did not show a significant change in PTSD). There were no significant changes in MDD or GAD over time in current or former smokers.

Table 1.

Prevalence of depression and anxiety disorders in 1990 vs. 2001a, by Smoking Status

Current Smoker Former Smoker Never a daily Smoker
Past 12-Month Diagnoses 1990
n=1356		 2001
n=1872		 RD
(95% CI)		 1990
n=637		 2001
n=1277		 RD
(95% CI)		 1990
n=2026		 2001
n=3540		 RD
(95% CI)		 Overall P-Value Comparing Group RDsd
Panic Attack 6.26% 19.01% 12.8 (10.6, 14.9) 4.77% 12.01% 7.3 (4.8, 9.7) 2.92% 10.10% 7.2 (5.9, 8.4) <.0001 A, B
Panic Disorder 3.38% 5.59% 2.2 (0.8, 3.6) 2.97% 2.52% −0.5 (−2.0, 1.1) 1.76% 2.33% 0.6 (−0.2, 1.3) .0370 A, B
Post-traumatic Stress Disorderb 6.76% 6.34% −0.4 (−2.4, 1.5) 2.04% 4.72% 2.7 (0.8, 4.6) 3.31% 1.69% −0.5 (−1.5, 0.5) .0130 A, C
Social Phobia 8.16% 10.20% 2.0 (0.0, 4.0) 5.53% 7.94% 2.4 (0.1, 4.7) 6.39% 7.02% 0.6 (−0.7, 2.0) .3128
Specific Phobia 12.25% 11.89% −0.4 (−2.7, 1.9) 8.20% 9.95% 1.8 (−1.0, 4.4) 7.12% 8.32% 1.2 (−0.2, 2.7) .4189
Generalized Anxiety Disorder 5.61% 7.11% 1.5 (−0.2, 3.2) 4.25% 4.67% 0.4 (−1.5, 2.4) 1.65% 3.12% 1.5 (0.7, 2.3) .5961
Any Anxiety disorderc 24.62% 32.51% 7.9 (4.8, 11.0) 16.26% 26.26% 10.0 (6.3, 13.8) 14.64% 21.75% 7.1 (5.1, 9.2) .4203
Major Depressive Disorder 13.32% 14.94% 1.6 (−0.8, 4.0) 8.71% 8.99% 0.3 (−2.4, 3.0) 8.13% 7.20% −0.9 (−2.4, 0.5) .1998
Dysthymia 3.25% 4.59% 1.3 (0.0, 2.7) 1.93% 2.65% 0.7 (−0.7, 2.1) 2.37% 1.71% −0.7 (−1.5, 0.1) .0221B
Bipolar I 3.15% 2.01% −1.2 (−2.2, −0.0) 1.02% 0.67% −0.4 (−1.3, 0.6) 0.45% 0.20% −0.3 (−0.6, 0.1) .3120
Bipolar II 3.15% 1.92% −1.2 (−2.4, −0.1) 1.02% 0.94% −0.1 (−1.0, 0.9) 0.45% 0.49% 0.0 (−0.3, 0.4) .0948
Any Mood disorderc 15.06% 16.42% 1.4 (−1.2, 3.9) 9.48% 9.61% 0.1 (−2.7, 2.9) 8.94% 7.45% −1.5 (−3.0, 0.0) .1441
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RD = Risk Difference, i.e. difference in prevalence across time; CI = confidence interval

a

All prevalence estimates incorporate sampling weights to represent US population between ages 18–54 years old.

b

The sample assessed for PTSD in 1990 and 2010 is slightly smaller but prevalence estimates incorporate sampling weights still representative of US population between 18–54. Sample includes: Current 1990 N=1310, Current 2001 N 1151, Former 1990 N=622, Former 2001 N=762, Never 1990 N=2059, Never 2001 N=2169.

c

Any Anxiety includes panic attack, panic disorder, PTSD, social phobia, specific phobia, GAD; Any Depression includes MDD, Dysthymia, Bipolar I or II

d

Overall p-value is based on 2 degree of freedom test assessing group by time interaction. Significant (p<.05) post-hoc comparisons of RDs across groups are labeled A, B, C where A indicates RD for Current Smokers is different than former Smokers, B indicates RD for Current Smokers is different than for Never Smokers, and C indicates RD for Former Smokers is different than for Never Smokers.

