Page 36 - Biobehavioral Resilence to Stress

Prediction of Resilience 13

on two or more occasions (compared with only 6% of nonsmokers). Heavy
smokers were more likely to have difficulty following orders, engage in alco-

hol and illicit drug use, find it difficult to sleep at night, and be in poor
physical condition.
Some studies indicate that smoking behavior may be a marker for other
types of psychopathology (Alvarado & Breslau, 2005). For example, smoking

has been associated with a significantly increased risk for depression, suicidal
ideation, and suicide attempts (e.g., Hallfors et al., 2004; Makikyro et al.,
2004; Toros, Bilgin, Sasmaz, Bugdayci & Camdeviren, 2004). The results from

these studies are correlative and thus may simply indicate that individuals

who suffer psychological difficulties are more likely to smoke. However, data

from an even more recent longitudinal study (Breslau et al., 2005) indicated
that current daily smoking (but not past smoking) predicted the subsequent

occurrence of suicidal thoughts and attempts. Th e effect of current smoking

was significant even when controlled for the possible effects of prior depres-

sion and substance abuse disorders (adjusted odds ratio, 1.82). Current daily
smoking was also predictive of suicidal thoughts and behavior when the

investigators controlled for the effect of prior suicidality and prior psychiat-
ric disorders (adjusted odds ratio, 1.74).
At least one recent study points to tobacco use (smoking) as a poten-
tial indicant of genetic predisposition to PTSD (Koenen et al., 2005). Th is
study was based on an analysis of data taken from the Vietnam Era Twin
Registry, which contains data on 6744 male–male twins who served in the

military during the Vietnam War era. The authors found a statistically sig-

nificant relationship between nicotine dependence (ND) and diagnosis of

PTSD (odds ratio = 1.55, confidence interval 1.22–1.97) among twins who

had experienced one or more traumatic events. The relationship between
ND and PTSD was greater for monozygotic twins than for dizygotic twins.
Approximately 62% (0.21/0.34) of the PTSD-ND covariance was accounted
for by shared genetic effects (Koenen et al., 2005).

Although smoking behavior is a powerful predictor of attrition when
paired with other information (e.g., whether someone is a non–high school
graduate), cautious interpretation is appropriate. Most individuals who
smoke will function capably and will not be separated from the military.

Mental Health History
Past and current mental health is predictive of future functioning. For
example, more than 80% of individuals who experience a major depressive
episode (a severe form of depression) will experience recurrent episodes
(Kessler et al., 2003).
Screening questions that address mental health are predictive of attri-
tion (Garb & Fiedler, 2006). When screening was done during basic training
for the U.S. Air Force, 46% of trainees who endorsed the item, “I usually

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