ABSTRACT
Age at onset of daily smoking (AODS) was compared in schizophrenia (N=258), mood disorders (N=166) and controls (N=381) to replicate a different AODS in schizophrenia patients, and to confirm that this is not necessarily explained by the prodromal period. The cumulative hazard curves for schizophrenia, mood disorders and controls were significantly different (p<0.001), even after controlling for gender and education (p<0.001). After excluding the patients who started smoking within 5 years of starting psychiatric medication, the cumulative hazard curve for schizophrenia patients was significantly different from that for ever-smoker controls (p=0.002), even after adjusting for gender and education (p=0.03).
Subject(s)
Schizophrenia/epidemiology , Smoking/epidemiology , Adult , Age of Onset , Demography , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Male , Mood Disorders/diagnosis , Mood Disorders/epidemiology , Mood Disorders/psychology , Prevalence , Schizophrenia/diagnosis , Severity of Illness Index , Time FactorsSubject(s)
Mental Disorders , Smoking Cessation , Smoking/epidemiology , Acute Disease/psychology , Adolescent , Adult , Female , Health Surveys , Humans , Kentucky/epidemiology , MaleABSTRACT
BACKGROUND: Co-occurrence of substance use disorders and severe mental illnesses (SMIs) is a major U.S. public health issue, although the role of tobacco is usually neglected. This study explored variables associated with alcohol, drug, and smoking cessation in a naturalistic setting. METHOD: Logistic regression was used to study variables associated with cessation of alcohol and drug use disorder and daily smoking in 560 SMI inpatients and outpatients from central Kentucky facilities. Patients with a lifetime history of alcohol or drug use disorder were considered to be in cessation if they had not suffered from abuse or dependence during the last year. Alcohol and drug use disorder diagnoses were determined using the Clinician Rating of Alcohol and Drug Use Disorder. Patients were recruited from July 2000 to March 2003. RESULTS: The cessation rates for alcohol and drug use disorders were, respectively, 44% (95% CI = 39% to 49%) and 46% (CI = 40% to 51%); these were higher than the daily cigarette smoking cessation rate of 10% (CI = 7% to 13%). Drug use disorders (p < or = .02), outpatient status (p < .001), and having a medical complication of obesity (diabetes mellitus, hypertension, or hyperlipidemia; p < .001) were significantly associated with alcohol cessation. Alcohol use disorder (p < .001), starting treatment with psychiatric medications after 33 years of age (p < .001), taking these medications for 14 years or more (p = .02), schizophrenia diagnosis (p < .001), outpatient status (p = .03), and obesity (p = .04) were significantly associated with drug cessation. Cessation of daily smoking was associated with hypertension (p = .02), late start of treatment with psychiatric medications (> 33 years old; p = .01), and lack of lifetime drug abuse (p < .001). CONCLUSIONS: These results are limited by the cross-sectional and naturalistic design but suggest that public health experts, researchers, and clinicians need to mindfully address smoking cessation in patients with SMIs. Clinicians may want to consider that medical illnesses may motivate patients with SMIs to stop substance abuse and that patients with SMIs who abuse both alcohol and drugs rarely stop abusing just one of them.
