Jessica Werth Cook

Posttraumatic Stress Disorder as a Risk Factor for Suicidal Ideation in Iraq and Afghanistan War Veterans

Posttraumatic stress disorder (PTSD) was examined as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans (N = 407) referred to Veterans Affairs mental health care. The authors also examined if risk for suicidal ideation was increased by the presence of comorbid mental disorders in veterans with PTSD. Veterans who screened positive for PTSD were more than 4 times as likely to endorse suicidal ideation relative to non-PTSD veterans. Among veterans who screened positive for PTSD (n = 202), the risk for suicidal ideation was 5.7 times greater in veterans who screened positive for two or more comorbid disorders relative to veterans with PTSD only. Findings are relevant to identifying risk for suicide behaviors in Iraq and Afghanistan War veterans.

Hedonic capacity, cigarette craving, and diminished positive mood

Cigarette craving has been linked to elevated negative and positive moods, but a connection to deficient positive affect has not been studied. We tested whether a low hedonic capacity predicts a heightened urge to smoke after acute nicotine deprivation, and whether such an effect is mediated by decreased positive mood or increased negative mood. A total of 35 smokers characterized for individual differences in hedonic capacity were deprived of nicotine for 48 hr. Using mixed-effects regression modeling, we found that lower hedonic capacity predicted greater increases in craving 24 hr after nicotine withdrawal, t(29)=-2.33, p=.03. The effect of hedonic capacity on increased 24-hr postquit craving to smoke was fully mediated by decreased positive affect. Findings suggest that in early nicotine withdrawal, smokers with diminished capacity to experience pleasure have heightened susceptibility to cigarette cravings that arises because of decreased positive mood rather than increased negative mood.

Influence of nicotine on positive affect in anhedonic smokers

RationaleThe possibility that individuals administer nicotine to self-regulate persistent negative affect has received interest as a possible explanation for the high prevalence of affectively vulnerable smokers. Relatively overlooked, however, is the possibility that smokers might also self-administer nicotine to elevate low positive affect.ObjectivesThis study examined whether nicotine administration augmented anhedonic smokers’ positive affective response to a positive mood induction.Materials and methodsFifty regular smokers (50% female) underwent two positive mood inductions during which they smoked either a nicotinized or denicotinized cigarette in counterbalanced order. Positive affect was assessed before and at two time points after smoking.ResultsRandom effects regression showed a significant anhedonia by condition-by-time interaction [t(181)=−2.01, p = 0.04], supporting the hypothesis that anhedonia moderated nicotine’s effect on changes in positive affect. Simple effect analyses showed a significant condition-by-time interaction among high anhedonic smokers [t(91)= 2.47, p = 0.01] but not among less anhedonic smokers [t(91)= 0.34, p = 0.73].ConclusionSmoking nicotine vs placebo heightened anhedonic smokers’ ability to be induced into a positive mood, whereas nicotine had no effect on more hedonic smokers’ positive mood.

Nicotine effects on affective response in depression-prone smokers

RationaleComorbidity between cigarette smoking and depression is thought to arise because depression-prone smokers self-administer nicotine to improve mood. Yet little evidence supports this view, and nicotine’s effect on positive affect deficiency in depression remains largely unstudied.ObjectivesWe hypothesized that (1) nicotine would dispel negative affect and enhance positive affect and (2) effects would be stronger for smokers vulnerable to depression, particularly during a depressed state.Materials and methodsRegular smokers (N = 165) were recruited from the community: 63 with no history of major depressive disorder (MDD), 61 with recurrent past but no current MDD, and 41 with both current and past MDD. During four sessions, participants smoked either a nicotinized (NIC+) or denicotinized (NIC−) cigarette double blind after experiencing a negative mood induction or while undergoing a positive mood induction. Positive and negative affects were measured at baseline and at two time points after smoking.ResultsPreviously depressed smokers showed a heightened positive mood response to positive mood induction when smoking a nicotinized cigarette. Nicotine also increased the degree to which positive mood induction dispelled negative mood in depression-vulnerable smokers. Finally, nicotine worsened the negative affect response to negative mood induction for all groups.ConclusionSelf-administering nicotine appears to improve depression-prone smokers’ emotional response to a pleasant stimulus.

The influence of personality and affect on nicotine dependence among male college students.

Many clinicians and researchers hypothesize that tobacco use disorders, regardless of the route of administration, are maintained by the ability of nicotine to regulate positive and negative mood states. The present study (N=137) examined whether certain mood states predicted dependence on either cigarettes or smokeless tobacco and whether specific personality characteristics (e.g., extraversion, neuroticism, and psychoticism) mediated these relationships among young male college students. Results indicated that positive and negative moods predicted cigarette dependence (p values=.01) and that neuroticism partially mediated the relationship between positive affect and cigarette dependence. Exploratory analyses revealed that positive affect also interacted with neuroticism to predict smokeless tobacco dependence (p=.04). Simple effects analyses revealed that this relationship was maintained only among individuals high in neuroticism. Results suggested that dependence on cigarettes and smokeless tobacco among male college students may have different affective correlates and that certain personality characteristics may enhance and explain the effects of mood on tobacco dependence.

Fluoxetine, Smoking, and History of Major Depression: A Randomized Controlled Trial

The study was a randomized placebo-controlled trial testing whether fluoxetine selectively enhances cessation for smokers with a history of depression. Euthymic smokers with (H+, n = 109) or without (H-, n = 138) a history of major depression received 60 mg fluoxetine or placebo plus group behavioral quit-smoking treatment for 12 weeks. Fluoxetine initially enhanced cessation for H+ smokers (p = .02) but subsequently impaired cessation regardless of depressive history. Six months after quit date, fluoxetine-treated participants were 3.3 times more likely to be smoking (p = .02). Further research is warranted to determine why high-dose fluoxetine produces continuing effects that oppose tobacco abstinence.

Cue-elicited negative affect in impulsive smokers.

Impulsivity is associated with cigarette smoking, but the nature of this relationship and the mechanisms that maintain it are relatively unknown. The relationship has often been thought to reflect appetitive processes, but research suggests that an affective pathway exists as well. The present study tested the effect of impulsivity on affective responses to an environmental smoking cue. Adult smokers (N=62) were exposed to a neutral cue and a smoking cue in separate experimental sessions in a repeated-measures design. Mixed-effects regression analyses showed that larger postexposure increases in negative affect were associated with high scores on 2 facets of impulsivity: urgency, t(179)=6.16, p<.001, and sensation seeking, t(179)=4.75, p<.001. Heightened impulsivity was associated with lower levels of positive affect generally but not with positive affective responses to cue exposure. Findings provide support for the existence of a negative affective pathway linking impulsivity and cigarette smoking, and they suggest that this pathway may be specific to the urgency and sensation-seeking components of impulsivity.

Attachment and Depression Differentially Influence Nicotine Dependence Among Male and Female Undergraduates: A Preliminary Study

The authors surveyed a convenience sample of 208 undergraduate students who reported that they smoked cigarettes. The primary hypothesis they tested was whether gender predicted nicotine dependence. They further tested whether depression and attachment would mediate or moderate this relationship. Hierarchical regression analyses with social desirability and smoking stage of change entered as covariates indicated that women exhibited greater nicotine dependence than men did (p < .01). Lower attachment scores fully mediated this relationship, whereas elevated depression scores moderated the relationship. These findings suggest that depression and the inability to bond with peers may promote nicotine dependence among young female students.