Association of anxiety disorders with the risk of smoking behaviors: A meta-analysis of prospective observational studies

Objective: Published articles reported controversial results about the association of anxiety disorders with the risk of smoking behaviors. A meta-analysis was performed to assess this association between anxiety disorders and smoking behaviors. Methods: A comprehensive search was performed to identify prospective observational studies (from January, 1990 to March, 2014) of the aforementioned association. The Q test and 12 statistic were used to examine between-study heterogeneity. Fixed or random effect model was selected based on heterogeneity test among studies. Meta-regression and the leave one out sensitive analysis were used to explore potential sources of between-study heterogeneity. Publication bias was estimated using Egger's regression asymmetry test. Results: Fifteen articles were included. After excluding studies that were the key contributors to between-study heterogeneity, the meta-analysis showed a significant association of anxiety disorders with increased risk of regular smoking (OR = 1.41, 95% Cl: 1.23-1.62) and nicotine dependence (OR = 1.58, 95% Cl: 1.45-1.73). No significant influence and publication bias were observed both before and after excluding the key contributors to heterogeneity. Conclusion: This meta-analysis suggested that anxiety disorders had significant positive effect on the risk of smoking behaviors. This association needs to be confirmed by further studies. (C) 2014 Elsevier Ireland Ltd. All rights reserved.