A systematic review of behavioural smoking cessation interventions for people with severe mental ill health—what works?

Abstract

Background and Aims: People with severe mental ill health smoke more and suffer greater smoking-related morbidity and mortality. Little is known about the effectiveness of behavioural interventions for smoking cessation in this group. This review evaluated randomized controlled trial evidence to measure the effectiveness of behavioural smoking cessation interventions (both digital and non-digital) in people with severe mental ill health. Design: Systematic review and random-effects meta-analysis. We searched between inception and January 2020 in Medline, EMBASE, PsycINFO, CINAHL, Health Management Information Consortium and CENTRAL databases. Setting and participants: Randomized controlled trials (RCTs) assessing the effects of behavioural smoking cessation and reduction interventions in adults with severe mental ill health, conducted in any country, in either in-patient or community settings and published in English.Measurements: The primary outcome was biochemically verified smoking cessation.Smoking reduction and changes in mental health symptoms and body mass index (BMI) were included as secondary outcomes. Narrative data synthesis and meta-analysis were conducted and the quality of included studies was appraised using the risk of bias 2 (RoB2) tool. Findings: We included 12 individual studies (16 articles) involving 1861 participants. The first meta-analysis (three studies, 921 participants) demonstrated effectiveness of bespoke face-to-face interventions compared with usual care across all time-points [medium-term: relative risk (RR) = 2.29, 95% confidence interval (CI) = 1.38-3.81; long-term: RR = 1.58, 95% CI = 1.09-2.30]. The second (three studies, 275 participants) did not demonstrate any difference in effectiveness of bespoke digital on-line interventions compared with standard digital on-line interventions (medium-term: RR = 0.87, 95% CI = 0.17-4.46). A narrative overview revealed mixed results when comparing bespoke face-to-face interventions with other active interventions. The methodological quality of studies was mixed, with the majority having some concerns mainly around risk of selective reporting. Panagiotis Spanakis and Emily Peckham joint first authors.

Using digital technology to promote physical health in mental healthcare: A sequential mixed‐methods study of clinicians' views

“…Nonetheless, it was widely noted that service users' may face additional barriers to making full use of smartphone apps, due to the limited availability and costs of data/WiFi and apps themselves. Recent UK data suggests even those people with SMI own phones at high rates, but lower digital literacy amongst some individuals may be an often unrecognized barrier (Spanakis et al, 2021). MHCPs suggested that apps recommended for use in mental healthcare services should be free for service users, and ideally usable 'offline' to some extent (without constant requirement for internet access to engage with app features).…”

The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review

“…Some studies tested examined the effects of community-based smoking cessation programmes on smokers with severe mental illness, but none specifically for people with BD ( 87 , 88 ). A variety of psychosocial interventions were examined in these studies, including motivational enhancements, smoking cessation education, cognitive behavioral strategies, and contingency management.…”

“…A variety of psychosocial interventions were examined in these studies, including motivational enhancements, smoking cessation education, cognitive behavioral strategies, and contingency management. Meta-analysis of these studies showed that individually tailored face-to face interventions are superior to standard care for smoking cessation, but comparing bespoke digital on-line interventions vs. standard digital on-line interventions did not demonstrate any difference in effectiveness ( 88 ).…”

Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals With Symptomatic Peripheral Artery Disease: A Scientific Statement From the American Heart Association

“…105 Pharmacological and behavioral interventions, especially if they are combined, for smoking cessation in individuals with mental illness are effective and therefore should be provided to individuals with PAD and mental illness. 106,107 The use of nicotine replacement therapies, including bupropion, nortriptyline, and varenicline, was investigated in a Cochrane systematic review, 108 which showed that these options are effective in smoking cessation in general and that combinations of different medications and with nicotine replacement therapies did not show a superior effect, although the evidence was inconsistent. The risk of adverse effects from smoking cessation treatment did not differ significantly by the type of medication used in individuals with depression, whereas varenicline combined with behavioral health counseling was seen to be more effective in individuals with depression.…”

“…105 Pharmacological and behavioral interventions, especially if they are combined, for smoking cessation in individuals with mental illness are effective and therefore should be provided to individuals with PAD and mental illness. 106,107…”