Skip to main content

Advertisement

SpringerLink
Log in

Areca nut chewing is associated with common mental disorders: a population-based study

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Introduction

Forms of habitual substance use including cigarette smoking and alcohol consumption have been documented as risk factors of common mental disorders (CMDs). The effects of areca nut chewing on biophysiological tests, metabolic syndromes, and liver function have been reported previously; however, the relationship between areca nut chewing and CMDs remains unclear. This study examined the association between areca nut chewing and CMDs and explored the relationships between areca nut chewing and biophysiological indicators.

Methods

A total of 4477 community dwellers who had enrolled in a cohort study and participated in health examinations in 2 consecutive years were selected for analysis in the present study. The community cohort was established in northern Taiwan during 2006–2012. The Chinese health questionnaire (CHQ-12) was used as a self-reported screening instrument to assess the potential for developing psychotic mental disorders (CHQ-12 score ≥ 3) among the community residents. Biophysiological tests performed 1 year before CMD assessment were analyzed to examine the causal pathways between areca nut chewing and CMDs. Multiple logistic regression and stratified analyses were performed.

Results

A total of 18.23% of the participants were diagnosed as having CMDs. Factors including areca nut chewing [odds ratio (OR) 1.828; 95% confidence interval (CI) 1.165–2.869], sex (women; OR 1.828; 95% CI 1.165–2.869), age (30–49; OR 1.302; 95% CI 1.073–1.579), and socioeconomic status (lower status; OR 1.373; 95% CI 1.084–1.738) were associated with CMDs in a multiple logistic regression model. Areca nut chewers exhibited significantly more triglycerides (220.04 vs. 124.16 mg/dL) and white blood cells (65.17 102/μL vs. 60.36 102/μL) and significantly higher diastolic blood pressure (78.83 vs. 75.84 mmHg) and glutamic oxaloacetic transaminase (30.30 vs. 25.45 U/L) than did the controls.

Conclusions

This study demonstrated the association between areca nut chewing and CMDs and its effects on biophysiological tests in a community-based population in Taiwan. The findings suggest the existence of mechanistic effects of areca nut chewing on CMDs exerted through multiple pathways that may interact with pre-existing biophysiological abnormalities. Lifestyle variables should be considered for the prevention and management of mental disorders in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Binns C, Low WY, Hewitt K (2011) Betel chewing and public health. Asia Pac J Public Health 23:1021–1024

    Article  PubMed  Google Scholar 

  2. Garg A, Chaturvedi P, Gupta PC (2014) A review of the systemic adverse effects of areca nut or betel nut. Indian J Med Paediatr Oncol 35:3–9

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chen MJ, Yang YH, Shieh TY (2002) Evaluation of a self-rating screening test for areca quid abusers in Taiwan. Public Health 116:195–200

    Article  PubMed  Google Scholar 

  4. Bales A, Peterson MJ, Ojha S, Upadhaya K, Adhikari B, Barrett B (2009) Associations between betel nut (Areca catechu) and symptoms of schizophrenia among patients in Nepal: a longitudinal study. Psychiatry Res 169:203–211

    Article  PubMed  Google Scholar 

  5. Tsai WC, Chen CY, Kuo HF, Wu MT, Tang WH, Chu CS et al (2013) Areca nut chewing and risk of atrial fibrillation in Taiwanese men: a nationwide ecological study. Int J Med Sci 10:804–811

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wen CP, Tsai SP, Cheng TY, Chen CJ, Levy DT, Yang HJ et al (2005) Uncovering the relation between betel quid chewing and cigarette smoking in Taiwan. Tob Control 14(Suppl 1):i16–i22

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wu GH, Boucher BJ, Chiu YH, Liao CS, Chen TH (2009) Impact of chewing betel-nut (Areca catechu) on liver cirrhosis and hepatocellular carcinoma: a population-based study from an area with a high prevalence of hepatitis B and C infections. Public Health Nutr 12:129–135

