Smoking and mental health - NCSCT

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Smoking and mental health co-morbidity with other primary mental disorders. However, co-morbid alcohol and substance misuse, as well as smoking, is extremely common in those with other mental disorders. 1.2 Occurrence and associations of mental disorder About a quarter of the population experience some form of mental disorder, most commonly mild and self-limiting depression or anxiety, in any one year. 4 Psychotic disorders are much less common – a recent review of studies in England reported that around 0.4% of the population had an active psychotic disorder in the past year. 5 Psychotic disorders are sometimes referred to as ‘serious mental illnesses’, although severe forms of non-psychotic disorders such as depression or obsessive–compulsive disorder can be similarly disabling. All mental disorders, but particularly mood disorders and schizophrenia, are associated with an increased risk of suicide. 6 Mental disorders are socially stigmatised and, as a result, people with mental disorders, particularly those with severe conditions, can experience discrimination and a sense of being shunned by society. 7 This stigma can lead to impoverishment, social marginalisation and low quality of life, 8 and to discrimination in access to and quality of services for physical illness. 9 People with mental disorders are also more likely to live in circumstances of socioeconomic deprivation, partly as a result of deprivation playing a role in the causal pathway to disorder (the stress-vulnerability model), and partly because the disorder itself can lead to loss of employment, housing, income and other attributes. The relative importance of these directional models differs for different disorders, with deprivation appearing to be a strong cause of depression, for example, 10 whereas the association with schizophrenia is largely due to the illness leading to worsening of socioeconomic circumstances. 11 This relationship with deprivation is also likely to impact on the prevalence of smoking in people with mental disorders, because smoking is strongly associated with socioeconomic deprivation. There is increasing recognition that people with mental disorders are at increased risk of adverse physical health outcomes, to the extent that people with severe mental illness have a substantially lower life expectancy. A recent study in south London found that having a psychiatric diagnosis was associated with a loss of at least 8 life-years for men, and 10 for women, with particularly high reductions for men with schizophrenia (14.6 years lost) and women with schizoaffective disorders (17.5 years lost). 12 This loss of life appears to be largely due to cardiovascular disease, 13 for which smoking is one of the main risk factors. 14 Smoking is a common, under-treated and under-recognised problem in this patient population. 15 2 © Royal College of Physicians 2013
Mental disorders 1 1.3 Common mental disorders Depression and anxiety are common mental disorders, with a lifetime prevalence of at least 25%. 4 Depression, defined as a disorder if symptoms have been present for at least 2 weeks, is the most common; symptoms include feeling sad or irritable most of the time, loss of pleasure or interest in things that used to be enjoyed, significant loss or gain of weight that is unrelated to physical illness or pregnancy, difficulty sleeping or over-sleeping, feeling restless or slowed down, fatigue, feelings of worthlessness or excessive guilt, and difficulties concentrating, remembering or making decisions. There may be thoughts of self-harm or suicide. Depressive disorders can also be associated with prominent symptoms of anxiety. Risk factors for depression include younger age, female gender, low educational achievement, a previous history of depression, a family history of depression, childhood maltreatment and adulthood domestic violence. 16–18 Less commonly, severe depression occurs with psychotic symptoms and is then classified as an affective (mood-related) psychotic disorder (see below). Anxiety disorders include phobias such as agoraphobia (fear and avoidance of crowds, public places or travelling away from home), social phobia (marked fear of being the focus of attention, fear of behaving in a way that will be embarrassing, and marked avoidance of situations in which there is fear of behaving in an embarrassing way), panic disorder (recurrent panic attacks) and generalised anxiety disorder (at least 6 months of prominent tension, worry and feelings of apprehension about everyday events and problems, with anxiety symptoms). Anxiety symptoms include autonomic arousal symptoms (eg palpitations, sweating, trembling, dry mouth), difficulty in breathing, and fear of dying or losing control. 1 The 2007 Adult Psychiatric Morbidity Survey (APMS) in England found that women were more likely than men to have a common mental disorder (19.7% and 12.5% respectively), and that this applied for all disorder categories except panic and obsessive–compulsive disorder. 4 Depression and anxiety tend to be recurrent or persistent in most patients. 19 1.4 Other non-psychotic disorders 1.4.1 Obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is characterised by the presence of obsessions (unwanted intrusive thoughts, images or urges, which repeatedly enter the person’s mind) or compulsions (repetitive behaviours or mental acts that the person feels driven to perform, such as checking that taps are switched off, or repeatedly cleaning), and commonly both. OCD occurs in around 1% of people, 20 with similar rates in men and women, and may follow an acute, © Royal College of Physicians 2013 3
Page 1 and 2: PDF not for circulation Smoking and
Page 3 and 4: Contents Members of the Tobacco Adv
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Page 9 and 10: Contents 10.5 Tobacco policy and me
Page 11 and 12: Contributors Anthony Aclet - Specia
Page 13 and 14: Contributors Jill Williams - Associ
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Page 27 and 28: Mental disorders 1 12 Chang CK, Hay
Page 29 and 30: Mental disorders 1 52 Young S, Toon
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Neurobiological and behavioural mec
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Epidemiology of the association bet
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Smoking cessation interventions for
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6 Population strategies to prevent
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Population strategies to prevent sm
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The economic cost of smoking in peo
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Ethical and legal aspects 9 pose co
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Ethical and legal aspects 9 less an
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Ethical and legal aspects 9 patient
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10 Summary and conclusions 10.1 Smo
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Summary and conclusions 10 although
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11 Key conclusions and recommendati
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Key conclusions and recommendations
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