Prevalence of depression and anxiety disorders by gender in 1990 vs. 2001

In 1990, the prevalence of all depression and anxiety disorders were significantly higher among female current smokers than among male current smokers with the exception of bipolar II. The higher prevalence of these disorders among female, compared to male current smokers, were also found in 2001.

Compared with 1990, the prevalence of panic attacks, panic disorder, social phobia, and dysthymia were higher among female current smokers in 2001 (see Table 2) and with the exception of panic disorder these increases were significantly greater than the respective changes over time in male current smokers. There were no significant changes in the prevalence of PTSD, specific phobia, GAD or MDD in either gender of current smokers.

Table 2.

Prevalence of depression and anxiety disorders among male and female current smokers in 1990 vs. 2001a

Current Smokers MALES Current Smokers FEMALES
Past 12-Month Diagnoses 1990
(n=674)		 2001
(n=1006)		 RD
(95% CI)		 1991
(n=682)		 2001
(n=866)		 RD
(95% CI)		 p-value comparing Group RDs
Panic Attack 3.53% 13.24% 9.7 (7.1, 12.2) 8.95% 25.71% 16.76 (13.1, 20.4) .0017
Panic Disorder 2.18% 3.41% 1.2 (−0.3, 2.8) 4.57% 8.13% 3.6 (1.2, 6.0) .1129
Post-traumatic Stress Disorderb 4.95% 3.19% −1.8 (−4.0, 0.5) 8.44% 9.76% 1.3 (−1.9, 4.6) .1243
Social Phobia 9.13% 8.82% −0.3 (−3.1, 2.5) 7.20% 11.81% 4.6 (1.7, 7.5) .0163
Specific Phobia 6.75% 7.76% 1.0 (−1.5, 3.5) 17.68% 16.68% −1.0 (−4.8, 2.8) .3854
Generalized Anxiety Disorder 3.98% 4.93% 1.0 (−1.0, 3.0) 7.22% 9.63% 2.4 (−0.4, 5.2) .4023
Any Anxiety disorderc 18.70% 24.55% 5.9 (1.9, 9.8) 30.47% 41.75% 11.3 (6.5, 16.0) .0867
Major Depressive Disorder 10.87% 11.77% 0.9 (−2.2, 4.0) 15.74% 18.63% 2.9 (−0.9, 6.7) .4228
Dysthymia 3.15% 2.91% −0.2 (−1.9, 1.5) 3.35% 6.54% 3.2 (1.1, 5.3) .0135
Bipolar I 3.04% 1.46% −1.6 (−3.1, −0.1) 3.29% 2.65% −0.6 (−2.4, 1.1) .4178
Bipolar II 3.00% 2.27% −0.7 (−2.3, 0.9) 3.29% 1.50% −1.8 (−3.4, −0.2) .3464
Any Mood disorderc 12.13% 12.59% 0.5 (−2.8, 3.7) 17.96% 20.87% 2.9 (−1.0, 6.9) .3447
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RD = Risk Difference, i.e. difference in prevalence across time; CI = confidence interval

a

All prevalence estimates incorporate sampling weights to represent US population of current smokers between ages 18–54 years old.

b

The sample assessed for PTSD in 1990 and 2010 is slightly smaller: Male 1990 N=631, Female 1990 N=679, Male 2001 N=599, Female 2001 N=552

c

Any Anxiety includes panic attack, panic disorder, PTSD, social phobia, specific phobia, GAD; Any Depression includes MDD, Dysthymia, Bipolar I or II

d

p-value is for test assessing gender by time interaction indicating difference in RDs

DISCUSSION

The present study compared the prevalence of depression and anxiety disorders among adults who smoke cigarettes current in the U.S. adult population in 2001 and 1990. There were three main findings. First, the prevalence of any anxiety disorder and dysthymia was higher among current smokers in 2001 compared with 1990. Second, there are specific types of anxiety disorders that appear more common among smokers in 2001 compared with 1990, including panic attacks, panic disorder and social phobia. Third, the increase in anxiety disorders among current smokers appears more pronounced among women compared with men. Overall, the present findings are generally consistent with the perspective that as the smoking prevalence has declined, the prevalence of some mood and anxiety disorders has risen among remaining smokers.

