Comorbidity and Familial Aggregation of Mood Disorders and Cigarette Smoking in a Controlled Family Study

Cigarette smoking and nicotine dependence are highly comorbid with mood disorders. Although the family-study method can be used to examine mechanisms of comorbidity, family studies of mood disorders and smoking are limited. This study examined the familial aggregation of mood disorder subtypes and multiple cigarette-smoking behaviors.

Lifetime smoking and mood disorders were assessed by semi-structured diagnostic interviews and family-history reports in adult probands (N = 297) and relatives (N = 510) from a community-based family study in the Washington (DC) metropolitan area. Familial aggregation and coaggregation of mood-disorder subtypes (major depression, bipolar-I, bipolar-II) with smoking behaviors (ever, daily, heavy, nicotine dependence) were estimated via mixed-effects models, adjusting for age, sex, and comorbid mood and anxiety disorders.

All smoking behaviors were familial. Smoking behaviors did not co-aggregate with mood disorders. In relatives, comorbid major depression was associated with all smoking behaviors; bipolar-I and bipolar-II were associated with heavy smoking and nicotine dependence. Anxiety was associated with ever and heavy smoking. Anxiety disorders typically preceded onset of smoking.

Family history of smoking and personal history of mood and anxiety disorders constitute independent risk factors for smoking. Major depression and bipolar subtypes are potent risk factors for severe smoking behaviors.

Results from this community-based family study suggest that preventing or treating cigarette smoking may reduce the risk of smoking within families. Additionally, intervening on anxiety and mood disorders may prevent cigarette smoking and the progression to severe smoking behaviors. Interventions that incorporate familial and individual factors may be especially effective at reducing smoking and improving public health.