Major Depression and PTSD in Pregnant Smokers Enrolled in Nicotine Gum Treatment Trial

Abstract

Background and Objectives Pregnant women face considerable barriers to smoking cessation. The purpose of this study was to determine the prevalence of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) and response to smoking cessation treatment in pregnant smokers participating in a randomized, placebo-controlled trial of nicotine gum. Methods Participants were 194 low-income, ethnically diverse pregnant smokers. Results Utilizing a structured interview, 45% and 18% of the subjects met criteria for a lifetime diagnosis of MDD and PTSD, respectively. There was no difference in response to treatment, based on the presence of either of these psychiatric disorders. Conclusions Cumulatively, these findings provide evidence of the high degree of unmet mental health needs in pregnant smokers. Scientific Significance Pregnant women with a history of MDD and PTSD appear to be as likely to benefit from smoking cessation treatment as those without such a history.

Posttraumatic stress disorder and cigarette smoking: A systematic review

“…Generally, these findings indicate that individuals with higher overall PTSD symptom levels smoked more cigarettes per day Kirby et al, 2008;Mathew et al, 2015) and reported smoking more heavily (Cook et al, 2009) when compared with those with lower PTSD symptoms. When examined categorically, smokers with PTSD had greater nicotine dependence Wilson et al, 2014) and higher nicotine withdrawal symptoms than in those without PTSD (Dornelas et al, 2013). Regarding specific symptom clusters, PTSD hyperarousal was associated with number of cigarettes per day (Ashare et al, 2011) and nicotine dependence in males (Baschnagel et al, 2008); greater PTSD avoidance symptoms were associated with higher smoking (Helstrom, Bell, & Pineles, 2009;Kirby et al, 2008) and nicotine dependence in males (Baschnagel et al, 2008); and PTSD severity was associated with smoking rate, nicotine dependence, and time to first cigarette among veterans.…”

“…In addition to highlighting several demographic (e.g., gender; Baschnagel et al, 2008;Weinberger et al 2009) and baseline psychological characteristics (e.g., psychiatric history; Dornelas et al, 2013;Vrana et al, 2013;Wilson et al, 2014), much of newer etiological work has focused on the influences of smoking outcome motives and expectancies (e.g., Ashare et al, 2011;Feldner, Babso, & Zvolensky, 2007;Langdon & Leventhal, 2014) and AS (e.g., Feldner, Babson, et al, 2008;Feldner, Leen-Feldner, et al, 2008;Mathew et al, 2015) as moderating factors underlying the association between PTSD and smoking. In addition to highlighting several demographic (e.g., gender; Baschnagel et al, 2008;Weinberger et al 2009) and baseline psychological characteristics (e.g., psychiatric history; Dornelas et al, 2013;Vrana et al, 2013;Wilson et al, 2014), much of newer etiological work has focused on the influences of smoking outcome motives and expectancies (e.g., Ashare et al, 2011;Feldner, Babso, & Zvolensky, 2007;Langdon & Leventhal, 2014) and AS (e.g., Feldner, Babson, et al, 2008;Feldner, Leen-Feldner, et al, 2008;Mathew et al, 2015) as moderating factors underlying the association between PTSD and smoking.…”

“…Similarly, a study by Wilson et al (2014) demonstrated that smokers with PTSD had higher incidence of lifetime major depressive disorder, current anxiety disorder other than PTSD, and lifetime alcohol dependence. In a study of pregnant smokers, those with a history of PTSD were more likely to report treatment for substance use, past psychiatric hospitalization, and prior suicide attempts (Dornelas et al, 2013).…”

“…current smokers were approximately twice that of nonsmokersForbes et al, 2015;Lopez, Konrath, & Seng, 2011).This prevalence is supported in studies utilizing samples comprised entirely of smokers, indicating rates of current PTSD (7%, Mathew et al, 2015) and lifetime PTSD (11%; Weinberger, Maciejewski, McKee, Reutenauer, & Mazure, 2009) were roughly twice the rates of current PTSD (3.5%) and lifetime PTSD (6.8%) in the general U.S. populationKessler, Chiu, Demler, Merikangas, & Walters, 2005). Further, data from a study of pregnant smoking women in a nicotine gum treatment trial found that 8.4% met criteria for current PTSD and 18% for lifetime PTSD(Dornelas, Oncken, Greene, Sankey, & Kranzler, 2013). More specifically, a survey of pregnant women(Lopez et al, 2011) found a higher rate of current or lifetime PTSD among lifetime smokers (16 and 32%, respectively) than nonsmokers (6 and 16%, respectively).…”

Examination of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) Factor Structure in a Sample of Pregnant Smokers

“…19,20 However, among women who continue to smoke during pregnancy, nicotine dependence scores, as assessed by measures such as the FTCD, have been found to be lower during pregnancy than prepregnancy, 21,22 falling in the low to moderate range of severity. [21][22][23][24][25] Lower scores are likely due to women's efforts to reduce smoking during pregnancy. 26,27 Data from a twin study indicate that 34% of variance in number of cigarettes smoked during pregnancy is due to heritable influences, with 66% variance related to nonshared environmental influences.…”