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

  • Tzu-Yu Lin
  • Huan-Cheng Chang
  • Kuang-Hung Hsu
Original Paper



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.


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.


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.


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.


Common mental disorders Areca nut chewing Biophysiological tests Community cohort Population-based study 



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].


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Healthy Aging Research CentreChang Gung UniversityTaoyuanTaiwan
  2. 2.Division of Family MedicineTaiwan Landseed HospitalTaoyuanTaiwan
  3. 3.Department of Health Care Management, College of ManagementChang Gung UniversityTaoyuanTaiwan
  4. 4.Department of UrologyChang Gung Memorial HospitalTaoyuanTaiwan

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