Smoking and quitting behaviours by mental health conditions in Great Britain (1993–2014)

Smoking is a major contributor to the disparity in life expectancy between those with and without a mental health condition. Previous work has found associations between individual conditions such as depression and current smoking, cigarette consumption and dependence, but did not compare a range of specific mental disorders. Using data from the nationally-representative Adult Psychiatric Morbidity Survey, we characterised trends in smoking prevalence in the general population in Great Britain and among those with and without mental health conditions for the period 1993–2014. We tested associations across different common mental health conditions (including depression, phobia, generalised anxiety and mixed anxiety and depression), in addition to personality conditions, and heaviness of smoking, desire to quit, perceived difficulty of remaining abstinent and successful cessation within the previous 12 months. Smoking prevalence among those without any mental health condition decreased from 29.3% in 1993 to 19.6% in 2014. Prevalence was higher among those with a condition but fell from 44.6% to 34.1%. Having a mental health condition was associated with current smoking, heavy smoking, difficulty remaining abstinent, desire to quit and perceived difficulty remaining abstinent. The same was found for all conditions individually but the strength and significance of the associations varied. Having any common mental health condition was associated with lower odds of smoking cessation—but not after adjustment for heavy smoking. We found no significant associations between individual conditions and cessation outcomes, however. In summary, smoking prevalence among people with common mental health conditions remained around 50% higher than among those without despite their higher desire to quit. Adequately addressing higher dependence could support cessation and contribute to narrowing health disparities.