The case for routine screening for e-cigarette use in psychiatry

Smoking e-cigarettes, also known as vaping, has become an increasingly common practice in the past decade, with recent estimates of lifetime prevalence of 23% globally.¹ Despite this, the incidence of documentation of e-cigarette use in medical records by clinicians remains relatively low,^2,3 perhaps indicating that e-cigarette use is not routinely screened for or that patients do not inform clinicians about their use.

As smoking e-cigarettes is a relatively new phenomenon, there remains a paucity of literature regarding its adverse effects. However, recent research has demonstrated a host of side-effects, including but not limited to cytotoxicity, oxidative stress and pulmonary injury.⁴ Although the impacts on mental health remain largely unknown, a recent cross-sectional study by Oh et al found a positive correlation between vaping and psychotic experiences in college students in the USA, even after adjusting for marijuana use and the presence of depression or anxiety.⁵ Similarly, a recent scoping review found positive associations between e-cigarette use and depression, suicidal ideation and suicide attempts.⁶ Although these findings do not necessarily suggest a causative relationship, especially acknowledging the significant heterogeneity among e-cigarette devices, these studies do indicate a potential link between e-cigarette use and mental illness.

As such, there may be benefit to routinely screening for e-cigarette use in a standard mental health history. Data derived from health services, as well as individual clinician experiences, can assist in determining the potential risks of this increasingly popular practice moving forward.