Mentally Ill Smoke.... A Lot

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Researchers at the Harvard School of Public Health have discovered that Americans with mental illness are nearly twice as likely to smoke cigarettes as people with no mental illness. Their study appeared in the Nov. 22 Journal of the American Medical Association.  Karen Lasser and her colleagues found that 41 percent of people with mental illness are smokers compared to 22.5 percent of people who have never been mentally ill. They also found that the mentally ill smoke more heavily than others. Based on their results the authors estimate that people with diagnosable mental illness comprise nearly 45 percent of the total tobacco market in the U.S. 

The authors also found that nearly one third of smokers with mental illness were able to quit smoking.  If they abstained from drugs and alcohol they had cessation rates equal to people without mental illness. "This finding should encourage us to help our patients with mental illness to quit smoking, especially given that persons with mental illness are at high risk for smoking related deaths" said Danny McCormick, one of the co-authors. 

The study analyzed data from 4411 respondents aged 15 to 54 years who participated in the National Comorbidity Survey of psychiatric disease, a nationally representative multistage probability survey conducted from 1991 to 1992. Their data is the most information available that looks at the association between type and severity of mental illness and the likelihood of smoking and smoking cessation.

Standard definitions of mental illness were employed that included major depression, bipolar disorder, agoraphobia, social and simple phobia, generalized anxiety disorder, alcohol abuse and dependence, antisocial personality, conduct disorder and nonaffective psychosis (including schizophrenia).  

The authors quote internal documents from the tobacco industry showing that R.J. Reynolds had conducted marketing studies targeting psychologically vulnerable consumers. The studies implied that smokers used nicotine to treat symptoms of depression, for "mood enhancement," for "anxiety relief," to "cope with stress" and to "gain self-control." The marketing study also suggested that smoking "helps perk you up" and "helps you think out problems." 

Why do persons with mental disorders smoke more than others?  This study does not really explain.  We do know that nicotine is a stimulant, and that it seems to ease the symptoms of some severe disorders such as schizophrenia.  65-90% of persons with schizophrenia are nicotine dependent, probably partly because nicotine relieves some of their symptoms and improves cognitive functioning.  Tobacco marketers have played on these statistics, but they probably didn't create them. 

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Reference: Karen Lasser, MD; J. Wesley Boyd, MD, PhD; Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD; Danny McCormick, MD, MPH; David H. Bor, MD. JAMA. 2000;284:2606-2610