Specialised advice on stopping smoking for people with serious mental illness

Review question

Does specialised advice about the benefits of stopping smoking work for people with a serious mental illness such as schizophrenia?

Background

People with serious mental health problems are more likely to smoke and to smoke more heavily than the general population. Around 60% to 70% of people with schizophrenia smoke, whereas around 20% of the general population smoke. People with mental illness may smoke more due to a range of factors. There may be a direct causal link between mental illness and smoking or it may be that smoking helps people deal with the stress of mental illness, or helps with the side effects of medication, such as tiredness, drowsiness, and boredom, or both. However, smoking is very bad for people’s physical health in general and can lead to serious diseases such as cancer. The provision of specific advice from health professionals may help people with serious mental illness to stop smoking.

Study characteristics

The review authors searched for randomised controlled trials up to 2 April 2015 that investigated the effects of providing advice about the effects of smoking and the effects of stopping smoking to people with serious mental illness compared to no advice about stopping smoking.No trials that met the inclusion criteria of this review were found..

Key results

Currently there is no high quality evidence from randomised trials to guide healthcare professionals about how effective giving advice is to help people stop smoking. It is therefore unclear if advice has any effect on helping people with serious mental illness stop smoking.

Quality of the evidence

Good quality Evidence relevant to smokers with serious mental illness is much needed, important. It is possible if a large, high quality trial is undertaken and gathers relevant, high quality evidence on advice to help people stop smoking.

Ben Gray, Senior Peer Researcher, McPin Foundation (http://mcpin.org/).

Authors' conclusions: 

People with serious mental illness are more likely to smoke than the general population. Yet we could not find any high quality evidence to guide the smoking cessation advice healthcare professionals pass onto service users. This is an area where trials are possible and needed.

Read the full abstract...
Background: 

People with a serious mental illness are more likely to smoke more and to be more dependent smokers than the general population. This may be due to a wide range of factors that could include a common aetiology to both smoking and the illness, self medication, smoking to alleviate adverse effects of medications, boredom in the existing environment, or a combination of these factors. It is important to undertake this review to facilitate improvements in both the health and safety of people with serious mental illness who smoke, and to reduce the overall burden of costs (both financial and health) to the smoker and, eventually, to the taxpayer.

Objectives: 

To review the effects of smoking cessation advice for people with serious mental illness.

Search strategy: 

We searched the Cochrane Schizophrenia Group Specialized Trials Register up to 2 April 2015, which is based on regular searches of CENTRAL, BIOSIS, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and trial registries. We also undertook unsystematic searches of a sample of the component databases (BNI, CINHAL, EMBASE, MEDLINE, and PsycINFO), up to 2 April 2015, and searched references of all identified studies

Selection criteria: 

We planned to include all randomised controlled trials (RCTs) that focussed on smoking cessation advice versus standard care or comparing smoking cessation advice with other more focussed methods of delivering care or information.

Data collection and analysis: 

The review authors (PK, AC, and DB) independently screened search results but did not identify any trials that fulfilled the inclusion criteria of this review.

Main results: 

We did not identify any RCTs that evaluated advice regarding smoking cessation for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to smokers with serious mental illness is possible.

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