Tobacco Use and Dependence among Psychiatry Out-Patients of a Health Institute in Eastern Nepal

Abstract

Background: Assessment of nicotine dependence among tobacco users is essential as highly dependent individuals have greater risk of developing tobacco related physical and psychiatric problems. There is little information about the tobacco use and nicotine dependence among psychiatric patients in developing countries, including Nepal.
 Objectives: To estimate the prevalence of tobacco use, the level of nicotine dependence and the psychiatric disorder specific prevalence among tobacco users visiting a psychiatry out-patient department.
 Materials and methods: A cross-sectional study was conducted in Out-patient setting of Department of Psychiatry, B. P. Koirala Institute of Health Sciences (BPKIHS). Ninety cases (calculated sample size) were enrolled. The Fagerström Test for Nicotine Dependence (FTND) was applied to assess the level of nicotine dependence and the Mini International Neuropsychiatric Interview (MINI) for diagnosis of Psychiatric disorders.
 Results: The prevalence of tobacco use was 55.6%. Tobacco use was more common among males (pvalue < 0.05). Smokeless form was the common form of tobacco. Majority of them had started their consumption in their adolescence. Most users had moderate nicotine dependence. Major depressive disorder and Alcohol dependence were the most common diagnoses among tobacco users.
 Conclusion: More than half of the psychiatry out-patients consumed tobacco. Future studies that help to understand the relationship and possible mechanism of increased tobacco use in patients with psychiatry disorders are required. Tobacco control and prevention strategies should be initiated targeting vulnerable populations such as male gender and adolescent.

Prevalence of Substance Use in Medical and Dental Students of a Medical University of Nepal

“…This prevalence points towards the extent of the problem in this part of the world. 17,18 A study conducted by Josseran et al 20 in a Paris medical school showed that more than one third of students were smokers (35%); 21% were daily smokers and 14% were occasional smokers which is comparable to this study. Budhathoki N et al 9 have studied substance use among third year Medical students of Nepal and found that about 56.20% of the students used tobacco after joining medical school in comparison to 43.80% consumed tobacco before joining medical school and majority of them were in hostels (53%) and rented house (62.50%).…”

“…Nicotine use doesn't appear to be lower than general population in this region. A study conducted at the department of Psychiatry by Limbu et al reveals that the prevalence of tobacco use was 55.6% in OPD, 17 62.2% in admitted 18 cases and 41.4% in community 19 . Tobacco use was more common among males in all three settings (p value < 0.05).…”

Prevalence of smoking among psychiatric patients in outpatient department of tertiary care centre: A descriptive cross-sectional study

“…Studies have identified that hormonal, cultural, and behavioural factors are linked with the differences in smoking among males and females. (14) A study done on the depressive patients in Tribhuwan University Teaching Hospital (TUTH), Nepal, (6) and another study done in the psychiatric outpatient department of BP Koirala Institute of Health Science (5) found that 37.2% and 38% of patients are current smokers, respectively which is higher than that of our study's finding. However, the study participants in those studies comprised a higher number of male patients which may have increased the overall prevalence of smoking in those studies.…”

“…Where, n= minimum required sample size z= 1.96 at 95% Confidence Interval (CI) p= prevalence taken as 38% from the previous study (5) q= 1-p e= margin of error, 5%…”

“…(2) This finding is consistent with many national and international studies, which found a higher prevalence of smoking in patients with mental illness compared to the general population. (5,6,(8)(9)(10) Combination of various psychological, social, and biological factors has been identified as the cause of the higher prevalence of smoking in psychiatric patients. (11,12) Gender differences in smoking prevalence present in the general population were consistent even in psychiatric patients.…”