A combined analysis of worldwide studies demonstrates an association between bipolar disorder and tobacco smoking behaviors in adults
Abstract
OBJECTIVES: Worldwide studies were combined to examine two hypotheses: (i) bipolar disorder is associated with smoking behaviors, compared with the general population; and (ii) smoking behavior prevalences in bipolar disorder are intermediate between those in major depressive disorder and those in schizophrenia. METHODS: Combined analyses used 56 articles on adults obtained from a PubMed search or the senior author's article collection. Odds ratios (ORs) and their 95% confidence intervals (CIs) compared current smoking, heavy smoking among current smokers, smoking cessation in ever smokers, and ever smoking in bipolar disorder versus control groups. RESULTS: The combined OR was 3.5 (CI: 3.39-3.54) in 51 current smoking studies of bipolar disorder versus the general population from 16 countries. More limited data provided an OR = 0.34 (CI: 0.31-0.37) for smoking cessation and an OR = 3.6 (CI: 3.30-3.80) for ever smoking. The combined OR was 0.76 (CI: 0.74-0.79) for current smoking in bipolar disorder versus schizophrenia in 20 studies from ten countries. Ever smoking may be lower in bipolar disorder than in schizophrenia (OR = 0.83, CI: 0.75-0.91). The OR was 2.05 (CI: 2.00-2.10) for current smoking in bipolar disorder versus major depression in 18 studies from seven countries. Ever smoking may be higher (OR = 1.5, CI: 1.40-1.70) and smoking cessation lower (OR = 0.51, CI: 0.45-0.59) in bipolar disorder than in major depression. CONCLUSIONS: Increased current smoking in bipolar disorder versus the general population reflected increased ever smoking (initiation) and decreased smoking cessation. Smoking behavior frequencies in bipolar disorder may be between those in depressive disorder and schizophrenia, with schizophrenia showing the highest severity level.
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A systematic review of studies on smoking in severe mental disorders placed bipolar disorder only second after schizophrenia but ahead of major depressive disorder.
“In contrast, a systematic review of studies on smoking in severe mental disorders placed BD only second after schizophrenia but ahead of major depressive disorder (10).”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [10]
Using general population controls, unadjusted odds ratios for people with bipolar disorder are 5.0 for current cigarette smoking, 2.6 for life-time cigarette smoking, and 0.13 for stopping smoking.
“Using data derived from the general population as controls resulted in unadjusted odds ratios (ORs) for people with BD of 5.0 (95% CI: 3.3–7.8) for current cigarette smoking, 2.6 (95% CI: 1.7–4.4) for life-time cigarette smoking, and 0.13 (95% CI: 0.03–0.24) for stopping smoking”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [10]
The willingness to quit smoking appears low in people with bipolar disorder.
“the latter indicating that the willingness to quit appears low in people with BD”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [10]
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- Authors
- Jackson, J. G., Diaz, F. J., Lopez, L., & de Leon, J.
- Affiliations
- University of Kentucky (US)
- Department of Biostatistics The University of Kansas Medical Center Kansas City KS USA
- School of Health Sciences Universidad Pontificia Bolivariana Medellin Colombia
- Mental Health Research Center at Eastern State Hospital University of Kentucky Lexington KY USA
- Venue
- Bipolar Disorders
- Publisher
- Wiley
- Published
- 2015-08-04
- Volume
- 17
- Issue
- 6
- Pages
- 575-597
- ISSN
- 1398-5647 (ISSN-L)
- 1399-5618
- OpenAlex
- W1559892056
- Cited by
- 120
- References
- 113
- Citations by year
- 2026: 6 · 2025: 17 · 2024: 8 · 2023: 16 · 2022: 16 · 2021: 11 · 2020: 16 · 2019: 5 · 2018: 2 · 2017: 11 · 2016: 10 · 2015: 1 · 2014: 1
- FWCI
- 0.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Bipolar Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- bipolar disorder, smoking, smoking prevalence, smoking cessation, ever smoking, heavy smoking, schizophrenia, major depressive disorder, psychiatric comorbidity
- MeSH terms
- Adult, Bipolar Disorder, Major Depressive Disorder, Humans, Schizophrenic Psychology, Severity of Illness Index, Smoking, Prevalence, Odds Ratio, Smoking Cessation
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