Reasons for the increase in prevalence of anxiety disorders among smokers between 1990 and 2001 remain unclear. It may be that smokers who have anxiety disorders, compared to those without these disorders, are less likely to quit smoking. Integrative models of smoking-anxiety comorbidity often posit a dynamic interplay between smoking and anxiety. For example, smokers with anxiety disorders tend to be fearful of anxiety-related symptoms and bodily sensations, react with anxiety and fear when confronted with stressors, and cope with emotionally distressing events by trying to escape or avoid them [61]. These affect-relevant characteristics may increase the likelihood that smokers with anxiety disorders will be especially sensitive and emotionally reactive to nicotine withdrawal-related aversive interoceptive cues that routinely occur during smoking cessation [62] and cope with such emotional distress by smoking [63].

Previous studies have shown that depression and anxiety disorders are associated with decreased likelihood of quitting [59] and that nicotine dependence predicts continued smoking over time [60]. We found that dysthymia was significantly increased among current smokers in 2001, compared with 1990, though we did not find the same trend with major depression. As such, it is conceivable that an increase in the prevalence of dysthymia among current smokers could be a contributing factor to the stagnation of smoking rates. Clinically, the present results suggest that addressing depression and anxiety disorders in smoking cessation treatment may help improve the efficacy of tobacco control efforts. Smoking cessation programs that routinely integrate mental health interventions with smoking cessation are likely needed. As such, programs—both community-based and clinical—aimed at moving the prevalence of smoking lower should consider that a substantial proportion of smokers have depression and anxiety disorders.

There are several limitations to the current study. First, we analyzed current smoking and could not compare various levels of smoking prospectively, as this was the one measure of smoking across the two surveys. It is possible that current smokers in the NCS-R differed in their persistence vs those in the NCS. However, data suggest current smoking persists for years on average [66]. Therefore, the extent to which this affects the results should be minimal. Shifts in the proportion of mood and anxiety disorders among other types of smokers (e.g., less frequent, those with and without nicotine dependence) may differ. Second, measurement of depression and anxiety disorders was based on the DSM-III-R criteria in the NCS and DSM-IV in the NCS-R; they are not identical although the likelihood that results are due to definitional differences is likely minimized by lack of consistent findings among non-smokers. Thus, it is possible that definitional changes in mental disorders between DSM-III-R and DSM-IV may impact the observed results. Third, we were only able to look at the time period from 1990 to 2001/2003. Ideally, trends in depression and anxiety in the context of smoking can be examined over additional decades (e.g., from 1950 to the present). This is an important timeframe in the history of smoking, as it includes the beginning of the stagnation in overall decline; still, data that are more proximal to current day are needed next to more fully understand the most recent trends. Finally, it is impossible to draw conclusions about a causal relation between increases in depression and anxiety disorders in the smoking population and stagnation in smoking at the individual level. There are third many variables that may play a role in the observed associations (e.g., physical health status).

In sum, this study provides empirical evidence that the prevalence of certain anxiety disorders and dysthymia among current smokers in the US population appears to be higher in 2001 than it was in 1990. We observed an increase among both men and women, though the increase in anxiety disorders appears stronger among women. This increase was not observed among non-smokers. These results offer one possible plausible contributing factor to the stagnation in smoking prevalence. Namely, the stagnation in smoking prevalence over the past decade may be related to an increase in the proportion of current smokers with certain anxiety disorders and persistent mood disturbance (dysthymia) and that tobacco control and clinical smoking cessation interventions available to most do not yet routinely address these complicating conditions.

