An application of the stress-diathesis model: A review about the association between smoking tobacco,smoking cessation,and mental health

BackgroundWorldwide, approximately 24% of all adults smoke, but smoking is up to twice as prevalent in people with mental ill-health. There is growing evidence that smoking may be a causal risk factor in the development of mental illness, and that smoking cessation leads to improved mental health.MethodsIn this scholarly review we have: (1) used a modern adaptation of the Bradford-Hill criteria to bolster the argument that smoking could cause mental ill-health and that smoking cessation could reverse these effects, and (2) by considering psychological, biological, and environmental factors, we have structured the evidence to-date into a stress-diathesis model.ResultsOur model suggests that smoking is a psychobiological stressor, but that the magnitude of this effect is mediated and modulated by the individual's diathesis to develop mental ill-health and other vulnerability and protective factors. We explore biological mechanisms that underpin the model, such as tobacco induced damage to neurological systems and oxidative stress pathways. Furthermore, we discuss evidence indicating that it is likely that these systems repair after smoking cessation, leading to better mental health.ConclusionBased on a large body of literature including experimental, observational, and novel causal inference studies, there is consistent evidence showing that smoking can negatively affect the brain and mental health, and that smoking cessation could reverse the mental ill-health caused by smoking. Our model suggests that smoking prevention and treatment strategies have a role in preventing and treating mental illness as well as physical illness.     

Psychosocial Predictors of Young Adolescent Cigarette Smoking: A Sixteen-Month,Three-Wave Longitudinal Study1

Understanding the psychosocial factors that predict cigarette smoking onset in young people is of crucial importance for prevention efforts. The present study examined prospective psychosocial predictors of smoking in a three-wave longitudinal data set. Similar in design to an earlier study by Chassin, Presson, Sherman, Corty, and Olshavsky (1984), the present study replicated their work, and extended it by (a) using composite predictors derived from exploratory factor analysis, (b) including prior behavior as a predictor, (c) using a design extended over three waves of data collection, and (d) using a sample composed primarily of urban teenagers. Subjects were 3295 7th-grade students at the beginning of the study. The subjects completed a questionnaire containing items tapping cigarette smoking behavior and psychosocial items that have previously been shown to predict smoking behavior. Forty-one psychosocial items on the Wave 1 (initial) questionnaire were factor analyzed, and five factors were retained. Subscale scores were constructed based on these factors and were used as predictors. Regression analyses were performed using the subscales and pretest smoking frequency to predict a continuous measure of smoking, and discriminant analyses were performed to predict transitions between qualitative levels of smoking. Prior smoking behavior was the most important predictor of future smoking. Four of the subscales, Social Disapproval, Risk Taking/Rebelliousness, Perceived Smoking Prevalence, and Motivation to Comply, were significant predictors. One subscale, Physical Consequences from Smoking, was not predictive of smoking in any of the analyses. The effect sizes cross-validated well. It is suggested that an integrative model of smoking initiation developed by Flay, d'Avernas, Best, Kersell, and Ryan (1983) best summarizes the results of the present study.     

Cigarette Smoking Among Youth with Attention-Deficit/Hyperactivity Disorder: Clinical Phenomenology, Comorbidity, and Genetics

Cigarette smoking and other forms of tobacco use among children and adolescents is a significant public health concern. The negative consequences of prolonged exposure to such substances are numerous, and include higher prevalence rates of cardiopulmonary dysfunction and certain cancers, and may lead to other forms of drug use. Identifying subgroups of youth who may be at greater risk than others to develop a nicotine habit is an important step forward in preventing smoking initiation, and controlling tobacco use. One such subgroup is children with attention-deficit/hyperactivity disorder (ADHD). This is because the prevalence of smoking among these youngsters is nearly twice as high as it is among those who are unaffected with ADHD. However, the etiology of this association is not known. It is possible that a constellation of social, behavioral, and biological factors influences this process, resulting in higher prevalence rates. To further our understanding of this problem, we reviewed each of these factors in relationship to smoking and to ADHD. Using the primary care population as a model, we then discuss clinical research methods that may shed additional light on this topic, as well as the strengths and limitations of current smoking prevention and cessation options for ADHD-affected youth who are assessed and treated in medical settings.     

