Research paperPhysical and mental health burden in cases of bipolar disorder classified as current, former, or non-tobacco smokers

•High prevalence of alcohol and substance use disorders in bipolar lifetime smokers.•No gender effect on addictive comorbidity amongst bipolar lifetime smokers.•Former smoking is as an at-risk vascular profile due to increased abdominal obesity.•No association between tobacco smoking and suicide attempts or anxiety disorders.•Preliminary evidence towards increased manic symptoms in current smokers.

BackgroundTobacco smoking increases the global burden of bipolar disorder (BD). We examined markers of physical and mental health that are associated with tobacco smoking, controlling for confounders that have not always been considered in previous studies of BD.MethodsOver 600 individuals with BD I or II referred to the French Network for bipolar disorder (FACE-BD) who completed standardized assessments, and could be reliably classified as current (CS) or former smokers (FS), were compared with those who were never smokers (NS) on: BD symptom load and psychiatric comorbidities; prevalence of alcohol and substance use disorders (ASUD); medication usage; functioning and physical health parameters. The bivariate and multivariate analyses took into account age and gender.Results300 cases (49%) were CS, 78 (13%) FS and 238 (39%) had never smoked. Rates were similar across genders regardless of BD subtype. Compared with NS, CS were more likely to have an ASUD (Odds Ratio (OR) 5.18), BD I (OR 2.09), and lower abdominal obesity (OR 0.97), and FS were more likely to have an ASUD (OR 6.32) and higher abdominal obesity (OR 1.03).LimitationsThe sample comprised of white Europeans; the FS subgroup was relatively small and we did not apply any statistical correction for the bivariate analyses.ConclusionsThe increased risk of physical and mental health burden in CS and FS compared to NS represents avoidable morbidity in BD. This study offers support to the argument that individuals with BD should be routinely offered support to prevent or stop tobacco smoking.