Smoking and drinking among patients with mental disorders: Evidence from a nationally representative Japanese survey

Abstract

Background: No studies to date have addressed the association of mental disorder with smoking and drinking behaviors independent of anxiety and depressive symptoms. We therefore examined this association, stratified by age and sex, to determine the target population for behavioral modification in Japan.

Methods: We analyzed data from participants aged 20-79 years without hospitalized or institutionalized status who participated in the nationwide Comprehensive Survey of Living Conditions conducted in 2016. Prevalence ratios (PRs) for current smoking, heavy daily smoking (>20 cigarettes per day), at-risk drinking (>100 g alcohol per week), and heavy drinking (>350 g) were calculated with adjustment for potential confounders. After stratification by age (20-39, 40-64, and 65-79 years) and sex, prevalence and PRs were calculated using propensity scores.

Results: From among 340,194 participants, 8275 (2.4%) had mental disorder. Presence of mental disorder was significantly associated with current smoking (PR=1.18, 95%CI=1.12-1.23) and heavy daily smoking (PR=1.35, 95%CI=1.21-1.50) and inversely associated with at-risk drinking (PR=0.70, 95%CI=0.66-0.75). PRs for smoking behavior were higher in women than in men and in younger adults than in the other age groups. They were particularly high in younger women (PR=1.67 for current smokers and PR=2.17 for heavy daily smokers).

Limitations: Our findings were obtained from a cross-sectional study.

Conclusion: This is the first evidence that the association of mental disorder with smoking behavior is independent of anxiety and depressive symptoms. Our results indicate the need for tailored behavioral modification interventions for young people with mental disorders in Japan, particularly young women.

Keywords: Alcohol; Anxiety and depressive symptoms; Drinking; Mental disorders; Smoking; Tobacco.