Smoking and the Association with Mental Health

*Abdihakim Mahamud Isse*

## **Abstract**

Tobacco use is the largest single cause of preventable mortality and morbidity worldwide and it is strongly associated with a variety of mental illnesses. Smoking is considered as a modifiable risk factor that has a significant impact on physical health, including lung diseases, cardiovascular disease, peptic ulcer disease, reproductive problems, and diminishment of bone minerals. Additionally, smoking is a major global public health issue and mortality is estimated to be around 6 million people per year. The prevalence of smoking in people with mental illness can range from 50 to 85%, and they are much less likely to quit smoking compared to the general population. Nicotine addiction plays a significant role in the maintenance of smoking in people with mental illnesses. Hence, it is important to encourage smoking cessation to reduce the health risk of smoking. In terms of smoking intervention, international guidelines recommend to treat smoking both pharmacological and with behavioral support in mentally ill patients. Furthermore, prevention strategies are also essential to control the harm of smoking at the public and individual levels. This chapter will highlight the effect of smoking and nicotine dependence among people with mental illness and their therapeutic policies to enhance the understanding of prevention and management of tobacco use as well as nicotine dependence.

**Keywords:** smoking, tobacco use, cigarette, nicotine addiction or dependence, mental health

### **1. Introduction**

Smoking is the leading cause of preventable morbidity and mortality worldwide, and there are significant health inequalities in terms of morbidity and mortality among individuals with mental illnesses and those without, and the main factor determining this inequality is that of smoking [1, 2]. Smoking is considered a modifiable risk factor that has a significant impact on physical health, including lung diseases, cardiovascular disease, peptic ulcer disease, reproductive problems, and diminishment of bone minerals [3]. Furthermore, smoking is a major global public health issue and mortality is estimated to be around 6 million people per year [4]. Evidence has indicated that individuals with psychiatric illnesses are vulnerable to smoking; thus, smoking is associated with a wide range of psychiatric disorders, such as depression, bipolar disorder (BD), anxiety disorder, and schizophrenia [3–5]. Recent studies suggest that the prevalence of smoking is significantly

higher among people with mental health issues in comparison to the general population, and further that they are more likely to be heavy smokers [6]. Campion et al. stressed that tobacco use is not only related to prevalence but also the first onset of mental disorder. The relationship between mental health disorders and smoking is complex and different for individual disorders [3, 5]. As a result, individuals with mental health issues struggled to quit smoking because they experience high levels of distress [3]

The incidence of tobacco use among people with mental health problems was estimated to be about 60%, compared to 25% in the general population [7]. In addition, the rate of smoking is double that among those with mental illnesses compared to those without. For instance, in Australia, a national mental health survey conducted in 2007 found that 32% of mental health patients were smokers, while 16% of smokers did not have a mental illness [5]. Similarly, a large survey of psychiatric disorders in the UK found that 64% of those with mental illnesses were smokers, compared with 29% without [5]. People with mental health issues are associated with high tobacco use, high nicotine dependency, and more severe withdrawal symptoms when they quit or reduce cigarette use [8]. The purpose of this chapter is to demonstrate and summarize the impact of smoking and the association between smoking and mental health issues. In order to improve the response to quitting smoking, it is important to understand the connection between smoking and mental illness. This should help to prevent other related diseases as well as reduce the mortality rate associated with smoking.
