Skip to main content
SpringerLink
Log in

Cigarette Smoking and Psychiatric Disorder in a Community Sample

  • Published:
Annals of Clinical Psychiatry

Abstract

We examined the lifetime prevalence of psychiatric disorders in cigarette smokers and nonsmokers in a non-patient sample. First-degree relatives of psychiatric patients (n = 697) and normal controls (n = 360) were interviewed with the Diagnostic Interview Schedule and the Structured Interview for DSM-III Personality Disorders. Using these interviews we diagnosed the major mental (Axis I) disorders and personality (Axis II) disorders. A cigarette smoker was defined as someone who smoked daily for a month or more at some time in their lives. We found that smokers more frequently had a lifetime history of major depression, alcohol and drug abuse/dependence, agoraphobia, unstable/acting out and anxious/fearful personality disorders. In a logistic regression analysis, the only significant variables independently associated with smoking status were the alcohol and drug use disorders. Age was an important modifying variable—the smoking-illness relationship was robust in the youngest age cohort and negligible in the oldest cohort. We conclude that cigarette smokers have increased rates of mood, anxiety, substance use, and personality disorders. However, after controlling for the comorbidity among the disorders only alcohol and drug abuse/dependence were independently associated with smoking. Young smokers had particularly high rates of substance use disorders. This age effect may reflect the impact of a quarter century of health education.

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

Similar content being viewed by others

REFERENCES

  1. Burling TA, Zift DC. Tobacco smoking: A comparison between alcohol and drug abuse inpatients. Addictive Beh 1988; 13:185–190

    Google Scholar 

  2. Hughes JR, Hatsukami DK, Mitchell JE, Dahlgren LA. Prevalence of smoking among psychiatric outpatients. Am J Psychiatry 1986; 143:993–997

    Google Scholar 

  3. Maletzky CM, Klotter J. Smoking and alcoholism. Am J Psychiatry 1974; 131:445–448

    Google Scholar 

  4. Mathew RJ, Weinman ML, Mirabi M. Physical symptoms of depression. Br J Psychiatry 1981; 139:293–296

    Google Scholar 

  5. Glassman AH. Cigarette smoking: Implications for psychiatric illness. Am J Psychiatry 1993; 150:546–553

    Google Scholar 

  6. Hall RG, Duhamel M, McClanahan R, Miles G, Nason C, Rosen S, Schiller P, Tao-Yonenaga L, Hill SM. Level of functioning, severity of illness, and smoking status among chronic psychiatric patients. J Nerv Ment Dis 1995; 183:468–471

    Google Scholar 

  7. Burke GL, Hunter SM, Croft JB, Cresanta JL, Berenson GS. The interaction of alcohol and tobacco use in adolescents and young adults: Bogalusa heart study. Addictive Beh 1988; 13:387–393

    Google Scholar 

  8. CDC. Tobacco use by adults—United States 1987. MMWR 1989; 38:685–687

    Google Scholar 

  9. Cummins RO, Shaper AG, Walker M, Wale CJ. Smoking and drinking by middle-aged British men: Effects of social class and town of residence. Br Med J 1981; 283:1497–1502

    Google Scholar 

  10. Golding JF, Harpur T, Brent-Smith H. Personality, drinking, and drug-taking correlates of cigarette smoking. Personality Individ. Diff 1983; 4:703–706

    Google Scholar 

  11. Revell AD, Warburton DM, Wesnes K. Smoking as a coping strategy. Addictive Beh 1985; 10:209–224

    Google Scholar 

  12. Rosengren A, Wilhelmsen L, Wedel H. Separate and combined effects of smoking and alcohol abuse in middle-aged men. Acta Med Scand 1988; 223:111–118

    Google Scholar 

  13. Backhouse CI, James IP. The relationship and prevalence of smoking, drinking and drug taking in (delinquent) adolescent boys. Br J Addict 1969; 64:75–79

    Google Scholar 

  14. Lester D, Parilis G. Personality correlates of the use of marijuana, tobacco and beer. Psychol Rep 1986; 59:414

    Google Scholar 

  15. Anda RF, Williamson DF, Escobedo LG, Mast EE, Giovino GA, Remington PL. Depression and the dynamics of smoking. JAMA 1990; 264:1541–1545

    Google Scholar 

  16. Chiles JA, Benjamin GA, Cahn TS. Who smokes? Why?: Psychiatric aspects of continued cigarette usage among lawyers in Washington state. Compr Psychiatry 1990; 31:176–184

