Extrapolating their results to the U.S. population, the researchers estimate that people with diagnosable mental illness comprise nearly 45 percent of the total tobacco market in the U.S.

The study findings are based on analysis of data gathered for the congressionally mandated National Comorbidity Survey (NCS) of psychiatric disease (www.hcp.med.harvard.edu/ncs/index.htm) that was conducted between September 1990 and February 1992 and released to the public in 1998. The data is the most recent national information available to examine the association between type and severity of mental illness and the likelihood of smoking and smoking cessation.

The lead author is Dr. Karen Lasser, a post doctoral student at the Harvard School of Public Health and Harvard Medical School and a physician at Cambridge Hospital. She and her colleagues employed standard psychiatric definitions of mental illness that included major depression, bipolar disorder, agoraphobia, social and simple phobia, generalized anxiety disorder, alcohol abuse and dependence, antisocial personality, conduct disorder and nonaffective psychosis.

The article quotes internal documents from the tobacco industry showing that R.J. Reynolds had conducted marketing studies targeting psychologically vulnerable consumers. The studies implied that smokers used nicotine for depressive symptoms and for “mood enhancement,” “anxiety relief,” to “cope with stress” and to “gain self-control.” The marketing study authors also stated that smoking “helps perk you up” and “helps you think out problems.”

Said Harvard study author Lasser: “Perhaps mental illness causes smoking by making people more vulnerable to tobacco advertising or nicotine addiction; however, other studies have called the direction of causality into question, suggesting that smoking may cause mental illness and, our findings are certainly compatible with that as well.”

The study found that nearly one third of smokers with mental illness were able to quit smoking and if they were abstaining from drugs and alcohol they had cessation rates equal to people without mental illness. “This finding should encourage us to help our patients with mental illness to quit smoking, especially given that persons with mental illness are at high risk for smoking related deaths” said Dr. Danny McCormick study co-author.

Authors of the study are Drs. Karen Lasser, Steffie Woolhandler, David Himmelstein, Danny McCormick, J. Wesley Boyd and David Bor of Harvard Medical School, Boston MA and Cambridge Hospital, Cambridge MA

The research was supported by a grant from the National Research Services Award and in part by a grant from the Open Society Institute.

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• Mental Health Research
• Smoking

• Mental Health
• Smoking Addiction

• Substance abuse
• Personality disorder
• Neurosis
• Phobia
• Psychopathology
• Adult attention-deficit disorder