Mentally Ill Twice as Likely to Use Tobacco

People with mental illnesses are approximately twice as likely to smoke cigarettes, according to a recent Harvard Medical School study published in today's issue of the Journal of the American Medical Association, the Los Angeles Times reports. The study also estimated that 44.3% of the cigarettes smoked in the United States are consumed by the mentally ill.

Researchers at Cambridge Hospital and Harvard Medical School analyzed data from the National Comorbidity Survey, a "nationally representative" database of interviews with 4,411 people ages 15-54 compiled in the early 1990s. Participants answered questions about their smoking habits and their mental health. Based on the data, researchers found that those who had "suffered from a mental illness during the month before the survey or at the some time in the past were more likely to smoke or have smoked in the past" than those who did not have a mental illness. In addition, the study found that those who reported a mental illness in the month before the survey were three times as likely to smoke as those who did not report a mental illness (Mestel, Los Angeles Times, 11/22).

Harvard research fellow and lead author Dr. Karen Lasser said, "Perhaps mental illness causes smoking by making people more vulnerable to tobacco advertising or nicotine addiction. However, other studies have called the direction of causality into question, suggesting that smoking may cause mental illness and our findings are certainly compatible with that as well" (Reuters/Baltimore Sun, 11/22). "Experts" say that since the mentally ill are more likely to be "cut off from mainstream society and less able to motivate themselves to quit," specifically targeted education may be necessary to reduce smoking in this group. However, Lasser noted the "surprising" and "hopeful" finding that a "sizable number of people with a history of psychiatric disorders had been able to quit smoking, though at a lower rate than those who weren't mentally ill."

Ranging from major depression, bipolar disorder, anxiety disorders and schizophrenia to alcohol and drug dependence, mental illness is sometimes "self-medicated" with smoking, as nicotine can have a "powerful impact on mood," the Times reports. Dr. Ernest Noble, professor of psychiatry at UCLA, said the link between mental illnesses and smoking is "well known," as "[p]atients smoke to enhance mood." In addition, antidepressants have helped people quit smoking. However, smoking not only places mentally ill individuals at a higher risk for heart disease and lung cancer, but may interfere with the effectiveness of some medications and may "trigger" or "exacerbate" some mental illnesses, the Times reports. A study published in the Nov. 8 issue of JAMA revealed that adolescents who smoked heavily were more likely to develop anxiety disorders later on (Los Angeles Times, 11/22).