    Article  PubMed  Google Scholar 

  8. Chen THH, Chen H, Chiu YH, Boucher BJ (2006) Transgenerational effects of betel-quid chewing on the development of the metabolic syndrome in the Keelung community-based integrated screening program. Am J Clin Nutr 83:688–692

    Article  CAS  PubMed  Google Scholar 

  9. Javed F, Al-Hezaimi K, Warnakulasuriya S (2012) Areca-nut chewing habit is a significant risk factor for metabolic syndrome: a systematic review. J Nutr Health Aging 16:445–448

    Article  CAS  PubMed  Google Scholar 

  10. Javed F, Bello Correra FO, Chotai M, Tappuni AR, Almas K (2010) Systemic conditions associated with areca nut usage: a literature review. Scand J Public Health 38:838–844

    Article  PubMed  Google Scholar 

  11. Shafique K, Mirza SS, Vart P, Memon AR, Arain MI, Tareen MF et al (2012) Areca nut chewing and systemic inflammation: evidence of a common pathway for systemic diseases. J Inflamm (Lond) 9:22

    Article  Google Scholar 

  12. Shafique K, Zafar M, Ahmed Z, Khan NA, Mughal MA, Imtiaz F (2013) Areca nut chewing and metabolic syndrome: evidence of a harmful relationship. Nutr J 12:67

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chandra PS, Carey MP, Carey KB, Jairam KR (2003) Prevalence and correlates of areca nut use among psychiatric patients in India. Drug Alcohol Depend 69:311–316

    Article  PubMed  Google Scholar 

  14. Liu WH, Hsu CC, Hsu YH (2013) Chewing areca nut as an independent risk factor for proteinuria in middle-aged men. Kaohsiung J Med Sci 29:214–220

    Article  PubMed  Google Scholar 

  15. Sullivan RJ, Allen JS, Otto C, Tiobech J, Nero K (2000) Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia. Br J Psychiatry 177:174–178

    Article  CAS  PubMed  Google Scholar 

  16. Center for Behavioral Health Statistics and Quality (2015) Key substance use and mental health indicators in the United States: results from the 2015 National Survey on Drug Use and Health (HHS publication no. SMA 16–4984, NSDUH series H-51). https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf.Accessed 4 May 2017

  17. Fu TS, Lee CS, Gunnell D, Lee WC, Cheng AT (2013) Changing trends in the prevalence of common mental disorders in Taiwan: a 20-year repeated cross-sectional survey. Lancet 381:235–241

    Article  PubMed  Google Scholar 

  18. Capuron L, Su S, Miller AH, Bremner JD, Goldberg J, Vogt GJ et al (2008) Depressive symptoms and metabolic syndrome: is inflammation the underlying link? Biol Psychiatry 64:896–900

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Chen CC, Huang TL (2006) Association of serum lipid profiles with depressive and anxiety disorders in menopausal women. Chang Gung Med J 29:325–330

    CAS  PubMed  Google Scholar 

  20. Toalson P, Ahmed S, Hardy T, Kabinoff G (2004) The metabolic syndrome in patients with severe mental illnesses. Prim Care Companion J Clin Psychiatry 6:152–158

    Article  PubMed  PubMed Central  Google Scholar 

  21. Liang Y, Yan Z, Cai C, Jiang H, Song A, Qiu C (2014) Association between lipid profile and depressive symptoms among Chinese older people: mediation by cardiovascular diseases? Int J Behav Med 21:590–596

    Article  PubMed  Google Scholar 

  22. Liao PJ, Chen CH, Chan HY, Tan HK, Hsu KH (2012) Serum lipid profile could predict the inception and impacts of violent behaviors among acute psychiatric inpatients. Chang Gung Med J 35:382–391