Footnotes

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References

  • 1.U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004. [Google Scholar]
  • 2.Armour B, Woollery T, Malarcher A, Pechacek TF, Husten C. Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States 1997–2001. MMWR Morb Mortal Wkly Rep. 2005;54:625–8. [Google Scholar]
  • 3.Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: Actual Causes of Death in the United States, 2000. JAMA: The Journal of the American Medical Association. 2005;293(3):293–4. doi: 10.1001/jama.293.3.293. [DOI] [PubMed] [Google Scholar]
  • 4.Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years — United States, 2005–2010. MMWR Morb Mortal Wkly Rep. 2011;60(35):1207–12. [PubMed] [Google Scholar]
  • 5.Koh HK, Sebelius KG. Ending the tobacco epidemic. JAMA : the journal of the American Medical Association. 2012;308(8):767–8. doi: 10.1001/jama.2012.9741. Epub 2012/08/23. [DOI] [PubMed] [Google Scholar]
  • 6.CDC. Cigarette Smoking Among Adults – United States, 1990. MMWR Morb Mortal Wkly Rep. 1992;41(20):354–5. 61–62. [PubMed] [Google Scholar]
  • 7.CDC. Surveillance for Selected Tobacco-Use Behaviors — United States, 1900–1994. MMWR Morbidity and Mortality Weekly Report. 1994;43 [PubMed] [Google Scholar]
  • 8.CDC. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years — United States, 2005–2010. MMWR Morbidity and Mortality Weekly Report. 2011;60(35):1207–12. [PubMed] [Google Scholar]
  • 9.CDC. Cigarette smoking among adults and trends in smoking cessation – United States, 2008. MMWR Morbidity and Mortality Weekly Report. 2009;58(44):1227–32. Epub 2009/11/17. [PubMed] [Google Scholar]
  • 10.Fiore M. Treating tobacco use and dependence: 2008 update: Clinical practice guideline: DIANE Publishing. 2008 [Google Scholar]
  • 11.Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness. JAMA: The Journal of the American Medical Association. 2000;284(20):2606–10. doi: 10.1001/jama.284.20.2606. [DOI] [PubMed] [Google Scholar]
  • 12.Wiesbeck G, Kuhl H-C, Yaldizli Ö, Wurst F. Tobacco smoking and depression–results from the WHO/ISBRA study. Neuropsychobiology. 2008;57(1–2):26–31. doi: 10.1159/000123119. [DOI] [PubMed] [Google Scholar]
  • 13.Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. American Journal on Addictions. 2005;14(2):106–23. doi: 10.1080/10550490590924728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry. 2004;61(11):1107–15. doi: 10.1001/archpsyc.61.11.1107. Epub 2004/11/03. [DOI] [PubMed] [Google Scholar]
  • 15.Hughes JR. Comorbidity and smoking. Nicotine & Tobacco Research. 1999;1(Suppl 2):S149–52. doi: 10.1080/14622299050011981. discussion S65–6. [DOI] [PubMed] [Google Scholar]
  • 16.Hughes JR. The hardening hypothesis: is the ability to quit decreasing due to increasing nicotine dependence? A review and commentary. Drug and Alcohol Dependence. 2011;117(2–3):111–7. doi: 10.1016/j.drugalcdep.2011.02.009. Epub 2011/03/18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Leventhal AM, Japuntich SJ, Piper ME, Jorenby DE, Schlam TR, Baker TB. Isolating the Role of Psychological Dysfunction in Smoking Cessation: Relations of Personality and Psychopathology to Attaining Cessation Milestones. Psychol Addict Behav. 2012 doi: 10.1037/a0028449. Epub 2012/05/31. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Japuntich SJ, Smith SS, Jorenby DE, Piper ME, Fiore MC, Baker TB. Depression predicts smoking early but not late in a quit attempt. Nicotine and Tobacco Research. 2007;9(6):677–86. doi: 10.1080/14622200701365301. Epub 2007/06/15. [DOI] [PubMed] [Google Scholar]
  • 19.Zvolensky MJ, Gibson LE, Vujanovic AA, Gregor K, Bernstein A, Kahler C, et al. Impact of Posttraumatic Stress Disorder on early smoking lapse and relapse during a self-guided quit attempt among community-recruited daily smokers. Nicotine and Tobacco Research. 2008;10(8):1415–27. doi: 10.1080/14622200802238951. Epub 2008/08/08. [DOI] [PubMed] [Google Scholar]
