Journal
BMC MEDICINE
Volume 10, Issue -, Pages -Publisher
BIOMED CENTRAL LTD
DOI: 10.1186/1741-7015-10-123
Keywords
agoraphobia; anxiety disorder; cigarette smoking; epidemiology; generalized anxiety disorder; nicotine dependence; obsessive-compulsive disorder; panic disorder; post-traumatic stress disorder; specific phobia
Categories
Funding
- Brain and Behaviour Research Institute
- National Health and Medical Research Council
- Geelong Medical Research Foundation
- The University of Melbourne
- Ian Potter Foundation
- Eli Lilly
- NHMRC Training Fellowship [628912]
- Amgen
- Sanofi-Aventis
- Barwon Health
- Dairy Research and Development Corporation
- Ronald Geoffrey Arnott Foundation
- ANZ Charitable Trust
- American Society for Bone and Mineral Research
- Amgen (Europe) GmBH
- NHMRC
- NIH
- Cooperative Research Centre
- Simons Autism Foundation
- Cancer Council of Victoria
- Stanley Medical Research Foundation
- MBF
- Beyond Blue
- Bristol Myers Squibb
- Glaxo SmithKline
- Organon
- Novartis
- Mayne Pharma and Servier
- Australian Rotary Health
- Perpetual Trustees
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Background: Multiple studies have demonstrated that rates of smoking and nicotine dependence are increased in individuals with anxiety disorders. However, significant variability exists in the epidemiological literature exploring this relationship, including study design (cross-sectional versus prospective), the population assessed (random sample versus clinical population) and diagnostic instrument utilized. Methods: We undertook a systematic review of population-based observational studies that utilized recognized structured clinical diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD)) for anxiety disorder diagnosis to investigate the relationship between cigarette smoking, nicotine dependence and anxiety disorders. Results: In total, 47 studies met the predefined inclusion criteria, with 12 studies providing prospective information and 5 studies providing quasiprospective information. The available evidence suggests that some baseline anxiety disorders are a risk factor for initiation of smoking and nicotine dependence, although the evidence is heterogeneous and many studies did not control for the effect of comorbid substance use disorders. The identified evidence however appeared to more consistently support cigarette smoking and nicotine dependence as being a risk factor for development of some anxiety disorders (for example, panic disorder, generalized anxiety disorder), although these findings were not replicated in all studies. A number of inconsistencies in the literature were identified. Conclusions: Although many studies have demonstrated increased rates of smoking and nicotine dependence in individuals with anxiety disorders, there is a limited and heterogeneous literature that has prospectively examined this relationship in population studies using validated diagnostic criteria. The most consistent evidence supports smoking and nicotine dependence as increasing the risk of panic disorder and generalized anxiety disorder. The literature assessing anxiety disorders increasing smoking and nicotine dependence is inconsistent. Potential issues with the current literature are discussed and directions for future research are suggested.
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