    PubMed  Google Scholar 

  23. Mufti RM, Balon R, Arfken CL (1998) Low cholesterol and violence. Psychiatr Serv 49:221–224

    Article  CAS  PubMed  Google Scholar 

  24. Kunugi H, Takei N, Aoki H, Nanko S (1997) Low serum cholesterol in suicide attempters. Biol Psychiatry 41:196–200

    Article  CAS  PubMed  Google Scholar 

  25. Benegal V, Rajkumar RP, Muralidharan K (2008) Does areca nut use lead to dependence? Drug Alcohol Depend 97:114–121

    Article  PubMed  Google Scholar 

  26. Lee CH, Chiang SL, Ko AM, Hua CH, Tsai MH, Warnakulasuriya S et al (2014) Betel-quid dependence domains and syndrome associated with betel-quid ingredients among chewers: an Asian multi-country evidence. Addiction 109:1194 – 204

    Article  PubMed  Google Scholar 

  27. Sullivan RJ, Andres S, Otto C, Miles W, Kydd R (2007) The effects of an indigenous muscarinic drug, betel nut (Areca catechu), on the symptoms of schizophrenia: a longitudinal study in Palau, Micronesia. Am J Psychiatr 164:670–673

    Article  PubMed  Google Scholar 

  28. Sullivan RJ, Hagen EH (2002) Psychotropic substance-seeking: evolutionary pathology or adaptation? Addiction 97:389–400

    Article  CAS  PubMed  Google Scholar 

  29. Tsai WC, Wu MT, Wang GJ, Lee KT, Lee CH, Lu YH et al (2012) Chewing areca nut increases the risk of coronary artery disease in Taiwanese men: a case-control study. BMC Public Health 12:162

    Article  PubMed  PubMed Central  Google Scholar 

  30. Berk M, Sarris J, Coulson CE, Jacka FN (2013) Lifestyle management of unipolar depression. Acta Psychiatr Scand Suppl 443:38–54

    Article  Google Scholar 

  31. Cheng TA, Williams P (1986) The design and development of a screening questionnaire (CHQ) for use in community studies of mental disorders in Taiwan. Psychol Med 16:415–422

    Article  CAS  PubMed  Google Scholar 

  32. Chen CS, Tsang HY, Chong MY, Tang TC (2000) Validation of the Chinese Health Questionnaire (CHQ-12) in community elders. Kaohsiung J Med Sci 16:559–565

    CAS  PubMed  Google Scholar 

  33. Cheng TA, Wu JT, Chong MY, Williams P (1990) Internal consistency and factor structure of the Chinese Health Questionnaire. Acta Psychiatr Scand 82:304–308

    Article  CAS  PubMed  Google Scholar 

  34. Gupta PC, Warnakulasuriya S (2002) Global epidemiology of areca nut usage. Addict Biol 7(1):77–83

    Article  CAS  PubMed  Google Scholar 

  35. Chu NS (2002) Effects of Betel Chewing on the Central and Autonomic Nervous Systems. Addict Biol 7(1):111–114

    Article  PubMed  Google Scholar 

  36. Chu NS (2001) Effects of Betel chewing on the central and autonomic nervous systems. J Biomed Sci 8:229–236

    Article  CAS  PubMed  Google Scholar 

  37. Chung FM, Chang DM, Chen MP, Tsai JC, Yang YH, Shieh TY et al (2006) Areca nut chewing is associated with metabolic syndrome: role of tumor necrosis factor-alpha, leptin, and white blood cell count in betel nut chewing-related metabolic derangements. Diabetes Care 29:1714

    Article  PubMed  Google Scholar 

  38. Giri S, Idle JR, Chen C, Zabriskie TM, Krausz KW, Gonzalez FJ (2006) A metabolomic approach to the metabolism of the areca nut alkaloids arecoline and arecaidine in the mouse. Chem Res Toxicol 19:818–827

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Lin SH, Liao YS, Huang SH, Liao WH (2014) Relationship between betel quid chewing and risks of cardiovascular disease in older adults: a cross-sectional study in Taiwan. Drug Alcohol Depend 141:132–137

