Smoking’s toll on mentally ill analyzed

Those in the United States with a mental illness diagnosis are much more likely to smoke cigarettes and smoke more heavily, and are less likely to quit smoking than those without mental illness, regardless of their specific diagnosis, a new study by researchers from the Yale School of Medicine shows.

They also found variations in smoking rates and likelihood of quitting among different diagnoses of mental illness. The results are reported in the April issue of the journal Tobacco Control.

Thirty-nine percent of adults with a psychiatric diagnosis smoked compared to 16% without a diagnosis, according to data from the National Epidemiologic Survey on Alcohol and Related Conditions analyzed by researchers. Two out of every three people with drug use disorder smoke, compared to one out of three with social phobia.

“We know that smokers with mental illness are more susceptible to smoking-related disease, and those with mental illness die 25 years earlier than adults without mental illness,” said Sherry McKee, associate professor of psychiatry, and senior author on the study. “Effective smoking cessation treatments are available and we know that smokers with mental illness can quit smoking. We need to address why smokers with mental illness are not being treated for their smoking.”

Over the three-year study period, 22% of smokers with no psychiatric disorders were able to quit smoking, whereas rates of quitting among those with psychiatric disorders were 25% lower. Rates of quitting were lowest among those with dysthymia (10%), agoraphobia (13%), and social phobia (13%). “We also found that individuals with multiple diagnoses had the lowest quit rates,” added Philip Smith, lead author on the study.

This study adds to evidence that smokers with mental illness consume nearly half of all cigarettes in the United States, despite making up a substantially smaller proportion of the population.

Researchers and policymakers are increasingly calling attention to this important public health issue, and this study helps point to a need for interventions and policy that directly help individuals with mental illness quit smoking. 

Carolyn Mazure of Yale also contributed to the study.

The study was funded by the National Institutes of Health and the Food and Drug Administration.

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