Mental illness and smoking show strong links

Mentally ill Americans are nearly twice as likely to smoke as those without mental illness, according to a study reported in late November in the Journal of the American Medical Association (JAMA). The study, conducted by a research group led by Karen Lasser of the Cambridge Hospital and Harvard Medical School, Cambridge, Massachusetts, suggests that people with mental illness account for nearly one half of the United States tobacco market.

The study used population-based data from a national survey mandated by US Congress to determine the prevalence of psychiatric disorders. The researchers questioned a sample of 4411 non-institutionalized people, who had participated in the survey, regarding their use of tobacco and also submitted them to a standard psychiatric diagnostic interview to determine prevalence of mental illnesses, as defined by international diagnostic criteria.

Of those who had ever had mental illness in their lifetimes 34.8% were current smokers, vs 22.5% of those who had never been mentally ill, and 55.3% had smoked at some time in their lives, vs 39.1% of people without mental illness, the study found. Extrapolating their results to the US population, the researchers estimated that persons with a recent diagnosable mental disorder consumed nearly half the cigarettes smoked in the United States.

In discussing their results, the Harvard researchers point out that tobacco manufacturers clearly target their market strategies to psychologically vulnerable persons, according to internal tobacco industry documents. Market researchers at the RJ Reynolds Company, for example, speak of smokers who smoke for ‘‘mood enhancement’’ and ‘‘anxiety relief’’.

A study published by another US research group in an earlier November issue of JAMA, found a significantly higher proportion of anxiety disorders among adolescents who were heavy smokers — at least 20 cigarettes a day — than among adolescents who smoked less or did not smoke at all. Among the nearly 700 youths followed up for the prospective study, those who smoked heavily had a nearly sixfold risk of generalized anxiety disorder, sevenfold risk of agoraphobia and sixteenfold risk of panic disorder. Heavy smoking in adolescence was associated with an almost elevenfold risk of anxiety disorders in early adulthood. The study was conducted by Jeffrey Johnson and his colleagues at Columbia University and the New York State Psychiatric Institute, the Mount Sinai Medical Center in New York, and the National Institute of Mental Health in Bethesda, Maryland.

Fred Charatan,
Boynton Beach, Florida, USA