Smoking and Mental HealthProblems in Treatment-SeekingUniversity Students
Eric Heiligenstein, M.D.
University of Wisconsin-Madison Health Services
Stevens S. Smith, Ph.D.
University of Wisconsin Center for Tobacco Research andIntervention
Smoking Prevalence in the U.S.
JAMA, 1989:261JAMA, 1989:261
Association of Smoking andPsychiatric Disorders
General population
o22-30%
Panic disorder
o35%
Alcohol abuse
o43%
Depression
o49%
Schizophrenia
o88%
Smoking Status According toPsychiatric Diagnosis
US Population
CurrentSmokers, %
LifetimeSmokers, %
Total
100
28.5
47.1
No mentalillness
50.7
22.5
39.1
Ever mentalillness
49.3
34.8
55.3
Any mentalillness in pastmonth
28.3
41.0
59.0
Adapted from Lasser, 2000
Broad Complications of Smokingand Psychiatric Disorders
Additive mortality risks from CV disease andcancer
Associated with substance abuse anddependence
Poorer HRQOL and functional status
Income diversion
Boyd et al., 2001; Bruce et al., 1994; Degenhardt et al,2001; Anda et al, 2003; Woolf et al, 1999
Specific Complications of Smoking andPsychiatric Disorders
Higher risk for suicide and suicide attempts
Smokers with PD have more severesymptoms than non-smokers with PD
Smokers with schizophrenia have greaternumber of hospitalizations than non-smokerswith schizophrenia
Miller et al., 2000; Zvolensky et al, 2003; Goff et al.,1992
Smoking Rates Compared to the Numberof Lifetime Psychiatric Diagnoses
Adapted from Lasser, 2000
Methods
Data Sources
University of Wisconsin-Madison
o40,000 undergraduate, graduate, andprofessional students
oVoluntarily presented for mental healthtreatment at Counseling Services (9/03-12/03)
Methods
Assessment (retrospective chart review)
Basic demographic measures
Smoking status
oNonsmoker/occasional
oLight smoker (at least weekly use)
oHeavy smoker (daily smoking, >10 cigarettes per day)
PsyberCare-MH (Polaris Health Directions)
oStandardized and validated computer assessment
PsyberCare-MH In Use
Typical Clinical Setting Process Flow
Real-TimeClinicalReport
Patient Self-ReportAssessment
(unassisted)
Physician /TreatmentProvider
Patient SetUp AtComputer(30 seconds)
MasterDatabase
AggregateDataReport
Question Presentation
Sample Report Page
Methods
PsyberCare-MH Scales
Subjective well-being ( includes SF-12)
Psychiatric symptom severity (DSM IV)
Functional disability (SSI guidelines)
Results
1259 students presented for evaluation
1148 took PsyberCare-MH (91%)
Reviewed random sample of ½ records(n=574)
Smoking status identified in 503 (88%)
Demographic Characteristics
According to Smoking Status
Variable
Nonsmokersa
(n=384)
LightSmokersb
(n=68)
HeavySmokersc
(n=51)
Mean
SD
Mean
SD
Mean
SD
Age
22.4
4.3
22.6
4.0
22.7
5.0
N
%
N
%
N
%
Male
121
71.6
26
15.4
22
13.0
Female
263
78.7
42
12.6
29
8.7
White
330
75.5
62
14.2
45
10.3
Non-Whited
54
81.8
6
9.1
6
9.1
dHispanic n=11, Black n=10, Asian n=16, International n=23, Other n=6
PsyberCare Scales By Smoking Status
PsyberCare
Scale
Non-smokerswithpercentilescores < 50a
(n=384)
Lightsmokerswithpercentilescores < 50
(n=68)
Heavy smokerswith percentilescores < 50
(n=51)
Non-smokers vsLight Smokers
Comparison
Non-Smokersvs. HeavySmokersComparison
Light Smokersvs. HeavySmokersComparison
Depression
32.3%
41.2%
80.4%
2(1)=2.0,p=.15
2(1)=44.2,p<.001
2(1)=18.4,p<.001
Anxiety
38.5%
48.5%
80.4%
2(1)=2.4,p=.12
2(1)=32.1,p<.001
2(1)=12.6,p<.001
Subjective
Well-being
54.7%
61.8%
96.1%
2(1)=1.2,p=.28
2(1)=32.0,p<.001
2(1)=19.1,p<.001
PersonalFunctioning
25.0%
35.3%
82.4%
2(1)=3.1,p=.08
2(1)=63.4,p<.001
2(1)=26.1,p<.001
Social
Functioning
24.5%
27.9%
54.9%
2(1)=0.4,p=.54
2(1)=20.6,p<.001
2(1)=8.9,p<.004
Vocational
Functioning
27.1%
32.4%
68.6%
2(1)=0.8,p=.37
2(1)=35.7,p<.001
2(1)=15.4,p<.001
aPercentile scores <50 indicate poorer functioning.
PsyberCare-MH Scales by SmokingStatus
Discussion
Heavy smokers compared to light and non-smokers
More severe depression and anxiety
Poorer overall well-being
Greater functional impairment
(all p<.008)
No differences between light smokers andnon-smokers
Discussion
Results support existing research ingeneral population and medicalsettings
Smoking is severity of illness multiplier
Understanding the Results
Neuropharmacologic effects of nicotine
Shared genetic and psychosocial factors
Cigarette smoke contains numerousother psychoactive compounds
Methodological Limitations
Cross-sectional data
Limited generalizability
Tobacco use determine by self-report
Psychiatric diagnoses not recorded
Clinical Implications
Systematic identification processes that meshwith a non-medical practice style
Integration of smoking cessation effortswithin primary mental health treatments
Evaluation of outcomes of standard mentalhealth treatments in smokers
Address the effects of psychiatric comorbidityon cessation efforts in primary care settings