Psychiatric disorders and stages of smoking

Background: We examined the role of DSM-III-R psychiatric disorders in predicting the subsequent onset of daily smoking, smokers' progression to nicotine dependence, and the persistence of smoking. Methods: The Tobacco Supplement of the National Comorbidity Survey was administered to a representative subsample of 4414 persons 15-54 years of age. DSM-III-R psychiatric disorders and information on age of onset of psychiatric disorders, daily smoking, and smoking cessation were ascertained with the World Health Organization's Composite International Diagnostic Interview. Results. Preexisting psychiatric disorders that have not remitted (i.e., active disorders) predicted an increased risk for the first onset of daily smoking and for smokers' progression to nicotine dependence. The increased risk applied across most of the disorders examined in the study, including major depression, anxiety disorders, and substance use disorders. Persons with four or more active disorders were at higher risk for daily smoking (2.1 vs. 1.4) and for nicotine dependence (2.9 vs. 1.4) than were persons with one active disorder. With few exceptions, remitted (i.e., past) disorders did not predict the subsequent onset of daily smoking. Preexisting psychiatric disorders did not influence smokers' potential for quitting; the persistence of smoking in the year preceding the interview was unrelated to history of psychiatric disorders. Conclusions. The results suggest the possibility of additional and previously unrecognized public health benefits of early treatment of mental disorders, in that persons with various mental disorders whose illness bad remitted were not at increased risk for daily smoking, in contrast with persons with active disorders. (C) 2004 Society of Biological Psychiatry.