  • 20.Zvolensky MJ, Stewart SH, Vujanovic AA, Gavric D, Steeves D. Anxiety sensitivity and anxiety and depressive symptoms in the prediction of early smoking lapse and relapse during smoking cessation treatment. Nicotine and Tobacco Research. 2009;11(3):323–31. doi: 10.1093/ntr/ntn037. Epub 2009/02/28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Piper ME, Smith SS, Schlam TR, Fleming MF, Bittrich AA, Brown JL, et al. Psychiatric disorders in smokers seeking treatment for tobacco dependence: relations with tobacco dependence and cessation. Journal of Consulting and Clinical Psychology. 2010;78(1):13–23. doi: 10.1037/a0018065. Epub 2010/01/27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Leventhal AM, Ramsey SE, Brown RA, LaChance HR, Kahler CW. Dimensions of depressive symptoms and smoking cessation. Nicotine and Tobacco Research. 2008;10(3):507–17. doi: 10.1080/14622200801901971. Epub 2008/03/08. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Piper ME, Cook JW, Schlam TR, Jorenby DE, Baker TB. Anxiety diagnoses in smokers seeking cessation treatment: relations with tobacco dependence, withdrawal, outcome and response to treatment. Addiction. 2011;106(2):418–27. doi: 10.1111/j.1360-0443.2010.03173.x. Epub 2010/10/27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Breslau N, Peterson EL, Schultz LR, Chilcoat HD, Andreski P. Major depression and stages of smoking. A longitudinal investigation. Archives of General Psychiatry. 1998;55(2):161–6. doi: 10.1001/archpsyc.55.2.161. Epub 1998/03/07. [DOI] [PubMed] [Google Scholar]
  • 25.Cuijpers P, Smit F, ten Have M, de Graaf R. Smoking is associated with first-ever incidence of mental disorders: a prospective population-based study. Addiction. 2007;102(8):1303–9. doi: 10.1111/j.1360-0443.2007.01885.x. Epub 2007/07/13. [DOI] [PubMed] [Google Scholar]
  • 26.Degenhardt L, Hall W. The relationship between tobacco use, substance-use disorders and mental health: results from the National Survey of Mental Health and Well-being. Nicotine Tob Res. 2001;3(3):225–34. doi: 10.1080/14622200110050457. Epub 2001/08/17. [DOI] [PubMed] [Google Scholar]
  • 27.Diaz FJ, Rendon DM, Velasquez DM, Susce MT, de Leon J. Datapoints: Smoking and smoking cessation among persons with severe mental illnesses. Psychiatr Serv. 2006;57(4):462. doi: 10.1176/ps.2006.57.4.462. Epub 2006/04/11. [DOI] [PubMed] [Google Scholar]
  • 28.Jochelson J, Majrowski B. Clearing the Air: Debating smoke-free policies in psychiatric units. London: King’s Fund; 2006. [Google Scholar]
  • 29.Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: A population-based prevalence study. JAMA. 2000;284(20):2606–10. doi: 10.1001/jama.284.20.2606. Epub 2000/11/22. [DOI] [PubMed] [Google Scholar]
  • 30.Leventhal AM, Ray LA, Rhee SH, Unger JB. Genetic and Environmental Influences on the Association Between Depressive Symptom Dimensions and Smoking Initiation Among Chinese Adolescent Twins. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2011 doi: 10.1093/ntr/ntr253. Epub 2011/12/20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Patton GC, Carlin JB, Coffey C, Wolfe R, Hibbert M, Bowes G. Depression, anxiety, and smoking initiation: a prospective study over 3 years. Am J Public Health. 1998;88(10):1518–22. doi: 10.2105/ajph.88.10.1518. Epub 1998/10/17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Audrain-McGovern J, Rodriguez D, Rodgers K, Cuevas J. Declining alternative reinforcers link depression to young adult smoking. Addiction. 2011;106(1):178–87. doi: 10.1111/j.1360-0443.2010.03113.x. Epub 2010/09/16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.McKenzie M, Olsson CA, Jorm AF, Romaniuk H, Patton GC. Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in young adulthood: findings from a 10-year longitudinal study. Addiction. 2010;105(9):1652–9. doi: 10.1111/j.1360-0443.2010.03002.x. Epub 2010/08/17. [DOI] [PubMed] [Google Scholar]
