Smoking as a risk factor for mental health disturbances after a disaster: a prospective comparative study

OBJECTIVE: To assess whether smoking is a(n) (independent) risk factor for mental health problems among adult disaster victims and among a nonexposed comparison group. METHOD: Surveys were conducted 18 months (T1) and 4 years (T2) after a fireworks disaster in Enschede, the Netherlands (May 13, 2000), among adult victims (N = 662) and a comparison group (N = 526) of residents of a city located in another part of the Netherlands. The surveys included measures of smoking (Dutch Local and National Public Health Monitor); severe anxiety, depression, and hostility symptoms (the Symptom Checklist-90, revised); and disaster-related post-traumatic stress disorder (PTSD; DSM-IV criteria) (the PTSD self-rating scale). RESULTS: Victims who smoked at T1 had a higher chance to suffer from severe anxiety symptoms (adjusted OR = 2.32 [95% CI = 1.19 to 4.53]), severe hostility symptoms (adjusted OR = 1.84 [95% CI = 1.06 to 3.22]), and disaster-related PTSD (adjusted OR = 2.64 [95% CI = 1.05 to 6.62]) at T2 than victims who did not smoke at T1, when controlling for symptoms at T1, demographic characteristics, and life events. Among the total comparison group, smoking was not an independent risk factor. However, smoking at T1 was associated with severe anxiety symptoms at T2 among controls who were confronted with stressful life events (adjusted OR = 4.11 [95% CI = 1.03 to 16.47]). CONCLUSIONS: Smoking is an independent risk factor for severe anxiety and hostility symptoms and PTSD among adult disaster victims and for anxiety symptoms among adult people who are confronted with stressful life events. Questions about smoking behavior among disaster victims may help to identify adult victims who are at risk for postevent mental health disturbances