Tuesday, December 7, 2010

Cigarette Smoking and Mental Illness: A Casual Relationship?

Issue: Is the evidence sufficient to conclude that there is a casual relationship between cigarette smoking and the onset of mental illness symptoms?

Research: Forty-one percent of individuals with a current mental disorder are smokers, as compared to the 22 percent of people who have never been diagnosed with a mental disorder (Lasser 2000). People with a mental illness are more likely to be heavy smokers, consuming a pack of cigarettes per day or more (Lasser 2000). People who have been diagnosed with multiple mental disorders have higher rates of smoking and smoke more heavily than people with fewer mental disorders (Lasser 2000). Forty-four percent of all cigarettes smoked in the United States are consumed by people with one or more mental disorders (Lasser 2000). The lifetime prevalence of developing major depression is strongly linked to the number of cigarettes consumed (Breslau &others, 1993, 1998; Kendler, Neale, & others, 1993b). People who smoke a pack of cigarettes or more per day have a 50 percent chance of experiencing major depression, while nonsmokers have about a 17 percent chance. Three separate studies focusing on adolescents fond that cigarette smoking predicted the onset of depressive symptoms, rather than the other way around (Goodman & Capitman, 2000; Ohayon, 2007; Windle & Windle, 2001; Wu & Anthony, 1999). In a study of patients with bipolar disorder, the prevalence and severity of cigarette smoking predicted the severity of psychotic symptoms during manic episodes (Corvin & others, 2001). A positive association was found between smoking and the severity of symptoms experienced by people with anxiety disorders (McCabe & others, 2004). In a study of people with schizophrenia, 90 percent of the patients had started smoking before their illness began (Kelly & McCreadie, 1999). This suggests that in vulnerable people, smoking may precipitate a person's initial schizophrenic episode.
Application: If both premises were accepted, that cigarettes were smoked to alleviate the symptoms of mental illness, but they in turn exasperated the symptoms themselves, then we are presented with a vicious spiral. People with mental disorders are more likely to smoke to alleviate anxiety and to relax, but they are in fact worsening future trauma caused by the mental disorders, while also putting them at risk for other disorders. Is the evidence sufficient though? Most of the evidence simply shows that smoking cigarettes followed the onset of mental disorder or visa versa. They don't show how smoking alleviates the symptoms or how it exasperates them, the physiological effects of smoking. I'm afraid that claiming the this particular group of evidence shows a casual relationship between smoking and the onset of mental illness will be committing the post hoc fallacy.

Conclusion: I do not believe that the evidence provided is sufficient to prove a casual relationship, as most of the evidence simply shows a correlation between smoking and the onset of mental illness symptoms, but not how smoking relates to the onset of mental illness symptoms.

Lasser, Karen; Boyd, J. Wesley; Woolhandler, Steffie; Himmelstein, David U.; McCormick, Danny; & Bor, David H. . (2000) Smoking and mental illness: A population-based prevalence study. Journal of the American Medical Association, 284, 2606-2610
Breslau, Naomi; Kilbey, M. Marlyne; & Andreski, Patricia (1993). Nicotine dependence and major depression: New evidence from a prospective investigation. Archives of General Psychiatry, 50, 31-35.
Kendler, Kenneth S.; Neale, Michael C.; MacLean, Charles J.; Heath, A.C.; Eaves, L. J., & Kessler, R.C. (1993). Smoking and major depression: A casual analysis. Archives of General Psychiatry, 50, 36-43.
Goodman, Elizabeth; & Capitman, John. (2000). Depressive symptoms and cigarette smoking among teens. Pediatric,106, 748 – 755.
Ohayon, Maurice M. (2007, April – June). Epidemiology of depression and its treatment in the general population. Journal of Psychiatry Research, 41(3-4), 207-213.
Windle, Michael; & Windle, Rebecca C. (2001). Depressive symptoms and cigarette smoking among middle adolescents: Prospective association and intrapersonal and interpersonal influences. Journals of Consulting and Clinical Psychology, 69, 215 – 226.
Wu, Li-Tzy & Anthony, James C. (1999). Tobacco smoking and depressed mood in late childhood and early adolescence. American Journal of Public Health, 89, 1837-1840.
Corvin, Aiden; O'Mahony, Ed; O'Regan, Myra; Comerford, Claire; O'Connel; Craddock, Nick; & Gill, Michael. (2001). Cigarette smoking and psychotic symptom in bipolar affective disorder. British Journal of Psychiatry, 179, 35-38.
McCabe, Randi E. ; Chudzik, Susan M.; Antony, Martin M.; Young, Lisa; Swinson, Richard P.; & Zolvensky, Michael J. (2004). Smoking behaviors across disorders, Anxiety Disorders, 18, 7-18.
Kelly, Ciara; & McCreadie, Robin (1999). Smoking habits, current symptoms, and premorbids characteristics of schizophrenia patient in Nithsdale, Scotland. American Journal of Psychiatry, 156, 1751-1757.

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