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Tailored Program Might Help Some With Severe Mental Illness Quit Smoking

April 18, 2019

By Anne Harding

NEW YORK—A smoking-cessation program tailored to people with schizophrenia and bipolar disorder may help some quit, new findings show.

"It doesn't disrupt their mental health. In fact we know from research that the opposite is true. Quitting smoking is really good for your mental health," Dr. Simon Gilbody of the Mental Health and Addictions Research Group at the University of York, in the U.K., told Reuters Health by phone.

Smoking is much more prevalent among people with severe mental illness, who also start smoking earlier and smoke more heavily than people in the general population, Dr. Gilbody and his team note in The Lancet Psychiatry, online April 10.

One factor holding back smoking-cessation efforts for these individuals could be that "smoking is part of the culture of mental health services, both among staff and patients," the authors add, while clinicians have also feared that trying to quit could worsen patients' mental health.

The smoking cessation for people with severe mental illness (SCIMITAR+) trial enrolled 526 patients with schizophrenia, bipolar disorder or schizoaffective disorder who smoked at least five cigarettes a day from 16 primary care sites and 21 community-based mental health sites in the U.K.

The participants were randomly assigned to an individually tailored intervention, which included support from a mental-health smoking-cessation practitioner, pharmacological smoking-cessation aids, extended pre-quit sessions, the option of cutting down to quit, and home visits, or usual care. The usual-care group received standard smoking cessation services available locally that were not tailored to people with mental illness.

Based on carbon monoxide testing and self-report, at six months 14% of those in the intervention group were abstinent from cigarettes, versus 6% of the control group, a significant difference.

At 12 months, 15% of the intervention group had quit versus 10% of the control group, but the difference was no longer statistically significant.

"We visited people in their own homes. It was also delivered by people who had a sense of what the particular challenges are of living on a day-to-day basis" with severe mental illness, Dr. Gilbody said.

He noted that the tailored program is "just a small tweak" to smoking-cessation programs designed for the general population. "We think this could form the basis for service delivery at scale for this neglected sector of the population."

Dr. Debbie Robson and Dr. Ann McNeill of King's College London wrote a commentary accompanying the new study. "Very few community mental-health services currently provide smoking-cessation treatment, which is why the Scimitar+ study's findings are so important," Dr. Robson, a mental health nurse and tobacco addiction researcher, told Reuters Health by email.

"Our national network of stop-smoking services have always offered support to people with a mental-health condition, but most services expect patients to go to them," she added, "whereas in Scimitar+ most of the support was delivered in patients' own homes. This obviously makes support more accessible and is likely to be more acceptable to patients."

"We need to make it as easy as possible for people with a mental-health condition to give up smoking. We also need to be flexible about how long we support people in their quit attempt and celebrate every small success in their smoke-free journey," Dr. Robson said. "Most of all, we need to have faith in our patients' ability to achieve something that we may personally believe is impossible!"


Lancet Psychiatry 2019.

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