Update in Smoking and Mental Illness: A Primary Care Perspective

Abstract

This article will review population-based nationally representative data on rates of smoking and tobacco cessation in adults with and without mental illness. We begin with a review of the methods and findings from the 1991–1992 National Comorbidity Survey. This study found that 41% of persons who had a mental illness in the past month were current smokers, that persons with mental illness are twice as likely to smoke as persons without mental illness, and that heavy smoking is rare in persons without mental illness. Persons with a current mental illness smoked 44% of all cigarettes in the United States. We then explore the reasons that persons with mental illness smoke at such high rates and examine the directions of causality between smoking and mental illness. We review tobacco companies’ marketing activities that have targeted mentally ill smokers. The health consequences of smoking in this vulnerable group are dire. An estimated 200,000 smokers with mental illness or addiction die each year from smoking. Despite their high rates of smoking, a substantial proportion of persons with psychiatric disorders are able to quit.

KEYWORDS:

• Smoking
• mental disorders
• primary care

The author would like to acknowledge Maxim D. Shrayer, PhD, for his constructive comments on earlier drafts of this paper.