Smoking as a form of self-medication for depression or anxiety in young adults: results of a mixed-methods study
DOI:
https://doi.org/10.20882/adicciones.127Keywords:
tobacco use, depression, anxiety, self-medication, adolescents, young adults.Abstract
Tobacco use and mental health problems in the depression/anxiety spectrum often begin in adolescence as co-occurring phenomena. Epidemiologically, the relationship between them is bidirectional, but in the case of young people it appears to be explained best by the unidirectional self-medication hypothesis. The aim of this study is to explore the relationship between tobacco use, symptoms of depression or anxiety, and the perception of adolescents and young adults concerning tobacco use as a form of self-medication. A sample of 105 young people between the ages of 17 and 21 years was selected from a longitudinal sociological study to create three groups of participants: 1) subjects with a previous diagnosis of depression or anxiety; 2) subjects with self-perceived but undiagnosed distress compatible with depression or anxiety; 3) and a group of control. A mixed quantitative/qualitative questionnaire on substance consumption was administered, as well as the BDI-II depression scale, the GHQ anxiety and depression scales, and the MISS (Mannheim Interview on Social Support) scale. The final results show that the subjects experiencing symptoms of depression or anxiety in adolescence start smoking later than subjects in the control group, and those who smoke give self-medication as the main reason for doing so. The association between habitual tobacco use and BDI scores for depression was not statistically significant for the sample as a whole, only for the male participants (OR: 6,22, IC95%, 1,06-36,21, p=.042). Anti-smoking campaigns targeting young people should take into consideration their use of tobacco as a form of self-medication for emotional distress.References
ATLAS.ti. Qualitative data analisys. Version 6.2.27. [Computersofware] (1993-2013) Berlin. ScientificSofwareDevelopment.
Alcalá, M., Azañas, S., Moreno, C. y Gálvez, L. (2002). Consumo de alcohol, tabaco y otras drogas en adolescentes, estudio de dos cortes. Medicina de Familia (Andalucía), 3, 81-87.
Audrain-McGovern, J., Rodriguez, D. y Kassel, J. D. (2009). Adolescent smoking and depression: evidence for self-medication and peer smoking mediation. Addiction, 104, 1743–1756. doi: 10.1111/j.1360-0443.2009.02617.x.
Balázs, J., Miklosi, M., Kereszteny, A., Apter, A, Avigal S, Bobes J,…Wasserman D. (2013). Adolescent Subthreshold-Depression and Anxiety: Psychopathology, Functional Impairment and Increased Suicide Risk. Journal of Child Psychology and Psychiatry. doi: 10.1111/jcpp.12016.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. y Erbaugh, J. (1961). An Inventory for Measuring Depression. Archives of General Psychiatry, 4, 561-571. doi:10.1001/archpsyc.1961.01710120031004.
Birchwood, M. y Singh, S. P. (2013). Mental health services for young people: matching the service to the need. British Journal of Psychiatry Supplements, 54:s1-2. doi: 10.1192/bjp.bp.112.119149.
Borgatti S. P., Everett M. G. y Freeman. L. C. (2002). Ucinet for Windows: Software for Social Network Analysis. Harvard, MA: Analytic Technologies.
Calleja, N. y Aguilar, J. (2008). Por qué fuman las adolescentes: un modelo estructural de la intención de fumar. Adicciones, 20, 387-394.
Chaiton M. O., Cohen J. E., O’Loughlin J. y Rehm J. (2009). A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BioMed Central Public Health. 9, 356. doi:10.1186/1471-2458-9-356.
Choi, W. S., Patten, C. A., Gillin, J. C., Kaplan, R. M. y Pierce, J. P. (1997). Cigarette smoking predicts development of depressive symptoms among U.S. adolescents. Annals of Behavioral Medicine, 19, 42–50.
Emory, K., Saquib, N., Gilpin, E. A. y Pierce, J. P. (2010). The association between home smoking restrictions and youth smoking behaviour: a review. Tobacco Control, 19, 495-506. doi:10.1136/tc.2010.035998
Escobedo, L. G., Reddy, M. y Giovino, G. A. (1998). The relationship between depressive symptoms and cigarette smoking in US adolescents. Addiction, 93, 433–440.
Fergusson, D. M., Goodwin, R. D. y Horwood, L. J. (2003). Major depression and cigarette smoking: results of a 21-year longitudinal study. Psychological Medicine, 33, 1357–1367. doi: 10.1017/S0033291703008596.
Fergusson, D., Horwood, J. y Boden, J. (2007). Childhood social disadvantage and smoking in adulthood: results of a 25-year longitudinal study. Addiction, 102, 475–482. doi:10.1111/j.1360-0443.2006.01729.x
Generalitat de Catalunya. (2013). Enquesta de Salut de Catalunya 2010-2014. Barcelona: Departament de Salut.
Glaser, B. G. y Strauss A. L. (1967). The Discovery of Grounded Theory; Strategies for Qualitative Research. Chicago; IL: Aldine Pub Co.
Goldberg, D., Bridges, K., Duncan-Jones, P.y Grayson, D. (1988). Detecting anxiety and depression in general medical settings. British Medical Journal, 297, 897-899.
Guo, H. J., McGee, R., Reeder, T., y Gray, A. (2010). Smoking behaviours and contextual influences on adolescent nicotine dependence. Australian and New Zealand Journal of Public Health, 34, 502–507. doi: 10.1111/j.1753-6405.2010.00597.x.
