Czech Republic: Proportion of smokers with mental health problems increases

A cohort study shows that the proportion of smokers with mental health problems attending a smoking cessation center in Prague has increased by 4% per year since 2011, with women being more affected. Quitting smoking leads to an improvement in their mental health.

Various studies have shown that people with mental health problems are more likely to smoke than the general population, smoke more cigarettes per day, and have a greater nicotine addiction; they have more difficulty maintaining smoking cessation over time, and over the years, their number decreases less rapidly than that of other smokers.

A team of Czech researchers has been studying the characteristics of this population of smokers among the patients at the Tobacco Addiction Treatment Centre at the University General Hospital in Prague since its establishment in 2005.[1].

A study of all patients in a smoking cessation center

Data from 2005, 2020, and 2021 were not included because they were considered atypical, as were data from smokers whose data were incomplete. In total, from the 7,498 available records, the population selected for analysis was 6,546 smokers.

At their initial consultation, the Beck Depression Inventory (BDI-II) questionnaire was administered to each smoker, and 1743 of them (26.6 %) self-reported a mental disorder (anxiety, depression, bipolar disorder, schizophrenia), present or past.

A preponderance of mental disorders in women

While 48% of patients consulting the Prague CTDT were women and 52% were men, the existence of mental disorders was reported by 34.2% of women and 19.6% of men. In total, among those reporting mental disorders, 62% were women and 38% were men, suggesting that female smokers are more prone to mental disorders. The proportion of smokers reporting mental disorders increased from 23% in 2006 to 35% in 2019, with an annual increase of approximately 4% since 2011.

In the Czech population, the overall smoking prevalence decreased from 31.1% in 2004 to 24.1% in 2021, and the prevalence of mental disorders was estimated at 29.6% in 2020, with a significant increase following the first lockdown, compared to 2017 (20.1% in 2017).[2]. Thus, the rate of people with mental health problems was higher among smokers consulting at this center than in the general population.

The researchers found no difference between smokers with and without mental health problems in the number of cigarettes smoked per day and in exhaled carbon monoxide (CO) levels. However, patients reporting mental health problems had higher scores on the Fagerström test, which measures smoking dependence.

A clear improvement in depressive states was observed in depressed smokers who had stopped and maintained their abstinence for one year.

Consider systematizing tobacco treatment

Given the increase in the number of smokers reporting mental health problems, and given the effectiveness of quitting smoking for some of them, the authors of the study conclude that it is necessary not to neglect the requests of these smokers and to offer them appropriate and more intensive care. They also suggest, following the example of a study by the French Observatory of Drugs and Addictive Trends (OFDT) on smoking cessation strategies (Tabatraj)[3], to more systematically include tobacco management in psychiatric care.

Keywords: Czech Republic, smoking cessation, mental disorders, prevalence.

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[1] Zvolska, K., Tichopad, A., Stepankova, L. et al. Increasing prevalence of mental disorders in smokers seeking treatment of tobacco dependence: a retrospective observational study. BMC Psychiatry, 23, 621 (2023). https://doi.org/10.1186/s12888-023-05115-x

[2] Winkler P, Formanek T, Mlada K, Kagstrom A, Mohrova Z, Mohr P, Csemy L. Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys. Epidemiol Psychiatr Sci. 2020 Sep 29;29:e173. doi:10.1017/S2045796020000888. PMID: 32988427; PMCID: PMC7573458.

[3] Rivierez I, Quitting smoking: a review of the social science literature, OFDT, report, July 2023, 40 p.