Prevalence of Smoking in Bipolar Disorder and Mental Illness
Smoking prevalence in bipolar disorder is dramatically elevated at 53.9-66% compared to the general U.S. population rate of 17.8-23.6%, representing a 2.36 to 5-fold increased risk, with similar elevations seen across other severe mental illnesses. 1, 2, 3, 4
Specific Prevalence Data by Diagnosis
Bipolar Disorder
- Current smoking rates range from 53.9% to 66% in bipolar patients, substantially higher than general population rates 3, 4
- Israeli study found 53.9% smoking prevalence (2.36 times higher than 22.8% general population) 3
- Kentucky study reported 66% current daily smoking in bipolar disorder 4
- Chinese inpatient study showed 17.5% prevalence, though notably lower than Western populations 5
Comparative Rates Across Mental Illnesses
- Schizophrenia shows the highest smoking prevalence at 59.1-74% 6, 4
- Major depressive disorder ranges from 10.6-57% depending on population studied 4, 5
- Overall mental illness prevalence: 24.9-27% versus 16.5-19.2% in those without mental illness 1, 7
- Adults with serious psychological distress: 34.3-59.1% depending on specific diagnosis 6
Hierarchical Pattern
Smoking prevalence appears to follow a gradient: schizophrenia (74%) > bipolar disorder (66%) > major depression (57%), though bipolar disorder and schizophrenia show no statistically significant difference from each other 4, 5
Why Mental Illness Patients Smoke More
Self-Medication and Comorbidity Patterns
- Bipolar smokers demonstrate significantly higher rates of substance use disorders: strong associations exist between smoking and lifetime alcohol dependence/abuse (p=0.02) and drug use history (p≤0.01) 3
- Alcohol use disorders affect 35% of bipolar patients over their lifetime, compared to 12.5% daily/almost daily use in severe mental disorder populations versus 7.4% in general population 2
- Smoking prevalence increases with number of comorbid mental illnesses, suggesting cumulative vulnerability 6
Social and Psychological Factors
- 82.8% of severe mental disorder patients avoid social interactions due to anxiety and 80.1% report loneliness, potentially driving tobacco use as coping mechanism 2
- Earlier age of illness onset correlates with smoking in bipolar disorder (p=0.04) 3
- Male gender, living alone, higher personal income, and first episode status associate with smoking across diagnostic groups 5
Cessation Challenges
- Adults with mental illness attempt to quit at comparable rates to general population but achieve significantly lower success rates 6
- Quit ratios are substantially lower despite similar cessation attempts, indicating greater difficulty maintaining abstinence 6
- Between 2004-2011, smoking declined significantly in those without mental illness (19.2% to 16.5%, p<0.001) but remained essentially unchanged in those with mental illness (25.3% to 24.9%, p=0.50), representing a significant 2.3% difference-in-difference (p=0.005) 7
Critical Clinical Implications
Treatment Engagement Benefits
Mental health treatment receipt significantly improves smoking cessation rates: 37.2% quit rate among those receiving treatment versus 33.1% among untreated (p=0.005) 7
Safety of Cessation Efforts
Quitting smoking does not cause deterioration in mental health and actually appears to improve psychological well-being in those with mental disorders, contradicting common clinical concerns 2
Intervention Approaches
- Combination nicotine replacement therapy plus motivational interviewing and CBT delivered over 9 months shows promise 2
- Both face-to-face and telephone-delivered interventions can achieve 6.2-12% biochemically verified abstinence rates with 16-42% achieving ≥50% reduction in cigarettes 1
- Supervised exercise (≥90 minutes moderate-to-vigorous weekly) can reduce psychiatric symptoms and support cessation 2
Common Pitfall
Tobacco control policies effective in general populations have demonstrably failed to work as effectively for persons with mental illness, necessitating specialized, intensive interventions integrated into mental health care settings 1, 7