Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres A study on tobacco use in women with major mental illnesses- schizophrenia, bipolar disorder and recurrent depression Bhupendra Khobragade 1 , Vikas Sharma 1 , Smita N. Deshpande ⁎ Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS Dr. Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001 ARTICLE INFO Keywords: Women Tobacco use Schizophrenia Bipolar disorder Recurrent depression ABSTRACT About 14.2% of women in the general Indian population and 4.8% in Delhi use tobacco but its use among women with Major Mental Illness (MMI) in developing countries has not been adequately studied. We assessed tobacco use in women with MMI in a tertiary care psychiatry outpatient department through a cross-sectional, observational study, with sample size of at least n= 77 each for schizophrenia-SZ, bipolar disorder-BD and Recurrent Depressive Disorder-RDD. Fagerstrom Test for Nicotine Dependence (FTND) both for smoke and smokeless tobacco were applied along with a subset of questions from Global Adult Tobacco Survey 2016. After diagnosis and referral by the treating psychiatrist and written informed consent, in our total sample of 321 women participants, lifetime use of tobacco was reported by 14.64%. Of all those who had ever used tobacco, 12.14% used it currently as well. As for diagnosis, those with BD (16.25%) used tobacco most frequently fol- lowed by SZ (14.18%) and RDD (6%). The FTND score was higher for schizophrenia indicating greater de- pendence. Tobacco use among women with MMI was thrice as common as women in general population of Delhi State, with smoke and smokeless tobacco use being equally prevalent, a grave cause for concern and inter- vention. 1. Introduction Tobacco is the most commonly used drug in the world and one of the most important preventable causes of mortality and morbidity (Ramakrishna et al., 2005, Prasad and Dhar, 2017). About 42.4% of Indian men, 14.2% of Indian women and a total of 28.6% (266.8 million) of all Indian adults use tobacco (both smoked and/or smokeless) (Tata Institute of Social Sciences 2016-17). At present, more than 250 million women smoke tobacco all over the world and the number is expected to rise annually (Fact Sheets World Health Organization, 2014; World Health Organization, 2014). The prevalence of smoking in males is expected to decrease, but will be counterbalanced by the increase in female smoking, especially in de- veloping countries, with aggressive marketing from companies and lack of health awareness in the population (Chadda and Sengupta, 2002). An analysis on smoking trends among Indian women indicated a significant rise in tobacco use from 1993 to 2009 (Goel et al., 2014). More than 11 million Indian women aged 15-69 smoke tobacco (Mishra et al., 2016). While smoking tobacco is more common, the use of smokeless tobacco (SLT) is also prevalent in low- and middle-income countries (LMIC) (Gupta and Ray, 2003). Smoking is the most common substance use disorder in patients with major mental illnesses (Srinivasan and Thara, 2002). Compared to the general population, smoking rates are 2-5 times higher in patients with Schizophrenia, Mood disorders, Anxiety disorders, Attention Def- icit Hyperactivity Disorder (ADHD) and Substance Use Disorders (Boksa, 2017) with fewer willing to quit (Pal and Balhara, 2016). Schizophrenia might be most strongly associated with tobacco use (LLerena et al., 2003), whereas depression is a major risk factor for initiation of tobacco smoking (Dierker et al., 2015). Lifetime smoking history in bipolar patients is associated with more severe illness (Ostacher et al., 2006). Since lifetime rates of mood and anxiety dis- orders are significantly higher among women than men (Conway et al., 2006), women may be at higher risk for tobacco use, abuse and de- pendence than men. Women are at higher risk of earlier development (‘telescoping’) of medical, psychiatric, and social complications of drug addiction than men (McHugh et al., 2014). But literature on tobacco use by women with mental illness is sparse. We undertook a cross sectional study of consecutive, community dwelling women with MMI presenting to our outpatients for the first time to bridge this gap. Based on literature, we https://doi.org/10.1016/j.psychres.2020.113121 Received 8 April 2020; Received in revised form 21 May 2020; Accepted 22 May 2020 ⁎ Corresponding author. E-mail address: smitadeshp@gmail.com (S.N. Deshpande). 1 Joint first author. Psychiatry Research 290 (2020) 113121 Available online 28 May 2020 0165-1781/ © 2020 Elsevier B.V. All rights reserved. T