Nicotine dependence and self-esteem in adolescents with mental disorders

Abstract

Recent studies in adolescents have found a weak association between lower self-esteem and smoking. However, this association has not been investigated in a psychiatric setting. In 223 inpatient adolescents [140 girls (16.5 years) and 83 boys (16.4 years)], self-esteem was measured with Coopersmith's self-esteem inventory (SEI), and smoking dependence with the Fagerström Test for Nicotine Dependence (FTND). DSM-IV categories included major depression ( n = 35), anxiety disorders ( n = 35), psychotic disorders ( n = 31), eating disorders ( n = 9), and conduct disorders ( n = 113). There were 101 smokers and 122 nonsmokers. Self-esteem scores were lower in smokers than in nonsmokers ( p = 0.039). Self-esteem scores were very significantly lower in smokers showing moderate or high nicotine dependence (i.e., FTND score ≥ 4) when compared with nonsmokers ( p = 0.002). Smoking with moderate or high nicotine dependence was associated with lower self-esteem in both girls and boys, whereas smoking with no or low nicotine dependence was associated with lower self-esteem only in girls. Smoking was associated with lower self-esteem in all diagnostic categories, except in eating disorders. Interventions targeted on self-esteem might be used to prevent smoking in adolescents with mental disorders.