The prevalence, odds, predictors, and management of tobacco use disorder or nicotine dependence among people with severe mental illness: Systematic review and meta-analysis
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The prevalence, correlates, and management of tobacco use disorder (TUD) or nicotine dependence (ND) among people with severe mental illness (SMI), namely schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD), remain unclear. Therefore, a systematic review and meta-analysis was conducted. Electronic databases were systematically searched from inception to July 12, 2020, for observational studies documenting the prevalence, odds, and correlates of TUD/ND among people with SMI; randomized controlled trials (RCTs) informing the management of TUD/ND in people with SMI were also included. Random-effects meta-analyses were conducted. Sources of heterogeneity were explored. Nineteen observational studies, including 7527 participants with SMI met inclusion criteria. TUD/ND co-occurred in 33.4-65% of people with SMI. Rates were higher among males. While bupropion and varenicline represent promising treatment opportunities for schizophrenia with TUD/ND, non-pharmacological interventions require further research, mainly for people with primary mood disorders. TUD/ND represent prevalent co-occurring conditions among people with SMI. Further well-designed RCTs are warranted to inform their management.
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The pooled point prevalence of tobacco use disorder or nicotine dependence among people with bipolar disorder is 46.3% (95% CI 33.9-59.2%).
“Finally, metanalytic analysis of three cross-sectional studies [one population based (12), two hospital based (13, 14)] also demonstrated a pooled point prevalence of TUD or ND among people with BD of 46.3 % (95 %CI = 33.9–59.2 %) (2).”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [2]
Tobacco use disorder or nicotine dependence is prevalent in 33.4-65% of people with severe mental illness, with a male preponderance.
“A recent meta-analysis found that TUD or ND is prevalent in 33.4–65% of people with severe mental illness, with a male preponderance (2).”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [2]
As a consequence of non-validated diagnostic interviews, prevalence, correlates, and odds of comorbid tobacco use disorder or nicotine dependence among people with severe mental disorders, including bipolar disorder, show a relatively wide range.
“As a consequence, prevalence, correlates, and odds of comorbid TUD or ND among people with severe mental disorders, including BD, show a relatively wide range (2).”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [2]
People with MDD are significantly more likely to engage in excessive alcohol and tobacco use.
“For instance, systematic reviews have found that people with MDD are significantly more likely to engage in excessive alcohol and tobacco use131,132, and have a higher total food intake and reduced diet quality133, higher levels of sedentary behavior134, and poorer sleep continuity and quality135, compared to non-depressed people.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [131]
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- Authors
- Fornaro, M., Carvalho, A. F., De Prisco, M., Mondin, A. M., Billeci, M., Selby, P., Iasevoli, F., Berk, M., Castle, D. J., & de Bartolomeis, A.
- Affiliations
- Federico II University Hospital (IT)
- Deakin University (AU)
- Centre for Addiction and Mental Health (CA)
- Barwon Health (AU)
- Corresponding author
- Carvalho, Andre F.
- ORCID
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2022-01
- Volume
- 132
- Pages
- 289-303
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W3215405232
- Cited by
- 82
- References
- 63
- Citations by year
- 2026: 22 · 2025: 21 · 2024: 19 · 2023: 15 · 2022: 5
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- tobacco use disorder, nicotine dependence, severe mental illness, schizophrenia, bipolar disorder, major depressive disorder, prevalence, predictive factors, bupropion, varenicline, tobacco dependence treatment, non-pharmacological treatment, comorbidities
- MeSH terms
- Varenicline, Mental Disorders, Humans, Male, Tobacco Use Disorder, Prevalence, Smoking Cessation
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