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Nearly half of all cigarettes consumed in the US are smoked by people suffering from mental illness, suggests new research.

The mentally ill account for over 44 per cent of the US tobacco market and are twice as likely to smoke as healthy people, says Karen Lasser of Harvard Medical School.

鈥淭o be honest, I鈥檓 surprised the figure isn鈥檛 higher,鈥� says a spokeswoman for MIND, the British mental health charity. 鈥淏ut no one鈥檚 sure whether smoking causes mental illness or whether people with mental illness are more likely to smoke.鈥�

Andy Parrott, an expert on smoking at the University of East London, thinks both factors probably come into play. 鈥淭here鈥檚 lots of evidence that nicotine dependency makes you more anxious and more depressed, but the mechanisms of that are unclear,鈥� he says.

鈥淢any American researchers have a notion that people with mental illness smoke to self-medicate. There鈥檚 a notion that nicotine improves functioning and performance 鈥� but they鈥檙e coming to realise that it doesn鈥檛.鈥�

Parrott thinks people with mental illness may believe smoking helps to relieve anxiety, when it simply relieves the symptoms of nicotine withdrawal.

Giving up

Lasser鈥檚 team looked at interviews with 4411 Americans aged 15 to 54. These were gathered between 1991 and 1992 as part of a national survey of mental illness and are the most recent data on mental health and smoking available, says Lasser.

People with disorders such as schizophrenia, bipolar disorder, anxiety disorder and major depression were included in the study. Lasser found that the rate of quitting among the mentally ill smokers was almost as high as in the healthy people. Previous studies have suggested that they find it much harder to give up smoking.

Since mentally ill people are over-represented in the lower socioeconomic groups, higher cigarette taxation could be an effective way of encouraging them to quit, she thinks.

More at: Journal of the American Medical Association (vol 284, p2606)