Psychiatric comorbidities in a comparative effectiveness smoking cessation trial: Relations with cessation success, treatment response, and relapse risk factors.
BACKGROUND
Comorbid psychiatric diagnoses have been shown to predict cessation failure. The relative impact of various diagnoses on cessation and other cessation processes is rarely studied, particularly among a general population. The impact of psychiatric history among primary care patients seeking cessation services on nicotine dependence, cessation outcomes, treatment effects and adherence, and withdrawal symptoms was examined.


METHODS
Secondary data analysis of a multi-site comparative effectiveness smoking cessation trial was conducted. Adult smokers (n  = 1051; 52.5 % Female, 68.1 % white) completed a structured clinical interview at baseline to assess psychiatric diagnostic history (past-year and lifetime). Nicotine dependence was assessed via self-report measures at baseline. Point-prevalence abstinence was assessed at 8 weeks and 6 months post-quit. Withdrawal symptoms were assessed for one week pre- and post-quit using ecological momentary assessment. Treatment adherence was self-reported at 1, 4, 8, and 12 weeks post-quit.


RESULTS
Past-year substance use disorder, lifetime mood disorder, and > one lifetime diagnosis, were related to lower rates of short-term, but not long-term, cessation. Lifetime psychiatric diagnosis was related to elevated nicotine dependence, particularly to secondary dependence motives associated with instrumental tobacco use. History of psychiatric diagnosis was associated with increased withdrawal-related craving. There was little evidence that psychiatric diagnostic status moderated the effects of the tested pharmacotherapies on long-term abstinence.


CONCLUSIONS
Psychiatric diagnoses affect risk factors that exert their effects early in the post-quit process and highlight the potential utility of examining transdiagnostic risk factors to better understand the relations between psychiatric vulnerabilities and the smoking cessation process.
['Johnson|Adrienne L|AL|', 'Kaye|Jesse|J|', 'Baker|Timothy B|TB|', 'Fiore|Michael C|MC|', 'Cook|Jessica W|JW|', 'Piper|Megan E|ME|']
D000328:Adult D015897:Comorbidity D066249:Craving D000072860:Ecological Momentary Assessment D005260:Female D006801:Humans D008297:Male D001523:Mental Disorders D012008:Recurrence D012307:Risk Factors D016540:Smoking Cessation D013375:Substance Withdrawal Syndrome D013997:Time Factors D014029:Tobacco Use Disorder D000074822:Treatment Adherence and Compliance
Psychiatric comorbidity Smoking Cessation Nicotine dependence Cigarette