Nicotine Dependence Risk is Higher in Patients with Major Depressive Disorder

Hamzah Alghzawi, PhD-c

A recent study, looking for correlations between lifetime nicotine dependence in patients with and without major depressive disorder (MDD) who smoked, found that an estimated 41% of people diagnosed with psychiatric illness were also smokers and were 70% more likely to be smokers than those without psychiatric diagnoses.

It has been reported in previous studies that between 40% and 50% of patients with MDD are smokers. To explore this further, the study examined data from Wave 1 of the National Epidemiology Survey on Alcohol and Related Conditions (NESARC, 2001-2002).

“The findings of this study will increase the psychiatric nurses’ understanding and awareness regarding the sociodemographic and smoking-related factors that may contribute to the development of lifetime nicotine dependence in people with the major depressive disorder,” author Hamzah Alghzawi, a PhD candidate from the University of Maryland School of Nursing in Baltimore, told MD Magazine. “This, in turn, will enhance the efforts and the interventions to prevent developing lifetime nicotine dependence by addressing those factors in the smoking cessation programs.”

Alghzawi wrote that smoking is “the leading preventable cause of disease, disability, and death among people with mental illness,” and “has been associated with cancer, cardiac diseases, respiratory disorders, and other chronic disorders.”

The study aimed to determine if age, gender, ethnicity, race, place of birth, education, income, marital status, employment status, and health played any role in the lifetime rates of nicotine dependence in patients with mental health diagnoses. Alghzawi also took into account age at the first use of tobacco, the age at the onset of daily smoking, the quantity of smoking, the duration of daily smoking in years, and gender.

The findings determined that the likelihood of nicotine dependence in patients with MDD was 77.4 % lower in patients older than 45 years, and 46% lower among patients 30 to 44 years, than in those between 18 and 29 years old.

Nicotine dependence was 8.3% lower among non-Hispanic ethnicity compared with Hispanic ethnicity, 57.4% lower among Asian, and 77.7% lower among Native American compared with white smokers. By contrast, the odds of lifetime nicotine dependence were 12% more among black smokers compared with white.

Geographically, the odds of nicotine dependence were 23.6% less among smokers born in the United States compared with those who were not. Related to income, the risk of nicotine dependence was 14.1% lower among smokers with an income from $20,000 to $69,000 and 15.2% lower among smokers with an income higher than $70,000 compared to those with income lower than $19,999.

The chance of nicotine dependence was 11.6% lower for patients who were never married compared with married patients, and 41.7% lower among patients who were employed vs. those who were unemployed. Nicotine dependence risk was 16.4% higher among smokers who were divorced, separated, or widowed compared with married smokers.

The risk of nicotine dependence was 10.4% among who had poor to fair overall health compared with those with good to excellent overall health. In regard to body weight, odds of nicotine dependence decreased by 46.5% as weight increased by 1 unit. The risk increased by 10% as the quantity of smoking increased by one unit.

The chance of nicotine dependence was 8.4% among smokers with high school education, and 3.6% more among those with some college or higher, compared with smokers with less than high school education.

Alghzawi noted that duration of daily smoking and its interaction with gender had no association with lifetime nicotine dependence.

The study, “Probability and correlates of nicotine dependence among smokers with and without major depressive disorder: Results from the national epidemiology survey on alcohol and related conditions,” was published in Perspectives in Psychiatric Care.

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