Smoking and mental health - NCSCT

Smoking and mental health
4.11 Smoking and increased mortality and morbidity among
people with mental disorders
It is plausible that people with mental disorders might have higher rates of
mortality or major morbidity because of their mental disorders, or their high
prevalence of smoking. The excess risk of death or morbidity among those with
mental health disorders has been studied in several reports, and Table A7
summarises the main findings from large prospective studies (>20,000
participants). 108–124 People with mental health problems, such as depression and
schizophrenia, appear to have a higher risk of cardiovascular disease and stroke,
even after adjustment for smoking status (never, former and current). There may
be some excess risk of cardiovascular death due to antipsychotic medications. 125
There was no consistent evidence for an increased risk for cancer among people
with mental disorders, which is surprising given that smoking has substantial
significant effects on several common cancers. One study of a cohort of 4,825
American patients 126 compared age-adjusted death rates (with allowance for
other confounding factors) in people with or without mental disorders in
relation to smoking status. The hazard ratio for cancer among current smokers
was 2.80 (95% CI 0.65–11.94) and 1.96 (95% CI 1.16–3.34) for those with and
without chronically depressed mood respectively (the reference group was nonsmokers
without depressed mood).
4.12 Summary
> Current smoking is associated with an increased risk of onset of depression,
including postnatal depression, and people with depression are more likely
to become smokers.
> Current smoking is associated with an increased risk of onset of anxiety
disorders, and people with anxiety disorders are more likely to take up smoking.
> Former smokers are not at an increased risk of subsequent onset of depression.
> Adolescents with eating disorders are more likely to become smokers.
> There is some evidence that people with behavioural disorders, particularly
ADHD and conduct disorder, are more likely to become smokers, but no
evidence that smoking increases the risk of onset of these conditions.
> There is a strong association between smoking and schizophrenia in crosssectional
studies, but longitudinal evidence on the temporal relationship is
mixed.
> Adolescents with bipolar disorder may be more likely to become heavy
smokers.
> Smoking is associated with an increased risk of dementia.
> People with mental disorders appear to have higher risks of cardiovascular
disease and stroke (after accounting for the effects of smoking); however,
there is no consistent evidence regarding an increased risk of cancer.
76 © Royal College of Physicians 2013