    Google Scholar 

  17. Frerichs RR, Aneshensel CS, Clark VA, Yokopenic P. Smoking and depression: A community survey. Am J Pub Health 1981; 71:637–641

    Google Scholar 

  18. Haines AF, Imeson JD, Meade TW. Psychoneurotic profiles of smokers and nonsmokers. Br Med J 1980; 280:1422

    Google Scholar 

  19. Parchman ML. Recognition of depression in patients who smoke. J Fam Practice 1991; 33:255–258

    Google Scholar 

  20. Schneider NG, Houston JP. Smoking and anxiety. Psychol Rep 1970; 26:941–942

    Google Scholar 

  21. Thomas CB. The relationship of smoking and habits of nervous tension. In Dunn WL, ed. Smoking Behavior: Motives and Incentives. Washington, DC: Winston and Sons, 1973: 57–170

    Google Scholar 

  22. Hämynen H, Vartiainen E, Sahi T, Pallonen U, Salonen JT. Social, personality and environmental determinants of smoking in young Finnish men. Scand J Soc Med 1987; 15:219–224

    Google Scholar 

  23. Knott VJ. Personality, arousal and individual differences in smoking. Psychol Rep 1979; 45:423–428

    Google Scholar 

  24. Mangan GL, Golding JF. The Psychopharmacology of Smoking. Cambridge: Cambridge University Press, 1984

    Google Scholar 

  25. Rae G. Extraversion, neuroticism and cigarette smoking. Br J Soc Clinical Psychology 1975; 14:429–430

    Google Scholar 

  26. Smith GM. Personality and smoking: A review of the empirical literature. In: Hunt WA, ed. Learning Mechanisms in Smoking. Chicago: Aldine Publishing Company, 1970:42–61

    Google Scholar 

  27. Spielberger CD, Jacobs GA. Personality and smoking behavior. J Personality Assess 1982; 46:396–403

    Google Scholar 

  28. Pomerleau CS, Pomerleau OF, Flessland KA, Bassen SM. Relationship of tridimensional personality questionnaire scores and smoking variables in female and male smokers. J Substance Abuse 1992; 4:143–154

    Google Scholar 

  29. Downey KK, Pomerleau CS, Pomerleau OF. Personality differences related to smoking and adult attention deficit hyperactivity disorder. J Substance Abuse 1996; 8:129–135

    Google Scholar 

  30. Cherry N, Kiernan K. Personality scores and smoking behavior: A longitudinal study. Br J Prev Soc Med 1976; 30:123–131

    Google Scholar 

  31. Fleming R, Levenethal H, Glynn K, Ershler J. The role of cigarettes in the initiation and progression of early substance use. Addictive Beh 1989; 14:261–272

    Google Scholar 

  32. Kandel DB, Davies M. Adult sequelae of adolescent depressive symptoms. Arch Gen Psychiatry 1986; 43:255–262

    Google Scholar 

  33. Stewart L, Livson N. Smoking and rebelliousness: A longitudinal study from childhood to maturity. J Consult Psychiatry 1966; 30:225–229

    Google Scholar 

  34. Glassman AG, Helzer JE, Covey LS, Cottler LB, Stetner F, Tipp JE, Johnson J. Smoking, smoking cessation, and major depression. JAMA 1990; 264:1546–1549

    Google Scholar 

  35. Breslau N, Kilbey M, Andreski P. Nicotine dependence, major depression, and anxiety in young adults. Arch Gen Psychiatry 1991; 48:1069–1074

    Google Scholar 

  36. Kandel DB, Johnson JG, Bird HR, Canino G, Goodman SH, Lahey BB, Regier DA, Schwab-Stone M. Psychiatric disorders associated with substance use among children and adolescents: Findings from the methods for the epidemiology of child and adolescent mental disorders (MECA) study. J Abn Child Psychol 1997; 25:121–132

    Google Scholar 

  37. Yates WR, Cadoret RJ, Troughton E. Axis I and Axis II comorbidity in nicotine dependence. Med Psychiatry 1998; 1:30–35

    Google Scholar 

  38. Merikangas KR, Gelernter CS. Comorbidity for alcoholism and depression. Psych Clin N A 1990; 13:613–632

    Google Scholar 

  39. Gertsley LJ, Alterman AI, McLellan AT, Woody GE. Antisocial personality disorder in patients with substance abuse disorder: A problematic diagnosis? Am J Psychiatry 1990; 147:173–178

