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Karestan C. Koenen, PhD; Brian Hitsman, PhD; Michael J. Lyons, PhD; Raymond Niaura, PhD; Jeanne McCaffery, PhD; Jack Goldberg, PhD; Seth A. Eisen, MD; William True, MD; Ming Tsuang, MD

Arch Gen Psychiatry. 2005;62:1258-1265.

Context  Recent studies indicate a strong association between posttraumatic stress disorder (PTSD) and nicotine dependence (ND). However, the explanation for the association remains unclear.

Objective  To test competing explanations for the association between PTSD and ND.

Design, Setting, and Participants  Analysis of data on 6744 members of the Vietnam Era Twin Registry, a national registry of all male-male twin pairs who served in the military during the Vietnam era interviewed in 1991-1992.

Main Outcome Measures  Risk of PTSD and ND using the Diagnostic Interview Schedule for the DSM-III-R.

Results  The prevalence of ND was elevated among trauma-exposed individuals (52.0%) and those with PTSD (71.7%) compared with unexposed individuals (40.5%). This association was significant for ND and for trauma without PTSD (odds ratio, 1.31; 95% confidence interval [CI], 1.18-1.45) and for PTSD (odds ratio, 2.34; 95% CI, 1.92-2.84) and was not entirely explained by shared risk factors. Shared genetic effects explained 63% of the PTSD-ND association; the remaining covariance was explained by individual-specific environmental effects. Using survival analysis with time-dependent covariates, ND was associated with a substantially increased risk of PTSD among trauma-exposed men (hazard ratio, 1.98; 95% CI, 1.61-2.42). Trauma (hazard ratio, 1.49; 95% CI, 1.35-1.64) and PTSD (hazard ratio, 1.36; 95% CI, 1.14-1.61) were less strongly but significantly associated with increased risk of ND onset after controlling for shared risk factors.

Conclusions  Most of the PTSD-ND association is explained by shared genetic effects. However, there is a substantial, robust PTSD-ND association not explained by shared risk factors. Multiple explanations for the association were supported; however, the strongest association was consistent with preexisting ND increasing the risk of PTSD onset. These data suggest that male veterans with a history of ND may be at increased risk for PTSD. Further research on the biological mechanisms underlying PTSD-ND comorbidity is needed.

Author Affiliations: Department of Society, Human Development, and Health, Harvard School of Public Health and the Department of Psychiatry, Boston University School of Medicine, Boston, Mass (Dr Koenen); Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Providence, Mass (Drs Hitsman and McCaffery); Department of Psychology, Boston University, Boston (Dr Lyons); Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Departments of Epidemiology and Psychiatry, Boston (Drs Lyons and Tsuang) and Massachusetts Mental Health Center, Academic Division of Public Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Drs Lyons and Tsuang); Department of Psychiatry and Human Behavior, Brown Medical School and Butler Hospital, Providence, RI (Dr Niaura); Seattle Veterans Affairs Epidemiologic Research and Information Center/Vietnam Era Twin Registry and the Department of Epidemiology, University of Washington, Seattle (Dr Goldberg); St Louis Veterans Affairs Medical Center, Research and Medical Services and Department of Internal Medicine, Washington University, Division of General Medical Sciences, St Louis, Mo (Dr Eisen); School of Public Health, St Louis University, St Louis (Dr True); and Institute of Behavioral Genomics, Department of Psychiatry, University of California and Veterans Affairs San Diego Health Care System, San Diego (Dr Tsuang).

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