Cigarette smoking and mental illness: a study of nicotine withdrawal

Abstract

Objectives: We compared prevalence, severity, and specific symptom profiles for nicotine withdrawal across categories of mental illness. We also examined the influence of nicotine withdrawal on efforts to quit smoking among those with mental illness.

Methods: We analyzed data from 2 sources: wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, limiting the sample to current smokers (2001-2002; n = 9913); and a 2-wave cohort telephone survey of a national sample of adult smokers (2004-2006; n = 751).

Results: Mental illness was associated with a substantially greater likelihood of nicotine withdrawal syndrome; approximately 44% of nicotine withdrawal syndrome diagnoses were attributable to mental illness. Symptom profiles were highly comparable between mental illness categories, although anxiety-related symptoms were better markers of withdrawal for those with an internalizing disorder. Smokers with mental illness were motivated to quit but were less likely to be successful in their quit attempts, and both dependence and withdrawal independently accounted for this lower likelihood of success.

Conclusions: Nicotine withdrawal may be a particularly important target for intervention among those with mental illness who smoke cigarettes.

FIGURE 1—

Nicotine withdrawal syndrome (NWS) and mental illness (MI) among cigarette smokers (n = 9913 current smokers): the National Epidemiologic Survey on Alcohol and Related Conditions, 2001–2002. Note. ED = externalizing disorder only; ID = internalizing disorder only; IED = internalizing and externalizing disorders; ND = no disorder; PD = psychotic episode or disorder. Error bars represent 95% confidence intervals. Nicotine withdrawal syndrome estimates are adjusted for gender, income, education, and age. Analyses accounted for the survey design, and we applied survey weights to generate nationally representative estimates.

FIGURE 2—

Quitting motives and nonspecific psychological distress: Assessing Hardcore Smoking Survey, Wave 1; 2004–2005. Note. Those with nonspecific psychological distress (NSPD) reported stronger quitting motives than did those without NSPD. The figure is derived from ordinary least squares regression, using data from a national sample of smokers (n = 751). We adjusted estimates for age, education, and gender. The quitting motives scale ranged from 0 to 2. Error bars represent 95% confidence intervals.

FIGURE 3—

Quit attempts, successful quitting, and nonspecific psychological distress: Assessing Hardcore Smoking Survey, Waves 1 and 2; 2004–2006. Note. Those with nonspecific psychological distress (NSPD) were more likely to make a quit attempt than were those without NSPD but less likely to be successful. The figure is derived from probit regression, using data from a national sample of smokers (n = 751 for quit attempt analyses; n = 368 made a quit attempt and were included in the quit success analyses). We adjusted estimates for age, education, and gender. Error bars represent 95% confidence interval.

FIGURE 4—

Successful quitting and nonspecific psychological distress, mediated by withdrawal symptoms and nicotine dependence: Assessing Hardcore Smoking Survey, Waves 1 and 2; 2004–2006. Note. Nicotine withdrawal (NW) symptom severity and dependence fully mediated the negative relationship between nonspecific psychological distress (NSPD) and quit success among smokers with NSPD. Values are parameter estimates from regression modeling. The figure is derived from a national sample of cigarette smokers who made a quit attempt between 2 waves of data collection (n = 368). Both the mediation pathways were statistically significant (P < .05). We adjusted estimates for age, gender, and education. *P < .05; **P < .01; ***P < .001.