    Google Scholar 

  40. Dulit RA, Fyer MR, Haas GL, Sullivan T, Frances AJ. Substance use in borderline personality disorder. Am J Psychiatry 1990; 147:1002–1007

    Google Scholar 

  41. Helzer JE, Pryzbeck TR. The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. J Stud Alcohol 1987; 49:219–224

    Google Scholar 

  42. Regier DA, Farmer ME, Rae DS, Lockhe BZ, Keith SJ, Lewis LJ, Goodwin FK. Comorbidity of mental disorders with alcohol and other drug abuse. JAMA 1990; 264:2511–2518

    Google Scholar 

  43. Weissman MM, Leaf PJ, Bruce ML, Florio L. The epidemiology of dysthymia in five communities: Rates, risks, comorbidity, and treatment. Am J Psychiatry 1988; 145:815–819

    Google Scholar 

  44. Zimmerman M, Coryell W. DSM-III personality disorder diagnoses in a nonpatient sample: demographic correlates and comorbidity. Arch Gen Psychiatry 1989; 46:682–689

    Google Scholar 

  45. Coryell W, Zimmerman M. Personality disorder in the families of depressed, schizophrenic and never-ill probands. Am J Psych 1989; 146:496–502

    Google Scholar 

  46. Black DW, Noyes R, Goldstein RB, Blum N. A family study of obsessive-compulsive disorder. Arch Gen Psychiatry 1992; 49:362–368

    Google Scholar 

  47. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics and validity. Arch Gen Psychiatry 1981; 38:381–389

    Google Scholar 

  48. Stangl D, Pfohl B, Zimmerman M, Bowers W, Corenthal C. A structured interview for the DSM-III personality disorders: Arch Gen Psychiatry 1985; 42:591–596

    Google Scholar 

  49. Pfohl B, Coryell W, Zimmerman M, Stangl D. DSM-III personality disorder: diagnostic overlap and internal consistency of individual DSM-III criteria. Compr Psychiatry 1986; 27:21–34

    Google Scholar 

  50. Zimmerman M, Coryell W. The reliability of personality disorder diagnoses in a nonpatient sample. J Pers Disord 1989; 3:53–57

    Google Scholar 

  51. Anda RF, Waller MN, Wooten KG, Most EE, Escobedo LG, Sanderson LM. Behavioral risk factor surveillance, 1988. MMWR 1990; 39:Supplement SS-2:1–21

    Google Scholar 

  52. Frederick T, Frerichs RR, Clark VA. Personal health habits and symptoms of depression at the community level. Prev Med 1988; 17:173–182

    Google Scholar 

  53. Linkins RW, Comstock GW. Depressed mood and development of cancer. Am J Epidemiol 1990; 132:962–972

    Google Scholar 

  54. Swan GE, Carmelli D, Rosenman RH. Psychological characteristics in twins discordant for smoking behavior: A matched-twin-pair analysis. Addictive Beh 1988; 13:51–60

    Google Scholar 

  55. Winokur G. The concept of secondary depression and its relationship to comorbidity. Psych Clin N A 1990; 13:567–583

    Google Scholar 

  56. Hughes JR. Clonidine, depression, and smoking cessation. JAMA 1988; 259:2901–2902

    Google Scholar 

  57. Glass RM. Blue mood, blackened lungs: Depression and smoking. JAMA 1990; 264:1583–1584

    Google Scholar 

  58. Carmody TP. Affect regulation, nicotine addiction, and smoking cessation. J Psychoactive Drugs 1989; 21:331–342

    Google Scholar 

  59. Jarvik ME, Henningsfield JE. Pharmacological treatment of tobacco dependence. Pharmacol Biochem Behav 1988; 30:279–294

    Google Scholar 

  60. Key SS. The motivational factors in cigarette smoking: A summary. In: Dunn WL, ed. Smoking Behavior: Motives and Incentives. Washington, DC: Winston and Sons, 1973:287–294

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Iowa College of Medicine, Iowa City, Iowa, 52242

    Donald W. Black & William H. Coryell

  2. Department of Psychiatry, Brown University School of Medicine, Providence, Rhode Island, 02912

    Mark Zimmerman

Authors
  1. Donald W. Black
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Zimmerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William H. Coryell
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Black, D.W., Zimmerman, M. & Coryell, W.H. Cigarette Smoking and Psychiatric Disorder in a Community Sample. Ann Clin Psychiatry 11, 129–136 (1999). https://doi.org/10.1023/A:1022355826450

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1022355826450

Search

Navigation