Tobacco use and impulsivity in people with mental illness: A systematic review

Impulsivity is a risk factor for the development and maintenance of tobacco use, especially among individuals with comorbid mental illness, but the nature of this relationship is poorly understood. We systematically examined evidence for the relationship between impulsivity and tobacco use in people with psychiatric disorders.

Following PRISMA guidelines, original peer-reviewed articles published from database inception to July 2024 were searched for using PubMed, Google Scholar, ProQuest, Ovid, and PsycINFO.

Of 1192 articles identified, 16 met the inclusion criteria. There was consistent evidence of a positive relationship between tobacco use and impulsivity in schizophrenia (SZ), major depressive disorder (MDD) and bipolar disorder (BD). However, the majority of studies were cross-sectional studies, preventing causal inferences.

Tobacco smoking is robustly associated with impulsivity in people with SZ, MDD, and BD, although causal conclusions cannot be drawn due to methodological limitations of the current literature. Future prospective and experimental studies are needed to ascertain whether impulsivity is a risk factor for smoking, how tobacco use affects impulsivity, and whether impulsivity may be a treatment target for smoking cessation.

To our knowledge, this article is the first comprehensive review of literature, specifically examining the relationship of tobacco smoking and impulsivity among individuals with psychiatric disorders. By highlighting this understudied intersection, our findings provide novel insights into the relationship between smoking behaviors and impulsivity in individuals with mental illness, contributing to more effective treatment strategies and emphasizing the need for tailored interventions to address these co-morbidities.