Smoking appears to be playing a very significant role in the fact that people diagnosed with mental illnesses have much shorter life spans, according to a study in New Jersey prisons published in Psychiatric Services in Advance. However, for reasons the researchers couldn’t explain, prison smoking bans reduced mortality rates among inmates diagnosed with mental illnesses but not among other inmates.
Between 2009 and 2011, the New Jersey Department of Corrections (NJDOC) began employing methods to proactively reduce smoking, and in 2012 made a decision to become “tobacco free” throughout the facility.
Rutgers University and correctional facility health care staff found that mortality rates did not change for most inmates, but dropped 48% among those inmates diagnosed as having “special mental health needs or mental illnesses.” The numbers of deaths in the NJDOC system for these special needs groups had regularly been in the twenties annually, but dropped to 11 people by 2013.
The researchers conducted a “bootstrap” analysis that found a significant association between these mortality rates and reductions in smoking in the special needs group, but found no such association in the non-special needs group. The researchers could not identify why the mortality decreases in the two groups would be so different, and suggested that those with mental illnesses had had higher, more dangerous tobacco use rates to begin with.
“This striking correlation of quick and substantial reduction of mortality among individuals with a mental illness in association with the reduction and subsequent ban of smoking suggests that smoking may play a major role in the reduced life span of persons with mental illness,” they concluded.
Smoking is also known to stimulate enzymes that metabolize some common psychiatric medications, and many practice guidelines therefore recommend that prescribers reduce medication dosage levels if patients are quitting smoking. In the NJDOC study, the researchers did not gather data about any possible concomitant reductions in the prisoners’ psychiatric medication dosages.
Dickert, Jeff, Jill M. Williams, Rusty Reeves, Michael Gara, and Lisa DeBilio. “Decreased Mortality Rates of Inmates With Mental Illness After a Tobacco-Free Prison Policy.” Psychiatric Services, May 15, 2015, appi.ps.201400429. doi:10.1176/appi.ps.201400429. (Abstract)
Study Finds New Jersey Correctional System’s Tobacco Ban Associated With Dramatic Drop in Mortality Among Mentally Ill (Psychiatric News Alert, June 2, 2015)
Kroon, Lisa A. “Drug Interactions with Smoking.” American Journal of Health-System Pharmacy 64, no. 18 (September 15, 2007): 1917–21. doi:10.2146/ajhp060414. (Abstract)
Lucas, Catherine and Jennifer Martin. “Smoking and drug interactions.” Australian Prescriber. 102, V. 36, No.3 (June 2013) (Full text)
Medication interactions with smoking and smoking cessation (New South Wales Government Health website, 2012)