Post-traumatic stress disorder and smoking: A systematic review

Abstract

We conducted a systematic review of what is known about the relationship between post-traumatic stress disorder (PTSD) and smoking to guide research on underlying mechanisms and to facilitate the development of evidence-based tobacco treatments for this population of smokers. We searched Medline, PsychINFO, and the Cochrane Central Register of Controlled Trials and identified 45 studies for review that presented primary data on PTSD and smoking. Smoking rates were high among clinical samples with PTSD (40%-86%) as well as nonclinical populations with PTSD (34%-61%). Most studies showed a positive relationship between PTSD and smoking and nicotine dependence, with odds ratios ranging between 2.04 and 4.52. Findings also suggest that PTSD, rather than trauma exposure itself, is more influential for increasing risk of smoking. A small but growing literature has examined psychological factors related to smoking initiation and maintenance and the overlapping neurobiology of PTSD and nicotine dependence. Observational studies indicate that smokers with PTSD have lower quit rates than do smokers without PTSD. Yet a few tobacco cessation treatment trials in smokers with PTSD have achieved quit rates comparable with controlled trials of smokers without mental disorders. In conclusion, the evidence points to a causal relationship between PTSD and smoking that may be bidirectional. Specific PTSD symptoms may contribute to smoking and disrupt cessation attempts. Intervention studies that test behavioral and pharmacological interventions designed specifically for use in patients with PTSD are needed to reduce morbidity and mortality in this population.

The role of acute cortisol and DHEAS in predicting acute and chronic PTSD symptoms

“…Further, although we collected and controlled for various important covariates, among which trauma history, injury severity and ICU admission, we did not account for other possible confounders, such as nicotine use, oral contraceptive use, experienced pain or alcohol or drug use at the time of blood sampling. Nicotine and oral contraceptives have been shown to suppress cortisol reactivity (Fu et al, 2007;Reynolds et al, 2013). Alternately, pain, alcohol and opiate drug use were found to increase the cortisol response to acute stress (Coventry et al, 2001;Ehring et al, 2008;Stankiewicz et al, 2013).…”

Associations of Discrimination and Violence With Smoking Among Emerging Adults: Differences by Gender and Sexual Orientation

“…Sexual assault is a traumatizing experience, but two reviews of the literature (Feldner, Babson, & Zvolensky, 2007;Fu et al, 2007) noted that the negative sequelae of traumas (i.e., PTSD) is more predictive of smoking than the actual traumatic experience itself. The inability to assess PTSD in our dataset may help explain the differential associations in sexual assault and smoking across the groups.…”

Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond

“…Indeed, individuals with PTSD and anxiety disorders are more likely to smoke (Fu et al, 2007;Morissette et al, 2007). PTSD and anxiety disorders are also associated with obesity, which may result in part from emotional eating behavior (Scott et al, 2008).…”