The Effects of Tobacco Smoking, and Prenatal Tobacco Smoke Exposure, on Risk of Schizophrenia: A Systematic Review and Meta-Analysis

Hunter, Abby; Murray, Rachael L; Asher, Laura; Leonardi‐Bee, Jo

doi:10.1093/ntr/nty160

Cited by 72 publications

(70 citation statements)

References 62 publications

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“…These meta-analyses consistently found a significantly heightened prospective risk of psychotic disorders, of around two-fold for smokers vs. non-smokers, in terms of daily tobacco use (n=6, RR=2.18, 95% CI: 1.23-3.85, I 2 =97.7%) 53 and "personal active smoking" (n=6, RR=1.99, 95% CI: 1.1-3.61, I 2 =97%) 52 . However, significant publication bias was indicated and high levels of statistical heterogeneity were found 52,53 (see Table 3).…”

Section: Smoking and Risk Of Psychotic Disorders And Bipolar Disordermentioning

confidence: 84%

“…The prospective risk for incident psychotic disorders in those who engaged in regular tobacco use compared to non-smokers were calculated in two meta-analyses, both using data from over 1.7 million individuals 52,53 . These meta-analyses consistently found a significantly heightened prospective risk of psychotic disorders, of around two-fold for smokers vs. non-smokers, in terms of daily tobacco use (n=6, RR=2.18, 95% CI: 1.23-3.85, I 2 =97.7%) 53 and "personal active smoking" (n=6, RR=1.99, 95% CI: 1.1-3.61, I 2 =97%) 52 . However, significant publication bias was indicated and high levels of statistical heterogeneity were found 52,53 (see Table 3).…”

Section: Smoking and Risk Of Psychotic Disorders And Bipolar Disordermentioning

confidence: 99%

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A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders

et al. 2020

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There is increasing academic and clinical interest in how “lifestyle factors” traditionally associated with physical health may also relate to mental health and psychological well‐being. In response, international and national health bodies are producing guidelines to address health behaviors in the prevention and treatment of mental illness. However, the current evidence for the causal role of lifestyle factors in the onset and prognosis of mental disorders is unclear. We performed a systematic meta‐review of the top‐tier evidence examining how physical activity, sleep, dietary patterns and tobacco smoking impact on the risk and treatment outcomes across a range of mental disorders. Results from 29 meta‐analyses of prospective/cohort studies, 12 Mendelian randomization studies, two meta‐reviews, and two meta‐analyses of randomized controlled trials were synthesized to generate overviews of the evidence for targeting each of the specific lifestyle factors in the prevention and treatment of depression, anxiety and stress‐related disorders, schizophrenia, bipolar disorder, and attention‐deficit/hyperactivity disorder. Standout findings include: a) convergent evidence indicating the use of physical activity in primary prevention and clinical treatment across a spectrum of mental disorders; b) emerging evidence implicating tobacco smoking as a causal factor in onset of both common and severe mental illness; c) the need to clearly establish causal relations between dietary patterns and risk of mental illness, and how diet should be best addressed within mental health care; and d) poor sleep as a risk factor for mental illness, although with further research required to understand the complex, bidirectional relations and the benefits of non‐pharmacological sleep‐focused interventions. The potentially shared neurobiological pathways between multiple lifestyle factors and mental health are discussed, along with directions for future research, and recommendations for the implementation of these findings at public health and clinical service levels.

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Section: Smoking and Risk Of Psychotic Disorders And Bipolar Disordermentioning

confidence: 84%

Section: Smoking and Risk Of Psychotic Disorders And Bipolar Disordermentioning

confidence: 99%

A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders

et al. 2020

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“…In pooling longitudinal studies ( n = 5), Gurillo and colleagues reported a 2-fold increase in the risk of incident psychotic disorders in people who were daily tobacco smokers compared to those who were not (RR = 2.18; 95% CI 1.23–3.85). Similarly, Hunter et al ( 3 ) who pooled data from studies identified using inclusion criteria with the outcome restricted to schizophrenia ( N = 5) also reported smoking tobacco was associated with a 2-fold risk of schizophrenia (RR = 1.99; 95% CI 1.10–3.61). Both studies concluded that further research was needed to examine the potential causal role of tobacco smoking in the onset of SSD.…”

