Smoking and mental health - NCSCT

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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
Epidemiology of the association between smoking and mental disorders 4 The appendix to Chapter 4 (Tables A1–7) is available online at www.rcplondon.ac.uk/publications/smoking-and-mental-health. References 1 McClave AK, McKnight-Eily LR, Davis SP, Dube SR. Smoking characteristics of adults with selected lifetime mental illnesses: results from the 2007 National Health Interview Survey. American Journal of Public Health 2010;100:2464–72. 2 Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Journal of the American Medical Association 2000;283:2008–12. 3 Cuijpers P, Smit F, ten Have M, de Graaf R. Smoking is associated with first-ever incidence of mental disorders: a prospective population-based study. Addiction 2007;102:1303–9. 4 Smiley E, Cooper SA, Finlayson J, et al. Incidence and predictors of mental ill-health in adults with intellectual disabilities: prospective study. British Journal of Psychiatry 2007;191:313–19. 5 Larson GE, Booth-Kewley S, Highfill-McRoy RM, Young SYN. Prospective analysis of psychiatric risk factors in marines sent to war. Military Medicine 2009;174:737–44. 6 Agrawal A, Madden PAF, Heath AC, et al. Correlates of regular cigarette smoking in a population-based sample of Australian twins. Addiction 2005;100:1709–19. 7 Blase SL, Gilbert AN, Anastopoulos AD, et al. Self-reported ADHD and adjustment in college: Cross-sectional and longitudinal findings. Journal of Attention Disorders 2009;13:297–309. 8 Boyle MH, Offord DR, Racine YA, et al. Predicting substance use in early adolescence based on parent and teacher assessments of childhood psychiatric disorder: results from the Ontario Child Health Study follow-up. Journal of Child Psychology and Psychiatry, and Allied Disciplines 1993;34:535–44. 9 Brook JS, Duan T, Zhang C, Cohen PR, Brook DW. The association between attention deficit hyperactivity disorder in adolescence and smoking in adulthood. American Journal on Addictions 2008;17:54–9. 10 Burke JD, Loeber R, Lahey BB. Which aspects of ADHD are associated with tobacco use in early adolescence? Journal of Child Psychology and Psychiatry and Allied Disciplines 2001;42:493–502. 11 Burke JD, Loeber R, White HR, Stouthamer-Loeber M, Pardini DA. Inattention as a key predictor of tobacco use in adolescence. Journal of Abnormal Psychology 2007;116:249–59. 12 Elkins IJ, McGue M, Iacono WG. Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Archives of General Psychiatry 2007;64:1145–52. 13 Fuemmeler BF, Kollins SH, McClernon FJ. Attention deficit hyperactivity disorder symptoms predict nicotine dependence and progression to regular smoking from adolescence to young adulthood. Journal of Pediatric Psychology 2007;32:1203–13. 14 Galéra C, Fombonne E, Chastang JF, Bouvard M. Childhood hyperactivity-inattention symptoms and smoking in adolescence. Drug and Alcohol Dependence 2005;78:101–8. 15 Galéra C, Bouvard M, Melchior M, et al. Disruptive symptoms in childhood and adolescence and early initiation of tobacco and cannabis use: The Gazel Youth study. European Psychiatry 2010;25:402–8. 16 Goodman A. Substance use and common child mental health problems: examining longitudinal associations in a British sample. Addiction 2010;105:1484–96. © Royal College of Physicians 2013 77
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PDF not for circulation Smoking and
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Contents Members of the Tobacco Adv
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Contents 4.4.3 Attention deficit hy
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Contents 6.4.3 Staff knowledge 122
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Contents 10.5 Tobacco policy and me
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Contributors Anthony Aclet - Specia
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Contributors Jill Williams - Associ
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1 Mental disorders 1.1 What is a me
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Mental disorders 1 1.3 Common menta
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Mental disorders 1 1.4.4 Somatisati
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Mental disorders 1 In addition to s
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Mental disorders 1 not diagnosed un
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Mental disorders 1 Similar to many
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Mental disorders 1 12 Chang CK, Hay
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Mental disorders 1 52 Young S, Toon
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Ethical and legal aspects 9 pose co
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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 10.4 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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