Wednesday, February 20, 2013

Smoking, But Not Smokeless Tobacco, Associated with Past-Year Psychiatric Disorders

Compared with the general population, smokers have elevated rates of psychiatric problems, and affected smokers tend to consume more cigarettes, inhale more deeply and quit less often (evidence here, here and here).  A new study confirming this link concludes that “smokeless tobacco is not significantly associated with psychiatric morbidity…”

The principal investigator of the study, which was published in Social Psychiatry and Psychiatric Epidemiology (abstract here), is Nicholas Peiper, a doctoral student in epidemiology at the University of Louisville; I am honored to be a co-author. 

Peiper analyzed data from the 2005 to 2008 National Survey on Drug Use and Health (NSDUH).  In addition to detailed information on tobacco use, the survey also measures past-year serious psychological distress and major depressive episodes using clinically validated instruments, and past-year anxiety disorder with proxy items.  Results were adjusted for other potential factors for these disorders, including age, race/ethnicity, education, income, marital status, diabetes and other illnesses, substance/alcohol abuse and pregnancy. 

Odds Ratios For Serious Pyschological Distress (SPD), Major Depressive Episode (MDE) and Anxiety Disorder (AD) Among Current Smokers, Smokeless Tobacco Users and Dual Users, NSDUH 2005-2008
SmokersSmokeless UsersDual Users
SPD1.14 (0.99 – 1.31)0.71 (0.55 – 0.91)0.86 (0.65 – 1.14)
MDE1.21 (0.99 – 1.48)0.88 (0.66 – 1.19)1.15 (0.82 – 1.63)
AD1.53 (1.17 – 2.00)1.21 (0.79 – 1.87)1.73 (1.13 – 2.65)
SPD1.60 (1.45 – 1.77)0.95 (0.51 – 1.77)2.24 (1.10 – 4.58)
MDE1.43 (1.26 – 1.63)0.38 (0.13 – 1.10)1.68 (0.71 – 3.98)
AD1.83 (1.56 – 2.14)0.99 (0.35 – 2.81)2.76 (1.09 – 7.00)

Both male and female smokers were more likely than never tobacco users to have experienced past-year serious psychological distress, major depressive episodes or anxiety disorders.  Smokeless users were less likely to experience psychological distress (statistically significant in men) and depressive episodes.  Female and male dual users were significantly more likely to experience anxiety; female dual users also experienced more psychological distress.

It is evident that tobacco harm reduction can be an effective adjunct to the management of patients with psychological problems.  We conclude: “considerable efforts should focus on addressing differential tobacco risks in treatment settings, as those with psychiatric morbidity suffer a disproportionate share of smoking-attributable morbidity and mortality.” 


Jackson said...

There's a few angles to this plus the fact that state funded psychiatrists always lie.

Many young first time "mentally ill" people are first diagnosed by their parents who are worried when their children behave like teenagers and are also smoking and/or drinking.

Non smoking psych patients who are prescribed major tranquilizers such as Risperidone often learn that tobacco provides some relief from the terrible effects of these drugs.

Once on Risperidone you are likely to be a psych patient for life and under the constant scrutiny of case managers, relatives, employers etc.

It's a terrible life and you are also likely to be coercively detained as an inpatient for any reason.

By the time you are 30 you are likely to be a smoker and have had multiple inpatient stays in hospital.

If you were to take up vaping you would be likely to be taken off to the hospital because it would cause some kind of discussion that is likely to result in an argument.

The feigned fear of vaping would likely result in you being unable to vape while in hospital but able to smoke. This would result in arguments and people with "mental illness" never win an argument.

Of course most people, including the so called mentally ill, who use nicotine do so by way of cigarettes.

nisakiman said...

...smokers have elevated rates of psychiatric problems...

I think you've put the cart before the horse.lecomb 9212

That statement infers that the psychiatric problems are as a result of smoking, whereas I would have thought that a more accurate statement would be: "People with psychiatric problems are more likely to smoke", smoking being well known as both a relaxant and a mild stimulant.

Jackson said...

I wrote a more lengthy comment along the same lines but it didn't appear. Maybe I made a slip in the posting.

Many nonsmokers who for whatever reason find themselves taking drugs such as Risperidone learn from others at clinics and inpatient stays that cigarettes provide some quick temporary relief from the effects of the psychotropes.