  • 34.Diaz FJ, Rendon DM, Velasquez DM, Susce MT, de Leon J. Datapoints: Smoking and smoking cessation among persons with severe mental illnesses. Psychiatric Services. 2006;57(4):462. doi: 10.1176/ps.2006.57.4.462. Epub 2006/04/11. [DOI] [PubMed] [Google Scholar]
  • 35.Hall SM, Muñoz RF, Reus VI. Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers. Journal of consulting and clinical psychology. 1994;62(1):141. doi: 10.1037//0022-006x.62.1.141. [DOI] [PubMed] [Google Scholar]
  • 36.Hitsman B, Borrelli B, McChargue DE, Spring B. History of depression and smoking cessation outcome: a meta-analysis. JOURNALIIII?? 2003 doi: 10.1037/0022-006x.71.4.657. [DOI] [PubMed] [Google Scholar]
  • 37.Johnson EO, Breslau N. Is the association of smoking and depression a recent phenomenon? Nicotine & Tobacco Research. 2006;8(2):257–62. doi: 10.1080/14622200600576644. Epub 2006/06/13. [DOI] [PubMed] [Google Scholar]
  • 38.Zvolensky MJ, Gonzalez A, Bonn-Miller MO, Bernstein A, Goodwin RD. Negative reinforcement/negative affect reduction cigarette smoking outcome expectancies: incremental validity for anxiety focused on bodily sensations and panic attack symptoms among daily smokers. Exp Clin Psychopharmacol. 2008;16(1):66–76. doi: 10.1037/1064-1297.16.1.66. Epub 2008/02/13. [DOI] [PubMed] [Google Scholar]
  • 39.Goodwin RD, Zvolensky MJ, Keyes KM. Nicotine dependence and mental disorders among adults in the USA: evaluating the role of the mode of administration. Psychological Medicine. 2008;38(9):1277–86. doi: 10.1017/S0033291708003012. Epub 2008/03/28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Grover KW, Goodwin RD, Zvolensky MJ. Does current versus former smoking play a role in the relationship between anxiety and mood disorders and nicotine dependence? Addictive behaviors. 2012;37(5):682–5. doi: 10.1016/j.addbeh.2012.01.014. Epub 2012/02/22. [DOI] [PubMed] [Google Scholar]
  • 41.Hwang KT, Kim YH, Kim YS, Choi IY. Cementless total hip arthroplasty with a metal-on-metal bearing in patients younger than 50 years. J Arthroplasty. 2011;26(8):1481–7. doi: 10.1016/j.arth.2011.02.020. Epub 2011/03/19. [DOI] [PubMed] [Google Scholar]
  • 42.Mathews R, Hall WD, Gartner CE. Is there evidence of ‘hardening’ among Australian smokers between 1997 and 2007? Analyses of the Australian National Surveys of Mental Health and Well-Being. Aust N Z J Psychiatry. 2010;44(12):1132–6. doi: 10.3109/00048674.2010.520116. Epub 2010/11/13. [DOI] [PubMed] [Google Scholar]
  • 43.Centers for Disease Control and Prevention. Cigarette smoking among adults–United States, 2004. MMWR Morb Mortal Wkly Rep. 2005;54(44):1121–4. Epub 2005/11/11. [PubMed] [Google Scholar]
  • 44.Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, et al. Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry. 2009;66(7):785–95. doi: 10.1001/archgenpsychiatry.2009.36. Epub 2009/07/08. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Kessler RC. National Comorbidity Survey: Baseline (NCS-1), 1990–1992. Inter-university Consortium for Political and Social Research (ICPSR) [distributor] 2008 [Google Scholar]
  • 46.Kessler RC, Merikangas KR. The National Comorbidity Survey Replication (NCS-R): background and aims. Int J Methods Psychiatr Res. 2004;13(2):60–8. doi: 10.1002/mpr.166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8–19. doi: 10.1001/archpsyc.1994.03950010008002. Epub 1994/01/01. [DOI] [PubMed] [Google Scholar]
  • 48.Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry. 1994;151(7):979–86. doi: 10.1176/ajp.151.7.979. Epub 1994/07/01. [DOI] [PubMed] [Google Scholar]
  • 49.Kessler RC, Little RJ, Groves RM. Advances in strategies for minimizing and adjusting for survey nonresponse. Epidemiol Rev. 1995;17(1):192–204. doi: 10.1093/oxfordjournals.epirev.a036176. Epub 1995/01/01. [DOI] [PubMed] [Google Scholar]
  • 50.World Health Organization. Composite International Diagnostic Interview (CIDI) Geneva: World Health Organization; 1990. [Google Scholar]
