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Smoking and mental illness: results from population surveys in Australia and the United States

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Lawrence, David, Mitrou, Francis, Zubrick, Stephen R·2009·BMC Public Health
DOI 10.1186/1471-2458-9-285PMC PMC2734850
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Abstract

BACKGROUND: Smoking has been associated with a range of mental disorders including schizophrenia, anxiety disorders and depression. People with mental illness have high rates of morbidity and mortality from smoking related illnesses such as cardiovascular disease, respiratory diseases and cancer. As many people who meet diagnostic criteria for mental disorders do not seek treatment for these conditions, we sought to investigate the relationship between mental illness and smoking in recent population-wide surveys. METHODS: Survey data from the US National Comorbidity Survey-Replication conducted in 2001-2003, the 2007 Australian Survey of Mental Health and Wellbeing, and the 2007 US National Health Interview Survey were used to investigate the relationship between current smoking, ICD-10 mental disorders and non-specific psychological distress. Population weighted estimates of smoking rates by disorder, and mental disorder rates by smoking status were calculated. RESULTS: In both the US and Australia, adults who met ICD-10 criteria for mental disorders in the 12 months prior to the survey smoked at almost twice the rate of adults without mental disorders. While approximately 20% of the adult population had 12-month mental disorders, among adult smokers approximately one-third had a 12-month mental disorder--31.7% in the US (95% CI: 29.5%-33.8%) and 32.4% in Australia (95% CI: 29.5%-35.3%). Female smokers had higher rates of mental disorders than male smokers, and younger smokers had considerably higher rates than older smokers. The majority of mentally ill smokers were not in contact with mental health services, but their rate of smoking was not different from that of mentally ill smokers who had accessed services for their mental health problem. Smokers with high levels of psychological distress smoked a higher average number of cigarettes per day. CONCLUSION: Mental illness is associated with both higher rates of smoking and higher levels of smoking among smokers. Further, a significant proportion of smokers have mental illness. Strategies that address smoking in mental illness, and mental illness among smokers would seem to be important directions for tobacco control. As the majority of smokers with mental illness are not in contact with mental health services for their condition, strategies to address mental illness should be included as part of population health-based mental health and tobacco control efforts.

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Crossref · 10.1186/1471-2458-9-285

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Figures

Figure 1 Proportion of Australian smokers with a mental disorder, by age group and sex. Source: 2007 Australian Survey of Mental Health and Wellbeing, customised tables [43].
Figure 1 Proportion of Australian smokers with a mental disorder, by age group and sex. Source: 2007 Australian Survey of Mental Health and Wellbeing, customised tables [43].CC BY · PubMed Central
Figure 2 Proportion of United States smokers with a mental disorder, by age group and sex. Source: National Comorbidity Survey-replication [46].
Figure 2 Proportion of United States smokers with a mental disorder, by age group and sex. Source: National Comorbidity Survey-replication [46].CC BY · PubMed Central
Figure 3 Proportion of US adult population who smoke, by level of psychological distress and sex. Source: 2007 United States National Health Interview Survey [49].
Figure 3 Proportion of US adult population who smoke, by level of psychological distress and sex. Source: 2007 United States National Health Interview Survey [49].CC BY · PubMed Central
Figure 4 Proportion of US adult population who smoke, by level of psychological distress and age group. Source: 2007 United States National Health Interview Survey [49].
Figure 4 Proportion of US adult population who smoke, by level of psychological distress and age group. Source: 2007 United States National Health Interview Survey [49].CC BY · PubMed Central
Figure 5 Current US adult smokers: Average number of cigarettes smoked per day, by level of psychological distress. Source: 2007 United States National Health Interview Survey [49].
Figure 5 Current US adult smokers: Average number of cigarettes smoked per day, by level of psychological distress. Source: 2007 United States National Health Interview Survey [49].CC BY · PubMed Central

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Citations

Cites

Research works printed but not linked: 12

  1. Boyd JW, Lasser K: Tobacco madness. Psychiatric Times. 2001, 18 (10): 1-4.
  2. Lawrence D, Holman CDJ, Jablensky AV: Duty to care Preventable physical illness in people with mental illness. 2001, Perth, University of Western Australia
  3. Australian Bureau of Statistics: National Survey of Mental Health and Wellbeing: Users' Guide. 2009, ABS Cat 4327.0. Canberra
  4. Alegria M, Jackson JS, Kessler RC, Takeuchi D: Collaborative Psychiatric Epidemiology Surveys, 2001–2003 United States [computer file]. 2007, Conducted by Harvard Medical School, Department of Health Care Policy/University of Michigan, Survey Research Center. ICSPR20240-v5. Ann Arbor, MI: Institute for Social Research, Survey Research Center [producer], Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2008-06-19
  5. National Center for Health Statistics: Data file documentation, National Health Interview Survey, 2007 (machine readable data file and documentation). 2008, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
  6. World Health Organization: The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. 1993, Geneva: World Health Organization
  7. Australian Bureau of Statistics: Mental health and wellbeing: Profile of adults, Australia, 1997. 1998, ABS Cat 4326.0. Canberra
  8. el-Guebaly N, Cathcart J, Currie S, Brown D, Gloster S: Smoking cessation approaches for persons with mental illness or addictive disorders. Psychiatr Serv. 2002, 53: 1166-1170. 10.1097/00001504-200305000-00006. · DOI · Paper page
  9. Marsh A, McKay S: Poor smokers. 1994, London: Policy Studies Institute
  10. Apollonio DE, Malone RE: Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill. Tob Control. 2005, 14: 409-415. 10.1136/tc.2005.011890. · DOI
  11. U.S. Department of Health and Human Services: Tobacco use in population groups: reduce tobacco use in adults. Cigarette smoking (27-1a). Healthy people 2010 (conference ed). 2000, Washington, DC: U.S. Department of Health and Human Services, 2:
  12. Australian Bureau of Statistics: 2004–05 National Health Survey: Summary of results Australia. 2006, ABS Cat 4364.0. Canberra

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Metadata

Authors
Lawrence, D., Mitrou, F., & Zubrick, S. R.
Affiliations
The Kids Research Institute Australia (AU)
Corresponding author
Lawrence, David
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2009-08-07
Volume
9
Issue
1
Pages
285-285
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/1471-2458-9-285
PMC
PMC2734850
OpenAlex
W1964578896
Cited by
517
References
77
Citations by year
2026: 14 · 2025: 19 · 2024: 26 · 2023: 19 · 2022: 27 · 2021: 32 · 2020: 28 · 2019: 25 · 2018: 39 · 2017: 41 · 2016: 38 · 2015: 51 · 2014: 38 · 2013: 41 · 2012: 32
FWCI
17.07
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eSpace (Curtin University) (submittedVersion, cc-by)
Funders
  • Robert Wood Johnson Foundation
  • John W. Alden Trust
  • Australian Government
  • Substance Abuse and Mental Health Services Administration
  • National Institute of Mental Health
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
smoking, mental illness, psychological distress, schizophrenia, anxiety disorders, depression, tobacco control, mental health service utilization, sex differences, age differences, cigarette consumption, Australia, United States
MeSH terms
Adolescent, Adult, Australia, Mental Disorders, Female, Humans, Male, Mental Health Services, Smoking, Stress, Psychological, United States, Young Adult

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