The report is based on information from the National Survey on Drug Use and Health, which interviewed 138,000 adults in their homes from 2009 to 2011. People were asked 14 questions to assess psychological distress and disability, and were deemed to have mental illness if their responses indicated they had a mental, behavior or emotional disorder in the past 12 months. Those with substance abuse or developmental disorders were not considered people with mental illness. The report did not include patients in psychiatric hospitals or individuals serving in the military.

People who reported smoking all or part of a cigarette in the previous 30 days were counted as smokers.

The study found that smoking rates for people with mental illness were generally higher in states where overall smoking rates were high. Utah had the lowest rate of smoking among people with mental illness — 18.1 percent — while West Virginia had the highest rate, at 48.7 percent. Smoking among people with mental illness was higher among the poor and less educated, and among American Indians and Alaska Natives, although every ethnic group had significant percentages of smokers.

The study noted several possible reasons that smoking among the mentally ill has been and remains high, including marketing by the tobacco industry and the historical use of cigarettes as an incentive to improve behavior in psychiatric hospitals.

“There are some effects of nicotine which can mask some of the negative effects of mental illness,” Dr. Frieden said. The study said that smoking can also make some medications less effective, which may then lead the person with mental illness to smoke more to quell symptoms. And it said that people with mental illness, many of whom struggle to live a financially and socially stable life, may be less able to cope with withdrawal symptoms from quitting cigarettes.