Department of Psychology, University of North Texas, Denton, Texas.
Institute of Mental Health Research, University of Texas at Austin, Austin, Texas.
Depress Anxiety. 2018 Nov;35(11):1056-1072. doi: 10.1002/da.22828. Epub 2018 Sep 7.
Previous reviews of the PTSD and cigarette smoking literature showed high PTSD-smoking comorbidity and problematic smoking outcomes (Feldner et al., 2007, Clinical Psychology Review, 27, 14-45; Fu et al., 2007, Nicotine & Tobacco Research, 9, 1071-1084). However, past reviews also noted several prominent gaps in the literature, including a lack of etiological work examining underlying mechanisms and research on specialized PTSD-smoking treatments. The present review summarizes an extensive body of research conducted since the previous reviews targeting these areas of need.
Literature searches identified 66 empirical studies specific to smoking and PTSD.
Smokers were approximately twice more likely to have PTSD than nonsmokers in the general population, and individuals with PTSD were approximately twice as likely to be current smokers. Smokers with PTSD evidenced more negative affect, trauma history, and comorbid psychiatric history, as well as quit attempts and higher relapse rates. PTSD symptoms were associated with expectations that smoking would reduce negative affect, which, in turn, was associated with increased smoking rate and nicotine dependence. Male sex was associated with nicotine dependence and PTSD avoidance, while the relationship between PTSD and smoking relapse due to withdrawal was stronger in females. Specialized, integrated PTSD and smoking cessation treatments showed promise in increasing quit success relative to standard care in randomized trials.
Rates of PTSD-smoking co-occurrence remain high. Notable gains have been made in relevant epidemiological and etiological research, although more work is needed in trauma-specific subpopulations. Several promising specialized treatments for comorbid smoking-PTSD have been developed and empirically tested but require replication.
之前对 PTSD 和吸烟文献的综述表明，PTSD 与吸烟高度共病，吸烟结果存在问题（Feldner 等人，2007 年，《临床心理学评论》，第 27 卷，第 14-45 页；Fu 等人，2007 年，《尼古丁与烟草研究》，第 9 卷，第 1071-1084 页）。然而，过去的综述也指出了文献中的几个突出空白，包括缺乏检查潜在机制的病因学工作以及针对特定 PTSD 吸烟治疗的研究。本综述总结了自前两次综述以来针对这些需求领域进行的大量研究。
文献检索确定了 66 项专门针对吸烟和 PTSD 的实证研究。
在普通人群中，吸烟者患有 PTSD 的可能性大约是不吸烟者的两倍，而患有 PTSD 的个体现在吸烟者的可能性大约是不吸烟者的两倍。患有 PTSD 的吸烟者表现出更多的负面情绪、创伤史和共病精神病史，以及戒烟尝试和更高的复发率。PTSD 症状与吸烟减轻负面情绪的期望有关，而这种期望反过来又与吸烟率和尼古丁依赖增加有关。男性与尼古丁依赖和 PTSD 回避有关，而由于戒断导致的 PTSD 与吸烟复发之间的关系在女性中更强。与标准护理相比，在随机试验中，专门的、综合的 PTSD 和戒烟治疗在提高戒烟成功率方面显示出希望。
PTSD 与吸烟共病的发生率仍然很高。在相关的流行病学和病因学研究方面取得了显著进展，尽管在特定创伤人群中仍需要更多的工作。已经开发并通过实证检验了几种针对共病吸烟-PTSD 的有前途的专门治疗方法，但需要复制。
