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Cigarette Smoking and Mental Health

In these studies of adult populations, smoking was strongly associated with disability and low quality of life.

Although smoking rates are high among patients with schizophrenia and some other psychiatric disorders, researchers have not adequately studied how smoking relates to mental health problems. In 2 new reports, investigators begin to address these issues.

One research group used data from the historic Stirling County study, which involved interviews with adults in 1952, 1970, and 1992 and included a longitudinal analysis of the 1952 and 1970 cohorts. An association between smoking and depression was found only in the 1992 sample. Although smoking at baseline did not predict subsequent depression, depressed individuals were more likely to start or continue smoking and less likely to quit than never-depressed individuals were.

To assess associations between smoking and health-related quality of life, other researchers analyzed data from a large German health survey conducted from 1997 to 1999 that involved interviews with 4181 individuals (36.2% smoked, and 9.4% were nicotine dependent [20 cigarettes/day]). Nicotine-dependent respondents reported poorer quality of life and greater one-month and one-year disability rates than never-smokers. More than half of nicotine-dependent participants met criteria for at least one other mental disorder.

Comment: Smoking was related to depression only within recent historical cohorts -- perhaps because many people stopped smoking as they became aware of smoking's deleterious health effects, whereas individuals with mood disorders might have been more likely to continue smoking due to nicotine's effects on mood (e.g., depression might re-emerge when formerly depressed patients stop smoking). Causal links between nicotine dependence and other psychiatric disorders may not be as clear-cut, although some evidence suggests that nicotine may contribute to the onset of anxiety disorders. In any event, the strong association between smoking, low quality of life, and increased disability underscores that smoking in psychiatric patients is a significant public health concern. These patients need better strategies to stop smoking.

— Joel Yager, MD

Published in Journal Watch Psychiatry November 5, 2003

Citation(s):

Murphy JM et al. Cigarette smoking in relation to depression: Historical trends from the Stirling County Study. Am J Psychiatry 2003 Sep; 160:1663-9.

• Original article (Subscription may be required)
• Medline abstract (Free)

Schmitz N et al. Disabilities, quality of life, and mental disorders associated with smoking and nicotine dependence. Am J Psychiatry 2003 Sep; 160:1670-6.

• Original article (Subscription may be required)
• Medline abstract (Free)