Hrubá, D. y Zaloudíková, I. (2010). Why to smoke? Why not to smoke? Major reasons for children’s decisions on whether or not to smoke. Central European Journal of Public Health, 18, 202–208.
Institut d’ Infància i Mon Urbà. Panel de Familias e Infancia. Barcelona. Recuperado de http://www.ciimu.org/images/stories/CIIMU/Estudios e Investigaciones/ 2panel-fam/14presentacio cggranell.pdf (Consultado en: 19/11/2012).
Julià, A., Escapa, S., Marí-Klose, M. y Marí-Klose, P. (2012). Factores de riesgo psicosociales en el consumo de tabaco de los adolescentes: estados de ánimo negativos, grupo de iguales y estilos parentales. Adicciones, 24, 309-318.
Kassel, J. D., Evatt, D.P., Greenstein, J. E., Wardle, M. C., Yates, M. C. y Veilleux, J. C. (2007). The Acute Effects of Nicotine on Positive and Negative Affect in Adolescent Smokers. Journal of Abnormal Psychology, 116, 543–553. doi: 10.1037/0021-843X.116.3.543
Klungsoyr, O., Nygard, J., Sorensen, T. y Sandanger, I. (2006). Cigarette smoking and incidence of first depressive episode: an 11-year, population-based follow-up study. American Journal of Epidemiology, 163, 421–432.
Lyons, M., Hitsman, B., Xian, H., Panizzon, M. S., Jerskey, B. A., Santangelo, S.,… Tsuang, M. T. (2008). A twin study of smoking, nicotine dependence, and major depression in men. Nicotine & Tobacco Research, 10, 97–108. doi: 10.1080/14622200701705332.
Martínez-Hernáez, Á., Marí-Klose, M., Julià, A., Escapa, S., Marí-Klose, P. y DiGiacomo, S. (2012). Adolescent daily smoking, negative mood-states and the role of family communication. Gaceta Sanitaria, 26, 421-428. doi:10.1016/j.gaceta.2011.09.030
Mendoza, R., López, P. y Sagrera, M. S. (2007). Diferencias de género en la evolución del tabaquismo adolescente en España (1986-2002). Adicciones, 19, 273-288.
Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L.,… Swendsen, J. (2010). Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49, 980-989. doi: 10.1016/j.jaac.2010.05.017.
Mineur, Y. S. y Picciotto, M. R. Nicotine receptors and depression: revisiting and revising the cholinergic hypothesis of depression. (2010). Trends in Pharmacological Sciences, 31, 580–586. doi: 10.1016/j.tips.2010.09.004
Ministerio de Sanidad y Políticas Sociales. (2010). Encuesta Estatal sobre Uso de Drogas en Estudiantes de Enseñanzas Secundarias (ESTUDES). Madrid: Plan Nacional sobre Drogas.
Montón, C., Pérez Echevarría, M. J., Campos, R., García Campayo, J. y Lobo, A. (1993). Escalas de ansiedad y depresión de Goldberg: una guía de entrevista eficaz para la detección del malestar psíquico. Atención Primaria, 12, 345-349.
Peters, E. N., Budney, A. J. y Carroll, K. M. (2012). Clinical correlates of co-occurring cannabis and tobacco use: a systematic review. Addiction, 107, 1404–1417. doi:10.1111/j.1360-0443.2012.03843.x
Rohde, P., Lewinsohn, P. M., Brown, R. A., Gau, J. M. y Kahler, C. W. (2003). Psychiatric disorders, familial factors and cigarette smoking: I. Associations with smoking initiation. Nicotine & Tobacco Research, 5, 85–98.
Rocha, K. B., Pérez, K., Rodríguez-Sanz, M., Borrell, C. y Obiols, J. E. (2011). Propiedades psicométricas y valores normativos del General Health Questionnaire (GHQ-12) en población general española. International Journal of Clinical and Health Psychology, 11, 125-139
Rubinstein, M.L., Luks, T.L., Moscicki, A.B., Dryden, W., Rait, M.A. y Simpson G.V. (2011). Smoking-cue induced brain activation in adolescent light smokers. Journal of Adolescent Health, 48, 7–12. doi:10.1016/j.jadohealth.2010.09.016.
Sanz, J., Perdigón, A. L., Vázquez, C. (2003). Adaptación española del Inventario para la Depresión de Beck-II (BDI-II): 2. Propiedades psicométricas en población general. Clínica y Salud, 14, 249-280.
Steuber, T. L. y Danner, F. (2006). Adolescent smoking and depression: which comes first? Addictive Behaviors, 31, 133–136.
Turner, L., Mermelstein, R. y Flay, B. (2004). Individual and contextual influences on adolescent smoking. Annals of the New York Academy of Sciences, 1021, 175–197.
Vázquez, A. J. y Garcia-Boveda, R. J. (1997). The Mannheim interview on social support psychometric characteristics of a Spanish version. Social Psychiatry and Psychiatric Epidemiology, 32, 208-214.
Weinberger, A. H., McKee, S. A., Picciotto, M. R. y Mazure, C. M. (2011). Examining antidepressant drug response by smoking status: why is it important and how often is it done? Journal of Psychopharmacology, 25, 1269–76. doi: 10.1177/0269881110389347.
