TUESDAY, Nov. 21 (HealthScout) -- The more you smoke, the more likely you are to have an emotional disorder, says a new study.

The researchers say people with mental disorders smoke almost half the cigarettes sold in this country. The finding doesn't prove that smoking leads to mental illness, or the other way around, but the researchers say doctors should look for signs of emotional distress in patients who use tobacco. "It's just a very strong relationship, but we couldn't determine causality," says lead study author Dr. Karen Lasser, a research fellow at Harvard Medical School. The study appears in the Nov. 22/29 Journal of the American Medical Association. "Not all smokers have a mental illness," but Lasser says the study showed that nine in 10 people who smoke more than 24 cigarettes a day suffer depression, panic attacks, phobias or other emotional problems. Other studies have looked at the link between smoking and mental illness in select groups of patients, such as those in psychiatric homes. The latest work is the first to describe the connection in a large number of people chosen at random from the general population, Lasser says. Lasser and her colleagues looked at data on more than 4,400 subjects, ages 15 to 54, from a national health survey conducted between 1991 and 1992. The study defined mental illness broadly and included: major depression, bipolar disorder, dysthymia, panic disorder, agoraphobia, social phobia, simple phobia, generalized anxiety disorder, drug or alcohol abuse or dependence and antisocial personality. It also included nonaffective psychosis, which covers schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder and atypical psychosis. Can kick the habit More than a third of people with a history of mental illness -- and nearly 42 percent of those who'd had such a condition in the month before the survey -- were smokers. Overall, people who said they had emotional troubles in the month before the survey were 2.7 times more likely than nonsmokers to also have a diagnosable mental illness, the study found. What's more, this group smoked 44.3 percent of the cigarettes used by subjects in the study. "We estimate that persons with a diagnosable mental disorder in the past month consume nearly half of all cigarettes smoked in the United States," the authors write. The good news, Lasser says, is that smokers with a history of mental problems can kick the habit, though at slightly lower rates than those without the disorders (37 percent vs. 42 percent). Unfortunately, she says many doctors behave as if mentally ill smokers somehow depend on cigarettes to keep from getting worse. "This study should encourage [doctors] to encourage their patients with mental illness to try and quit smoking," Lasser says. Even so, people with some mental problems find quitting more difficult. Subjects who had schizophrenics in the month before the study had a 0 percent quit rate. And those with manic depression -- more than 80 percent of whom smoked at some point in their lives -- had a quit rate below 17 percent. The researchers didn't look at whether treating smokers' emotional problems helps them stop using tobacco, but Lasser says there's good reason to think it might. After all, she says the popular antismoking drug Zyban is an antidepressant. "Treating the underlying illness is important, but that doesn't necessarily seem to enhance their ability to quit as much as you would hope. It's not a one-to-one relationship," says Dr. Gregory Dalack, chief of psychiatry at the Department of Veterans Affairs (VA) Health Care System in Ann Arbor, Mich., and a smoking expert at the University of Michigan. Cigarette companies may be exploiting the tie between smoking and shaky mental health, says Lasser, citing marketing documents from the R. J. Reynolds Co. which show that company executives are aware that people use its products to lift their mood and get "positive stimulation." "I think that tobacco companies have targeted their marketing" efforts at the psychologically vulnerable, Lasser says. "It makes perfect sense," says Dr. Kenneth Warner, a tobacco expert at the University of Michigan, who notes that research has hinted that alcohol makers appear to pitch liquor to those most likely to drink heavily. R. J. Reynolds did not return calls for comment. What To Do For more on smoking research, check the University of Michigan Tobacco Research Network. To learn more about the health effects of smoking, try Tobacco.org or the Centers for Disease Control and Prevention. For information about how to quit smoking, check the National Cancer Institute.

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