    Article  PubMed  Google Scholar 

  40. Tseng CH (2008) Betel nut chewing is associated with hypertension in Taiwanese type 2 diabetic patients. Hypertens Res 31:417–423

    Article  PubMed  Google Scholar 

  41. Hsiao TJ, Liao HW, Hsieh PS, Wong RH (2007) Risk of betel quid chewing on the development of liver cirrhosis: a community-based case-control study. Ann Epidemiol 17:479–485

    Article  PubMed  Google Scholar 

  42. Gibson M, Carek PJ, Sullivan B (2011) Treatment of co-morbid mental illness in primary care: how to minimize weight gain, diabetes, and metabolic syndrome. Int J Psychiatry Med 41:127–142

    Article  PubMed  Google Scholar 

  43. Gallagher D, Kiss A, Lanctot K, Herrmann N (2016) Depression with inflammation: longitudinal analysis of a proposed depressive subtype in community dwelling older adults. Int J Geriatr Psychiatry. https://doi.org/10.1002/gps.4645

    Google Scholar 

  44. Pierce GL, Kalil GZ, Ajibewa T, Holwerda SW, Persons J, Moser DJ et al (2017) Anxiety independently contributes to elevated inflammation in humans with obesity. Obesity 25:286–289

    Article  CAS  PubMed  Google Scholar 

  45. Heald AH, Martin JL, Payton T, Khalid L, Anderson SG, Narayanan RP et al (2017) Changes in metabolic parameters in patients with severe mental illness over a 10-year period: a retrospective cohort study. Aust NZ J Psychiatry 51:75–82

    Article  Google Scholar 

  46. Barnes J, Mondelli V, Pariante CM (2017) Genetic contributions of inflammation to depression. Neuropsychopharmacology 42:81–98

    Article  CAS  PubMed  Google Scholar 

  47. Lindqvist D, Dhabhar FS, James SJ, Hough CM, Jain FA, Bersani FS et al (2017) Oxidative stress, inflammation and treatment response in major depression. Psychoneuroendocrinology 76:197–205

    Article  CAS  PubMed  Google Scholar 

  48. Sanchez-Villegas A, Martinez-Gonzalez MA (2013) Diet, a new target to prevent depression? BMC Med 11:3

    Article  PubMed  PubMed Central  Google Scholar 

  49. Smith RS (1992) A comprehensive macrophage-T-lymphocyte theory of schizophrenia. Med Hypotheses 39:248–257

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgement

This work was supported by the Chang Gung Medical Foundation [CMRPD3F0021, CMRPD3F0022, CMRPG2F0071, CMRPG2F0072, CMRPG2F0081, CMRPG2F0082], and the Health Aging Research Centre of Chang Gung University [EMRPD1G0221].

Author information

Author notes

  1. Tzu-Yu Lin and Huan-Cheng Chang contributed equally to this paper.

Authors and Affiliations

  1. Healthy Aging Research Centre, Chang Gung University, Taoyuan, Taiwan

    Tzu-Yu Lin & Kuang-Hung Hsu

  2. Division of Family Medicine, Taiwan Landseed Hospital, Taoyuan, Taiwan

    Huan-Cheng Chang

  3. Department of Health Care Management, College of Management, Chang Gung University, No. 259, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, 333, Taiwan

    Huan-Cheng Chang & Kuang-Hung Hsu

  4. Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Kuang-Hung Hsu

Authors
  1. Tzu-Yu Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Huan-Cheng Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kuang-Hung Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kuang-Hung Hsu.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, TY., Chang, HC. & Hsu, KH. Areca nut chewing is associated with common mental disorders: a population-based study. Soc Psychiatry Psychiatr Epidemiol 53, 393–401 (2018). https://doi.org/10.1007/s00127-017-1460-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-017-1460-3

Keywords

Search

Navigation