Psychosocial Interventions for Children with Early-Onset Bipolar Spectrum Disorder

Once considered virtually nonexistent, bipolar disorder in children has recently received a great deal of attention from mental health professionals and the general public. This paper provides a current review of literature pertaining to the psychosocial treatment of children with early-onset bipolar spectrum disorder (EOBPSD). Commencing with evidence of the emerging interest in this topic, we then focus on terminology, the rationale for studying EOBPSD in children, current research and clinical progress, possible explanations for the recent increase in recognition, and essential issues that form the foundation of effective psychosocial treatment. Next we explore areas of research with direct implications for psychosocial treatment. These include biological and psychosocial risk factors associated with bipolar disorder; and the psychosocial treatment of adult-onset bipolar disorder, childhood-onset unipolar disorder, and anger management in children. Following this, we discuss treatments being developed and tested for children with EOBPSD. Finally, we conclude with recommendations for future studies needed to move the field forward.     

Traffic congestion, perceived control, and psychophysiological stress among urban bus drivers

The operation of public transit vehicles in urban centers is a highly stressful job. There has been, however, little detailed analysis of what specific characteristics of the psychosocial or physical job environmental of public transit operators contribute to the high levels of job stress associated with this occupation. In the present study, we show a high degree of association between exposure to peak traffic conditions and on-the-job elevations of urinary catecholamines. These significant relations remain after incorporating various controls for possible selection factors (e.g., job seniority) and health-relevant parameters (e.g., age, smoking). Furthermore, we show that reductions in perceived control on the job partially account for the linkages between traffic congestion and psychophysiological stress.     

Reducing smoking among pregnant adolescents

Pregnant adolescents who smoke present a double obstetrical risk. Not only is the adolescent mother at risk from the biological, social, educational, and economic factors associated with childbearing at a young age, she and her developing infant also risk the complications associated with maternal smoking. This paper describes a psychosocial intervention designed to reduce smoking in a group of pregnant adolescents. Five modules are presented. Each is designed to: (1) heighten awareness of the issue, (2) provide motivational messages, (3) enhance the adolescent's social skills, and (4) teach specific smoking-cessation skills.     

Intrapersonal and Interpersonal Factors Influencing Adolescents' Decisions About Having Sex: A Test of Sufficiency of the Theory of Planned Behavior1

This study tested the theory of planned behavior's (TPB) expectation that attitudes, social norms, and self‐efficacy would mediate other variables' effects on intention for having sex and probability of having sex. Longitudinal data were collected from 790 high‐school‐aged adolescents. In an intrapersonal variable model, sensation seeking, alcohol use, hard work, smoking, and moral beliefs had mediated effects, but the last 2 also had direct effects (on intention and behavior, respectively). In an interpersonal model, school attachment had mediated effects, pressure to have sex had a direct effect on behavior, and parent communication and number of sexually active friends had both. Intrapersonal variable effects were better described by the TPB than those of interpersonal variables. Targeting distal psychosocial factors may enhance intervention efficacy.     

Counseling Women in Midlife: An Integrative Approach to Menopause

Menopause is a normative life transition that is experienced by virtually all women, yet remains poorly understood. The dominance of the biomedical model results in a unidimensional definition of menopause as a biological event, ignoring the influence of cultural and psychosocial factors. Counselors who use an integrative approach can not only provide accurate biomedical information but also conceptualize menopause as a normative midlife transition. The purpose of this article is to provide a foundation in biomedical issues and to consider how these independently, and in interaction with cultural and psychosocial factors, influence the experience of menopause.     

Psychosocial factors in the course and treatment of bipolar disorder: introduction to the special section

Bipolar disorder is associated with high rates of relapse and high social and economic costs, even when patients are maintained on proper pharmacotherapy. The background and rationale are offered here for a series of articles that address the role of psychosocial agents in the course of bipolar disorder and psychosocial treatments as adjuncts to pharmacotherapy in the disorder's outpatient maintenance. It is argued that stressful life events and disturbances in social-familial support systems affect the cycling of the disorder against the backdrop of genetic, biological and cognitive vulnerabilities. Current models of psychosocial treatment focus on modifying the effects of social or familial risk factors as an avenue for improving the course of the disorder.     

