Smoking and mental illness in the U.S. population

Abstract

Objectives: Those with any psychiatric diagnosis have substantially greater rates of smoking and are less likely to quit smoking than those with no diagnosis. Using nationally representative data, we sought to provide estimates of smoking and longitudinal cessation rates by specific psychiatric diagnoses and mental health service use.

Design and participants: Data were analysed from a two-wave cohort survey of a U.S. nationally representative sample (non-institutionalised adults): the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002, n=43,093; 2004-2005, n=34,653).

Main outcome measures: We examined smoking rates (lifetime, past year and past year heavy) and cross-sectional quit rates among those with any lifetime or past year psychiatric diagnosis (DSM-IV). Importantly, we examined longitudinal quit rates and conducted analyses by gender and age categories.

Results: Those with any current psychiatric diagnosis had 3.23 (95% CI 3.11 to 3.35) times greater odds of currently smoking than those with no diagnosis, and were 25% less likely to have quit by follow-up (95% CI 20% to 30%). Prevalence varied by specific diagnoses (32.4% to 66.7%) as did cessation rates (10.3% to 17.9%). Comorbid disorders were associated with higher proportions of heavy smoking. Treatment use was associated with greater prevalence of smoking and lower likelihood of cessation.

Conclusions: Those with psychiatric diagnoses remained much more likely to smoke and less likely to quit, with rates varying by specific diagnosis. Our findings highlight the need to improve our ability to address smoking and psychiatric comorbidity both within and outside of healthcare settings. Such advancements will be vital to reducing mental illness-related disparities in smoking and continuing to decrease tobacco use globally.

Keywords: mental illness; nicotine; psychiatric; smoking; tobacco.

Figure 1

Heavy Smoking Rates by Number of Lifetime Diagnoses. All estimates accounted for the NESARC survey design. Statistical comparisons were made using multinomial logistic regression, with “0 diagnoses” as the reference group. Heavy smokers were defined as those whose usual cigarette consumption exceeded 24 cigarettes per day. Light to moderate smokers consumed 24 or less cigarettes per day. All comparisons were statistically significant (p < 0.001). Error bars represent 95% CI. There was also a significant linear trend for both light-moderate smokers (OR = 1.45; p < 0.001) and heavy smokers (OR = 1.68, p < 0.001; not displayed in figure).