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Tobacco-Related Mortality and Mental Illness

November 04, 2013

Addiction goes hand in hand with other mental illnesses. People with psychiatric conditions smoke at twice to four times the rate of the general population, and they are estimated to purchase nearly half of all cigarettes sold in this country. Yet physicians have tended to ignore the smoking behavior of their psychiatric patients.

Image of hand holding cigarette with caption "It's drug addiction"

A new study published in the Journal of Psychiatric Research reveals the mortality toll caused by the elevated smoking rates in psychiatric patients. The study used death certificate data and hospital records for individuals over 35 who had been hospitalized for a psychiatric illness in California between 1990 and 2005 to calculate standardized mortality ratios for diseases causally linked to tobacco use. Markedly increased mortality from respiratory or cardiovascular diseases (although not cancers) was found in this population. There were 145% more deaths from tobacco-related diseases in people with schizophrenia than would be expected in the general population; 57% more deaths in people with bipolar disorder; and 95% more deaths in people with depression.

This translates into considerably shorter life expectancy for people with mental illnesses. A 2011 study in England and published in PLOS One found that men with schizophrenia lost on average 14.6 years of life, and that women with schizoaffective disorders lost 17.5 years of life—losses likely attributable in part to smoking.

In the past, clinicians have tended not to address smoking in psychiatric patients, among other things because of a belief that nicotine functioned as a form of self-medication, improving cognitive function or mood or counteracting some of the adverse effects of psychiatric medications. Recent research (such as a new NIDA-funded study in Biological Psychiatry) is casting doubt on the validity of these beliefs. Regardless, the deadly consequences of smoking in patients with mental illnesses require us to pay greater attention to this addictive disorder as a serious comorbidity in these populations and to much more aggressively treat it.

This page was last updated November 2013

Comments

Psychological Drives to Smoke?

While it is clear that a significant disparity exists between the rate of smoking in people with mental illness and that of the general population, it seems there is more research to be done into understanding why that disparity exists. Considering the doubt recently cast on the "tobacco as self-medication" explanation, this gap in our understanding becomes even more pronounced.

To be sure, the heightened correlation between tobacco use and mental illness helps emphasize the important role of mental health in the wider policy sphere of public health; however, by seeking to understand the psychological factors driving people with mental illness toward nicotine, we can take steps to save lives and improve public health through prevention, and not just by treating smoking-related diseases at the tail end.

Nicotine Affect the Brain Differently in the Mentally Ill?

Since we're understanding addiction as a disease of the brain, and since we know people with certain mental disorders have different brain structures, I ask: Does nicotine affect the brain of the mentally ill differently than in people who do not have major mental illnesses?

It is very possible that

It is very possible that nicotine affects the brains of people with mental illnesses differently, and in fact this is a subject of active research interest. Learning the answer to this question could ultimately lead to better treatments for tobacco use among people with mental illnesses. It could potentially even lead to better treatments for certain mental illnesses themselves (e.g., schizophrenia).

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    Welcome to my blog, here I highlight important work being done at NIDA and other news related to the science of drug abuse and addiction.

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