Why does ADHD Confer Risk for Cigarette Smoking? A Review of Psychosocial Mechanisms

Research has documented that adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking, but less attention has examined why this risk exists. The current paper reviews the literature on different psychosocial mechanisms [self-medication hypothesis, social factors (social modeling, social impairments), cognitive factors (attitudes, coping skills), and psychological variables (ADHD symptom dimensions, comorbidity)] that might explain this increased smoking risk. Results of the review suggest that, while the self-medication hypothesis has some theoretical merit, it has not been adequately examined among adolescents and young adults with ADHD. Further, cognitive and social factors may be important mechanisms that help to explain the association between ADHD and cigarette smoking, but research in these areas is sparse. Finally, a larger body of literature suggests that different psychological aspects of ADHD (e.g., comorbidity, symptom dimensions) are related to smoking. Interpretation of findings of many of these studies was hindered due to significant methodological problems and the lack of a guiding theoretical orientation. Potential theories that might facilitate future work in this area are discussed. Future research should continue to explore these important psychosocial mechanisms as well as gene–environment interactions in examining the link between ADHD and cigarette smoking.     

Temporal associations of cigarette smoking with social influences, academic performance, and delinquency: a four-wave longitudinal study from ages 13-23.

This study examined the temporal associations of cigarette smoking with prosmoking social influences, academic performance, and delinquency in a cohort of 6,527 adolescents surveyed at ages 13, 16, 18, and 23 years. Prosmoking peer and family influences were risk factors for future smoking throughout adolescence, with family influences perhaps also operating indirectly through the adolescent's exposure to prosmoking peers. There were reciprocal associations of youth smoking with parental approval, peer smoking, and poor grades (but not delinquency), with youth smoking emerging as a stronger antecedent than consequence of these psychosocial factors. Few gender differences in these associations were observed. Implications of these findings for efforts to prevent youth smoking are discussed.     

Social psychology of mental health: the social structure and personality perspective

Previous research has revealed a persistent association between social structure and mental health. However, most researchers have focused only on the psychological and psychosocial aspects of that relationship. The present paper indicates the need to include the social and structural bases of distress in our theoretical models. Starting from a general social and psychological model, our research considered the role of several social, environmental, and structural variables (social position, social stressors, and social integration), psychological factors (self-esteem), and psychosocial variables (perceived social support). The theoretical model was tested working with a group of Spanish participants (N = 401) that covered a range of social positions. The results obtained using structural equation modeling support our model, showing the relevant role played by psychosocial, psychological and social, and structural factors. Implications for theory and intervention are discussed.     

Impulse Control Disorders in Parkinson’s Disease: A Psychosocial Perspective

Parkinson's disease (PD) is a progressive neurodegenerative disease primarily characterised by motor symptoms. However, another feature of PD which is receiving increasing attention is the phenomenon of impulse control disorders (ICDs), such as pathological gambling. To date, research into ICDs in PD has centred on a biomedical model of cause, related to the effects of dopamine replacement therapy. However, there are several areas of discrepancy in the current biomedical account of ICDs in PD. In addition, we argue that social and psychological factors also need to be considered to achieve a more complete understanding of the phenomenon. We present a novel conceptual model which combines biomedical and psychosocial factors in the genesis of ICDs in PD and use the model to identify a number of potential treatment intervention points and to highlight important outstanding questions concerning the inter-relationship between psychosocial and biomedical factors in the genesis of ICDs in PD.     

心理社会应激的免疫反应规律与机制

心理社会应激会引起免疫系统发生免疫防御、免疫自稳和免疫监视方面的功能变化, 并随着应激刺激的时间和强度的变化而发生着异常与正常之间的动态转变。其机制与遗传、神经内分泌、自由基代谢和肠道菌群变化等生物学因素相关, 且小胶质细胞可能在其中起着重要的中介作用。诸多的生物学因素与年龄、性别和经济地位等人口学因素共同决定着心理社会应激的免疫反应发生发展。在其干预中, 运动疗法中的体育锻炼是极为值得重视的一种手段。     

The Contributing Role of Negative Affectivity and Experiential Avoidance to Increased Cardiovascular Risk

Depression and anxiety are independent risk factors for the onset of cardiovascular disease, independent of classical risk factors, such as smoking, obesity, or hypertension. The present paper argues that the tendency to avoid difficult thoughts and feelings helps explain this relationship. There is a strong positive relationship between experiential avoidance and negative affectivity. Experiential avoidance is also related to several health behaviors recognized for increasing cardiovascular risk and may help functionally explain why individuals engage in problematic behaviors, such as smoking, drinking, and binge eating. Treatments that undermine experiential avoidance could be useful psychosocial approaches to cardiovascular risk reduction.     

