Secondhand smoke exposure associated with psychological distress

Exposure to secondhand smoke appears to be associated with psychological distress and the risk of future psychiatric hospitalization among healthy adults, according to a report posted online today that will appear in the August print issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"A growing body of literature has demonstrated the harmful physical health effects of secondhand smoke exposure," the authors write as background information in the article. "Given the highly prevalent exposure to secondhand smoke—in the United States, an estimated 60 percent of American non-smokers had biological evidence of exposure to secondhand smoke—even a low level of risk may have a major public health impact."

Mark Hamer, Ph.D., of University College London, and colleagues studied 5,560 non-smoking adults (average age 49.8) and 2,595 smokers (average age 44.8) who did not have a history of mental illness and participated in the Scottish Health Survey in 1998 or 2003. Participants were assessed with a questionnaire about psychological distress, and admissions to psychiatric hospitals were tracked over six years of follow-up. Exposure to secondhand smoke among non-smokers was assessed using saliva levels of cotinine—the main product formed when nicotine is broken down by the body—"a reliable and valid circulating biochemical marker of nicotine exposure," the authors write.

A total of 14.5 percent of the participants reported psychological distress. Non-smokers with a high exposure to secondhand smoke (cotinine levels between 0.70 and 15 micrograms per liter) had higher odds of psychological distress when compared with those who had no detectable cotinine.

Over the six-year follow-up, 41 individuals were newly admitted to psychiatric hospitals. Smokers and non-smokers with high exposure to secondhand smoke were both more likely than non-smokers with low levels of secondhand smoke exposure to be hospitalized for depression, schizophrenia, delirium or other psychiatric conditions.

Animal data have suggested that tobacco may induce a negative mood, and some human studies have also identified a potential association between smoking and depression. "Taken together, therefore, our data are consistent with other emerging evidence to suggest a causal role of nicotine exposure in mental health," the authors write.

"To our knowledge, this is the first study to demonstrate a prospective association between objectively assessed secondhand smoke exposure and mental health in a representative sample of a general population," they conclude.