Trauma exposure influences cue elicited affective responses among smokers with and without a history of major depression
Introduction
In most studies (Boscarino et al., 2002, Boyd et al., 1997, Breslau, 2002, Brown et al., 2000, Creamer et al., 2005, Galea et al., 2002, Shalev et al., 1998), but not all (Breslau, Davis, Peterson, & Schultz, 2000), exposure to traumatic life events (TE) has been associated with the development of or the co-occurrence with severe psychopathology, such as Major Depressive Disorder histories (MDD Hx) and/or Posttraumatic Stress Disorder (PTSD). Such TE-related disorders also influence the onset of cigarette smoking behavior (e.g., Koenen et al., 2005, Koenen et al., 2006, Rauch et al., 2006) and are associated with greater smoking prevalence rates (e.g., Acierno et al., 1996, Acierno et al., 2000) compared with the general population (Centers for Disease Control, 2005). Despite this evidence, most research is focused on PTSD-related cigarette smoking (Feldner et al., 2007, Fu et al., 2007) with very little attention placed on other psychological sequelae, such as TE-related MDD Hx. Given that approximately 77% of the TE population does not develop PTSD (Breslau, Davis, Andreski & Peterson, 1991), broadening knowledge of health risk behavior among subgroups of non-PTSD smokers with a TE history (TE only) would provide important information for the study of trauma on smoking behavior.
Research suggests that lifetime violent assault status with a MDD Hx predicts 45% of current smokers compared with TE only (non-PTSD) individuals without a history of MDD (30%) and non-vulnerable individuals (23%; Acierno et al., 1996). TE only and MDD Hx also produce independent additive effects on smoking-related health risks (Benyamini and Solomon, 2005, Kramer et al., 2003, Links and Comstock, 1990, Spertus et al., 2003) and on health care utilization (Adams et al., 2006, Kates and Mach, 2007, Kramer et al., 2003). Little is unknown about biobehavioral mechanisms that may uniquely influence such dually vulnerable (TE + MDD Hx) compared with singularly vulnerable (e.g., MDD Hx without TE or TE only) and non-vulnerable smokers.
One mechanism that may help differentiate dually vulnerable smokers from singularly vulnerable and non-vulnerable smokers is a selective susceptibility to negative affective states (i.e., increased vulnerability to experience negative affective states). Selective emotional responsiveness, particularly among subgroups of depression-prone smokers, may increase a person's drive to smoke to dispel these distressing emotional states (Spring et al., 2007). Most research exploring affective processing among TE only populations have shown that TE only veterans have greater negative affective reactions to trauma-related and non-trauma-related stressor scripts compared with neutral scripts (Beckham et al., 2007). After controlling for nicotine dependence and current MDD, trauma-related scripts compared with neutral scripts also were shown to shorten cigarette smoking puff onset intervals (McClernon et al., 2005). Lastly, TE only and MDD Hx individuals, independently, self-report smoking for negative affect reduction reasons (Beckham et al., 2004, Feldner et al., 2007, Feldner et al., 2007, Haaga et al., 2004, McChargue et al., 2004).
Despite suggestions that individuals with TE only or a MDD Hx may smoke for negative affective reasons (e.g., Feldner et al., 2007, Feldner et al., 2007, McChargue et al., 2004) and that, at least, TE only smokers show the expected negative affect reactivity to trauma-related stressors (e.g., Beckham et al., 2007), laboratory studies have yet to show that smokers with this dual vulnerability are disproportionately prone to negative affect compared with singularly vulnerable (i.e., those with TE only or MDD Hx only) and non-vulnerable smokers. Therefore, the purpose of the present study was to address gaps in extant literature by testing for interactive effects of TE only and MDD Hx on affective reactivity among smokers. Our general linear hypothesis is that negative affective elevations resulting from non-trauma-related stressors compared with neutral emotional stimuli would be the greatest in the dually vulnerable group followed, respectively, by the singularly vulnerable and non-vulnerable groups. Given that environmental smoking cues may increase negative affective substrates associated with use (e.g., Doran et al., in press, Drobes et al., 2006), emotional manipulations (stressor vs. neutral) were stratified across in vivo cigarette cue and neutral environmental cue exposure to explore for possible potentiated negative affect reactivity that results from the combination of negative mood induction with the presence of an environmental smoking cue. This was done because, for some, environmental smoking cues appear to be needed to selectively prime internal drives (negative mood) associated with use during stressful situations (Doran et al., in press).
Section snippets
Participants
The current study was a secondary analysis of a larger study featuring smokers with and without a MDD Hx. Given the high comorbidity with this population and those with a history of trauma (Brady et al., 2000, Maes et al., 2000, Pfefferbaum et al., 2002), it was deemed a suitable sample in which to assess the study question after controlling for nicotine and depression-related variables. Participant recruitment was accomplished by distributing flyers and newspaper advertisements in a large
Preliminary analysis
Initially, univariate statistics from individuals who completed the study versus individuals who were originally found eligible before the telephone screening and subsequent screening session were compared. Independent samples t-tests revealed no differences between demographic variables including age, ethnicity, gender (ps > .12) as well as smoking-related variables including FTND and cigarettes smoked per day (ps > .36). Additionally, while no significant differences were found in
Discussion
The overall study results produced expected and unexpected effects. Most notably, individuals with TE only histories showed the greatest elevations in negative mood-induced depressive symptoms compared with all other groups (i.e., non-vulnerable, MDD Hx only, dually vulnerable). This global depression reaction was also independent of cigarette cues. The MDD Hx group had similar global changes in depressive symptoms following both negative mood induction conditions, but to a lesser magnitude.
Acknowledgment
This project was partially supported by NIH (DA00467) and VA Merit Review Entry Program grants to Dr. McChargue.
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