Anxiety disorders and cigarette smoking: results from the Australian Survey of Mental Health and Wellbeing

Objective: The aim of this study was to describe current and daily smoking rates, and smoking cessation rates in adults with anxiety disorders, by type of disorder, severity, use of services, and time since first onset of symptoms. Method: Data were taken from the 2007 National Survey of Mental Health and Wellbeing, a nationally representative probability sample of 8841 Australian adults aged 16–85 years. The survey assessed symptoms of mental disorders including anxiety disorders using a fully structured interview, the Composite International Diagnostic Interview (CIDI) Version 3.0. Results: More than one-fifth of Australian adult smokers had 12-month anxiety disorders. Smoking rates increased with illness severity, but even in those with mild anxiety disorders the smoking rate was double that of adults with no lifetime history of mental disorders. In the majority of adults with anxiety disorders the first onset of symptoms was 10 or more years prior to the survey. Median duration of daily smoking was 22 years in adults with anxiety disorders (95% CI: 20–26 years) compared with 14 years for adults with no lifetime history of mental disorder (95% CI: 12–16 years). Adult smokers with anxiety disorders were significantly less likely to cease daily smoking (hazard ratio 0.57; 95% CI: 0.49–0.69). Conclusions: People with anxiety disorders are over-represented among smokers, are less likely to cease daily smoking and on average smoke for longer exposing them to greater risk of tobacco-related harm. The small proportion of adults with anxiety disorders who access services, and the small differences in smoking and smoking cessation rates between service users and non-users suggest that targeted population-based rather than service-based anti-smoking strategies are required to reach this vulnerable population group, who represent a significant proportion of Australia's daily smokers.