Section: Introductionmentioning

confidence: 94%

“…Schizophrenia spectrum disorders (SSD) are heterogeneous syndromes with well-established risk factors including exposure to childhood adversity, cannabis use during adolescence, a history of obstetric complications, stressful events during adulthood, and low maternal serum folate level ( 1 ). In recent years, there has been a growing interest in tobacco smoking as a risk factor for SSD ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…It is the leading cause of preventable death, through increasing the risk of lung and other malignancies, chronic obstructive pulmonary disease (COPD), coronary heart disease, cerebrovascular disease, asthma and diabetes ( 4 ). Two systematic reviews and meta-analyses have examined the association between tobacco smoking and psychotic disorders ( 2 , 3 ). In pooling longitudinal studies ( n = 5), Gurillo and colleagues reported a 2-fold increase in the risk of incident psychotic disorders in people who were daily tobacco smokers compared to those who were not (RR = 2.18; 95% CI 1.23–3.85).…”

Section: Introductionmentioning

confidence: 99%

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Evidence of a Causal Relationship Between Smoking Tobacco and Schizophrenia Spectrum Disorders

et al. 2018

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There has been emerging evidence of an association between tobacco smoking and schizophrenia spectrum disorders (SSD). Two meta-analyses have reported that people who smoke tobacco have an ~2-fold increased risk of incident schizophrenia or psychosis, even after adjusting for confounding factors. This study aimed to critically appraise the research which has examined the association between tobacco smoking and SSD against the Bradford Hill criteria for causality, to determine the strength of the evidence for a causal relationship. Eight longitudinal studies (seven cohort studies and one case control study) were identified which examined tobacco smoking as an exposure and psychosis as an outcome. All seven cohort studies were assessed as being of high quality using the Newcastle-Ottawa Scale. Six of the eight studies found a statistically significant positive association between tobacco smoking and onset of SSD. These studies reported a consistent association with a moderate to large effect size and a dose response relationship. The studies adjusted for multiple potential confounders including age, sex, socioeconomic status, shared genetic risk, prodromal symptoms, and comorbid cannabis and other substance use. The studies did not adjust for exposure to childhood trauma or prenatal tobacco. There was substantial though inconclusive evidence supporting a causal relationship between tobacco smoking and increased risk of SSD. If a causal relationship does exist, nicotine is most likely responsible for this association. This raises serious public health concerns about the increasing use of e-cigarettes and other products, particularly by adolescents whose nicotine use may increase their risk of SSD. Research is urgently needed to examine the association between e-cigarette use and incident psychosis, particularly in adolescents and young adults.

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Development Over Time of the Population-Attributable Risk Fraction for Cannabis Use Disorder in Schizophrenia in Denmark

2021

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everal studies and meta-analyses 1,2 have indicated that the risk of schizophrenia and related psychoses is increased for people who use cannabis. The association appears to be particularly driven by heavy and frequent cannabis use. 2,3 This has led to a persisting hypothesis that cannabis may be a component cause of schizophrenia, at least in some people. This hypothesis is strengthened by several factors, such as strong attempts to control for reverse causation (eg, people self-medicating prodromal symptoms of schizophrenia). Similarly, cannabis-induced psychosis has been found to be associated with later onset of schizophrenia. [4][5][6] Furthermore, experimental evidence strongly suggests that cannabis, even in relatively low doses, causes psychoticlike symptoms in healthy individuals. [7][8][9]

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The Effects of Tobacco Smoking, and Prenatal Tobacco Smoke Exposure, on Risk of Schizophrenia: A Systematic Review and Meta-Analysis

Cited by 72 publications

References 62 publications

A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders

A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders

Evidence of a Causal Relationship Between Smoking Tobacco and Schizophrenia Spectrum Disorders

Development Over Time of the Population-Attributable Risk Fraction for Cannabis Use Disorder in Schizophrenia in Denmark

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