Deakin University School of Medicine, Barwon Health, Geelong, Victoria, Australia.
BMC Med. 2012 Oct 19;10:123. doi: 10.1186/1741-7015-10-123.
Multiple studies have demonstrated that rates of smoking and nicotine dependence are increased in individuals with anxiety disorders. However, significant variability exists in the epidemiological literature exploring this relationship, including study design (cross-sectional versus prospective), the population assessed (random sample versus clinical population) and diagnostic instrument utilized.
We undertook a systematic review of population-based observational studies that utilized recognized structured clinical diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD)) for anxiety disorder diagnosis to investigate the relationship between cigarette smoking, nicotine dependence and anxiety disorders.
In total, 47 studies met the predefined inclusion criteria, with 12 studies providing prospective information and 5 studies providing quasiprospective information. The available evidence suggests that some baseline anxiety disorders are a risk factor for initiation of smoking and nicotine dependence, although the evidence is heterogeneous and many studies did not control for the effect of comorbid substance use disorders. The identified evidence however appeared to more consistently support cigarette smoking and nicotine dependence as being a risk factor for development of some anxiety disorders (for example, panic disorder, generalized anxiety disorder), although these findings were not replicated in all studies. A number of inconsistencies in the literature were identified.
Although many studies have demonstrated increased rates of smoking and nicotine dependence in individuals with anxiety disorders, there is a limited and heterogeneous literature that has prospectively examined this relationship in population studies using validated diagnostic criteria. The most consistent evidence supports smoking and nicotine dependence as increasing the risk of panic disorder and generalized anxiety disorder. The literature assessing anxiety disorders increasing smoking and nicotine dependence is inconsistent. Potential issues with the current literature are discussed and directions for future research are suggested.
多项研究表明，焦虑障碍患者的吸烟率和尼古丁依赖率增加。然而，在探索这种关系的流行病学文献中，存在显著的变异性，包括研究设计（横断面与前瞻性）、评估人群（随机样本与临床人群）和使用的诊断工具。
我们对基于人群的观察性研究进行了系统回顾，这些研究使用公认的结构化临床诊断标准（《精神障碍诊断与统计手册》（DSM）或《国际疾病分类》（ICD））来诊断焦虑障碍，以调查吸烟、尼古丁依赖和焦虑障碍之间的关系。
共有 47 项研究符合预先设定的纳入标准，其中 12 项研究提供了前瞻性信息，5 项研究提供了准前瞻性信息。现有证据表明，一些基线焦虑障碍是开始吸烟和尼古丁依赖的危险因素，尽管证据存在异质性，而且许多研究没有控制共病物质使用障碍的影响。然而，已确定的证据似乎更一致地支持吸烟和尼古丁依赖是某些焦虑障碍（例如惊恐障碍、广泛性焦虑障碍）发展的危险因素，尽管并非所有研究都复制了这些发现。文献中存在一些不一致的地方。
尽管许多研究表明焦虑障碍患者的吸烟率和尼古丁依赖率增加，但使用经过验证的诊断标准，前瞻性地在人群研究中检查这种关系的文献有限且存在异质性。最一致的证据支持吸烟和尼古丁依赖会增加惊恐障碍和广泛性焦虑障碍的风险。评估焦虑障碍增加吸烟和尼古丁依赖的文献不一致。讨论了当前文献中的潜在问题，并提出了未来研究的方向。
