Betel-quid dependence and oral potentially malignant disordersin six Asian countries

• Published in: British journal of psychiatry 2012-11, Vol.201 (5), p.383-391
• Main Authors: Chien-Hung, Lee, Ko, Albert Min-Shan, Cheng-Fang, Yen, Chu Koung-Shing, Yi-Jun, Gao, Warnakulasuriya Saman, Sunarjo, Ibrahim Salah Osman, Zain, Rosnah Binti, Patrick, Walter K, Ying-Chin, Ko
• Format: Article
• Language: English
• Subjects: Access; Addictions; Alcohol; Chewing; Consortia; Craving; Data collection; Dependency; Drug use; Environmental aspects; Environmental factors; Lesions; Malignant; Men; Mental disorders; Mucosa; Oral cancer; Population; Population studies; Psychiatry; Questionnaires; Smoking; Sociodemographics; Tobacco; Tolerance; Withdrawal
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.bp.111.107961

BackgroundDespite gradual understanding of the multidimensional health consequencesof betel-quid chewing, information on the effects of dependent use isscant.AimsTo investigate the 12-month prevalence patterns of betel-quid dependencein six Asian populations and the impact of this dependence on oralpotentially malignant disorders (OPMD).MethodA multistage random sample of 8922 participants was recruited fromTaiwan, mainland China, Indonesia, Malaysia, Sri Lanka and Nepal.Participants were evaluated for betel-quid dependency using DSM-IV andICD-10 criteria and assessed clinically for oral mucosal lesions.ResultsThe 12-month prevalence of dependence was 2.8-39.2% across the six Asiansamples, and 20.9-99.6% of those who chewed betel-quid were betel-quiddependent. Men dominated the prevalence among the east Asian samples andwomen dominated the prevalence in south-east Asian samples. ‘Time spentchewing’ and ‘craving’ were the central dependence domains endorsed bythe Chinese and southern/south-east Asian samples respectively, whereasthe Nepalese samples endorsed ‘tolerance’ and ‘withdrawal’. Dependencywas linked to age, gender, schooling years, drinking, smoking,tobacco-added betel-quid use and environmental accessibility ofbetel-quid. Compared with non-users, those with betel-quid dependency hadhigher pre-neoplastic risks (adjusted odds ratios 8.0-51.3) than peoplewith non-dependent betel-quid use (adjusted odds ratio 4.5-5.9) in thesix Asian populations.ConclusionsBy elucidating differences in domain-level symptoms of betel-quiddependency and individual and environmental factors, this study drawsattention to the population-level psychiatric problems of betel-quidchewing that undermine health consequences for OPMD in six Asiancommunities.