Lifetime history of cigarette smoking associated with aggression and impulsivity in both healthy and personality disordered volunteers

Cigarette smoking has been associated with several personality and behavioral traits including impulsivity and aggression, primarily in adolescents and/or pregnant women. In this study, the authors tested the hypothesis that history of cigarette smoking is also associated with dimensional measures of aggression and impulsivity in adult subjects. Subjects were 179 personality disordered (PD), and healthy volunteer control (HV), subjects in whom history of cigarette smoking and measures of both aggression and impulsivity were collected. Scores on measures of both aggression and impulsivity were elevated as a function of personality disorder status and history of cigarette smoking status; no interaction between these two factors were noted on these measures. Including socio-economic status and global psychosocial functioning in the model eliminated the difference associated with diagnostic grouping and impulsivity but not the difference in aggression associated with lifetime history of smoking. These data suggest that lifetime history of cigarette smoking is associated with elevations in life history of aggression regardless of the presence of psychiatric disorder in nontreatment seeking individuals.     

Cigarette Smoking in Young Adults: Childhood and Adolescent Personality,Familial, and Peer Antecedents

Three models (independent, interdependent, and mediational) were hypothesized in this study, to examine the interrelation of personality, family, and peer determinants and their effects on tobacco use by young adults. Mothers were first interviewed about their children when they were between the ages of 1 and 10 years old. Three subsequent interviews were conducted with the children when they reached adolescence and young adulthood. Results show support for the mediational model. In accordance with family interactional framework conceptions, there was a sequence in patterning: from parenting during early adolescence; to personality and peer factors, extending to smoking in late adolescence; and culminating in smoking in adulthood. With a developmental approach, a number of psychosocial measures were related in both younger and older children. Nevertheless, some interesting developmental differences emerged. The findings suggest at least four possible targets for therapeutic or preventive intervention: the parent, the child, the adolescent, and the peer group.     

Social status,everyday interpersonal processes,and coronary heart disease: A social psychophysiological view

Lower socioeconomic position is associated with increased risk of coronary heart disease. This robust gradient is found across levels of socioeconomic position and after controlling access to health care and traditional biological and behavioral risk factors. Thus, previous theory and research has examined the role of other, relatively static psychosocial factors (e.g., social isolation and negative emotional traits) that may account for this association. Utilizing an interpersonal perspective on psychosocial risk (Smith & Cundiff, 2011 ; Smith, Gallo, & Ruiz, 2003 ; Smith, Glazer, Ruiz, & Gallo, 2004 ), this review examines the role of recurring interpersonal experiences and their physiological effects as a pathway linking socioeconomic position and coronary heart disease. Specifically, we focus on proximal interpersonal experiences that may not only explain the increased prevalence of more chronic psychosocial vulnerabilities in lower socioeconomic environments and individuals but may also link those psychosocial vulnerabilities to the momentary physiological mechanisms (i.e., stress responses) that directly contribute to coronary heart disease. Recurring experiences of reduced support and increased conflict in important personal relationships, work stress, multiple aspects of interactions with higher‐status others, the effects of negative stereotypes about lower socioeconomic groups and individuals, greater use of suppressive strategies for emotion regulation and greater negative consequences for more direct and expressive social behavior, and greater engagement in perseverative cognition all plausibly combine to perpetuate psychosocial risk and produce overall greater physiological burden at lower levels of socioeconomic position.     

Psychosocial risk factors, natural immunity, and cancer progression: Implications for intervention

One of the more important and emerging fields in which psychologists collaborate with other disciplines is psychoimmunology. Centuries of clinical anecdote and decades of psychosomatic hypotheses have gained credibility in the eyes of the medical establishment—and many patients—by the systematic investigation of mechanisms potentially explaining how events intrapsychic and interpersonal could affect physical disease processes. The central nervous system is connected with the immune system by both neuronal and endocrinological pathways. The immune system has been found to mediate the organism’s response to aberrations of its own normal functions, as well as to invading organisms from without. AIDS, arthritis, asthma, lupus, and herpes are some of the illnesses in which research is demonstrating important relationships among psychosocial and immunological factors and disease course. In this article, we first discuss the immunological apparatus in order to provide a base for subsequent discussions of the effects of stress on immune function. Then we discuss malignant diseases and current evidence that disease course is related to both psychosocial stressors and immune function. We next discuss a model of these interactions, and finally we talk about interventions incorporating psychosocial factors aimed at influencing immune status and, thus, disease course.