Mental illness: South Africa’s blind spot

Abstract

Mental illness: South Africa's blind spotTo the Editor: The articles by Odendaal et al. [1] and Pillay-van Wyk et al. [2] indicate poor recognition of mental illness and its complex interplay with physical health in South African (SA) research. While Odendaal et al. [1] screened for depression in pregnant women, the relationship between mental illness and persistent smoking was not explored and the possible need to tailor interventions to perceptual, cognitive or personality functioning was not discussed. Pillay-van Wyk et al. [2] include mental illness among 'other' comorbidities in COVID-19 deaths, but do not mention substance use. Furthermore, they do not discuss the low prevalence of these comorbidities among COVID-19 deaths, although it is an unexpected finding given the excess mortality associated with mental disorders. [3] In pregnancy, mental disorders are associated with preterm delivery, low birth weight, hypertension, gestational diabetes and neonatal morbidity. [4][5][6] The extent to which these outcomes are mediated by smoking and/or social deprivation is unknown. Smoking is more prevalent among people with mental illness (PWMI) than in the general population, with more intense addiction and reduced response to population-level interventions. [7,8] Mental illness is also associated with social deprivation. The association between persistent smoking and social deprivation found by Odendaal et al. [1] is similar to that found in Canada among PWMI, [9] and is consistent with the well-documented mental health/poverty cycle [10] (related to social exclusion as well as social and/or occupational impairment).While mental healthcare may improve socioeconomic outcomes among PWMI, [10] it alone does not reduce smoking. Neither does education. However, behavioural and pharmacological interventions may. Prochaska et al. [8] discuss the application of the Host-Agent-Vector-Environment (HAVE) public health model to smoking cessation among PWMI. The four domains of this application are: • 'Host -tobacco user characteristics (e.g. biobehavioural, social/ cognitive, mental health). • Agent -tobacco product characteristics (e.g. nicotine content, delivery, flavourings). • Vector -tobacco industry efforts (e.g. research, develop ment, advertising, distribution). • Environment -broader community and policy structures (e.g. taxation, smoking bans, insurance coverage, retailers). ' [8] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Smoking cessation among people with mental illness: A South African perspective

“…Both mental illness and smoking are associated with deprivation, further perpetuating the mental health–poverty cycle. 39 , 40 …”

“…International commentaries argue that PWMI who smoke should be a priority group when it comes to scientific funding and treatment resources. 40 Despite the robust associations between smoking and mental illness, PWMI have a motivation to quit smoking that is comparable to the general population. 49 If motivation is lacking, motivational interviewing can initiate the cycle of change.…”