Population-based prevalence of smoking in psychiatric inpatients: a focus on acute suicide risk and major diagnostic groups

Objective: The aim of the study was to define the extent of current and lifetime smoking by diagnostic groups and suicide risk as reason for admission in a geographically defined psychiatric inpatient cohort. Design: The study used a population-based retrospective chart review. Methods: Smoking status and discharge diagnoses for Olmsted County, Minnesota, inpatients aged 18 to 65 admitted for psychiatric hospitalization in 2004 and 2005 were abstracted from the electronic medical record. Diagnostic groups were compared to each other using χ² tests and Fisher exact test to analyze smoking status within the inpatient sample with significance defined as P ≤ .05. Results: Eighty percent (80.41) of our sample of 776 patients was hospitalized due to acute suicide risk. Discharge diagnostic group composition included affective disorders (80.3%), substance abuse disorders (36.1%), anxiety disorders (19%), psychotic disorders (16.4%), and personality disorders (10.3%). Of the sample, 72.2% had at least one comorbid disorder. Of the 776 patients, 356 (45.9%) were current smokers. Substance abuse and psychotic disorder diagnoses were significantly correlated with current smoking status (<.0001, .02) with 77.1% and 55.9%, respectively, being current smokers compared to other psychiatric inpatient groups. All diagnostic groups smoked at higher rates and had less success stopping than the US general population. Conclusion: Our findings clearly demonstrate stratification of current smoking and quit rates in psychiatric inpatient' diagnostic groups vs the US general population and Minnesota. Further research into the association between suicide risk, smoking, and mortality in the seriously mentally ill is necessary. Recognizing and addressing smoking in psychiatric patients in both hospital and outpatient settings is critical to addressing survival differences compared to the general population.