  • 51.Wittchen HU, Kessler RC, Zhao S, Abelson J. Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder. J Psychiatr Res. 1995;29(2):95–110. doi: 10.1016/0022-3956(94)00044-r. Epub 1995/03/01. [DOI] [PubMed] [Google Scholar]
  • 52.Wittchen HU, Zhao S, Abelson JM, Abelson JL, Kessler RC. Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders. Psychol Med. 1996;26(6):1169–77. doi: 10.1017/s0033291700035893. Epub 1996/11/01. [DOI] [PubMed] [Google Scholar]
  • 53.Kessler RC, Wittchen HU, Abelson JM, McGonagle K, Schwarz N, Kendler KS, et al. Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US national comorbidity survey (NCS) International Journal of Methods in Psychiatric Research. 1998;7(1):33–55. [Google Scholar]
  • 54.Breslau N. Psychiatric comorbidity of smoking and nicotine dependence. Behavior Genetics. 1995;25(2):95–101. doi: 10.1007/BF02196920. Epub 1995/03/01. [DOI] [PubMed] [Google Scholar]
  • 55.Breslau N, Kilbey MM, Andreski P. Vulnerability to psychopathology in nicotine-dependent smokers: an epidemiologic study of young adults. American Journal of Psychiatry. 1993;150(6):941–6. doi: 10.1176/ajp.150.6.941. Epub 1993/06/01. [DOI] [PubMed] [Google Scholar]
  • 56.Kessler RC, Ustun TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) International Journal of Methods in Psychiatric Research. 2004;13(2):93–121. doi: 10.1002/mpr.168. Epub 2004/08/07. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.First MB, Spitzer RL, Gibbon M, Qilliams JBW. Structured Clinical Interview for DSM-IV-TR Axis Disorders, Research Version, Non-Patient Edition (SCID-I/NP) New York, NY: New York State Psychiatric Institute; 2002. [Google Scholar]
  • 58.Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, et al. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research. 2006;15(4):167–80. doi: 10.1002/mpr.196. Epub 2007/02/03. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 59.Goodwin RD, Pagura J, Spiwak R, Lemeshow AR, Sareen J. Predictors of persistent nicotine dependence among adults in the United States. Drug and Alcohol Dependence. 2011;118(2–3):127–33. doi: 10.1016/j.drugalcdep.2011.03.010. Epub 2011/04/26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Goodwin RD, Perkonigg A, Hofler M, Wittchen HU. Mental disorders and smoking trajectories: A 10-year prospective study among adolescents and young adults in the community. Drug Alcohol Depend. 2013;130(1–3):201–7. doi: 10.1016/j.drugalcdep.2012.11.009. Epub 2013/02/05. [DOI] [PubMed] [Google Scholar]
  • 61.Zvolensky MJ, Bernstein A. Cigarette smoking and panic psychopathology. Current Directions in Psychological Science. 2005;14(6):301–5. doi: 10.1177/0963721410388642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Brandon TH, Tiffany ST, Obremski KM, Baker TB. Postcessation cigarette use: the process of relapse. Addictive behaviors. 1990;15(2):105–14. doi: 10.1016/0306-4603(90)90013-n. [DOI] [PubMed] [Google Scholar]
  • 63.Parrott AC. Does cigarette smoking cause stress? The American psychologist. 1999;54(10):817–20. doi: 10.1037//0003-066x.54.10.817. Epub 1999/11/30. [DOI] [PubMed] [Google Scholar]
  • 64.McCabe RE, Chudzik SM, Antony MM, Young L, Swinson RP, Zolvensky MJ. Smoking behaviors across anxiety disorders. Journal of anxiety disorders. 2004;18(1):7–18. doi: 10.1016/j.janxdis.2003.07.003. [DOI] [PubMed] [Google Scholar]
  • 65.Zvolensky MJ, Feldner MT, Eifert GH, Brown RA. Affective style among smokers: Understanding anxiety sensitivity, emotional reactivity, and distress tolerance using biological challenge. Addictive behaviors. 2001;26(6):901–15. doi: 10.1016/s0306-4603(01)00242-8. [DOI] [PubMed] [Google Scholar]
  • 66.Hu MC, Griesler PC, Schaffran C, Wall MM, Kandel DB. Trajectories of criteria of nicotine dependence from adolescence to early adulthood. Drug Alchol Depend. 2012;125(3):283–9. doi: 10.1016/j.drugalcdep.2012.03.001. [DOI] [PMC free article] [PubMed] [Google Scholar]

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