Post-traumatic stress disorder and smoking: a systematic review.

Journal Article (Journal Article;Review;Systematic Review)

We conducted a systematic review of what is known about the relationship between post-traumatic stress disorder (PTSD) and smoking to guide research on underlying mechanisms and to facilitate the development of evidence-based tobacco treatments for this population of smokers. We searched Medline, PsychINFO, and the Cochrane Central Register of Controlled Trials and identified 45 studies for review that presented primary data on PTSD and smoking. Smoking rates were high among clinical samples with PTSD (40%-86%) as well as nonclinical populations with PTSD (34%-61%). Most studies showed a positive relationship between PTSD and smoking and nicotine dependence, with odds ratios ranging between 2.04 and 4.52. Findings also suggest that PTSD, rather than trauma exposure itself, is more influential for increasing risk of smoking. A small but growing literature has examined psychological factors related to smoking initiation and maintenance and the overlapping neurobiology of PTSD and nicotine dependence. Observational studies indicate that smokers with PTSD have lower quit rates than do smokers without PTSD. Yet a few tobacco cessation treatment trials in smokers with PTSD have achieved quit rates comparable with controlled trials of smokers without mental disorders. In conclusion, the evidence points to a causal relationship between PTSD and smoking that may be bidirectional. Specific PTSD symptoms may contribute to smoking and disrupt cessation attempts. Intervention studies that test behavioral and pharmacological interventions designed specifically for use in patients with PTSD are needed to reduce morbidity and mortality in this population.

Full Text

Duke Authors

Cited Authors

  • Fu, SS; McFall, M; Saxon, AJ; Beckham, JC; Carmody, TP; Baker, DG; Joseph, AM

Published Date

  • November 2007

Published In

Volume / Issue

  • 9 / 11

Start / End Page

  • 1071 - 1084

PubMed ID

  • 17978982

International Standard Serial Number (ISSN)

  • 1462-2203

Digital Object Identifier (DOI)

  • 10.1080/14622200701488418


  • eng

Conference Location

  • England