Research indicates that better smoking cessation programs are needed for those living with severe mental illness

By: Caine Meyers

The most recent report by the Royal College of Psychiatrists (RCP) on smoking and mental health indicated that severe mental illness can increase an individual’s odds of smoking. In fact, people with severe mental illnesses such as schizophrenia are three times more likely to smoke than the general population. Because these individuals are not likely to attend smoking cessation programs, inequality in health is growing. As such, those with severe mental illnesses are more likely to face the life-threatening consequences of smoking. In fact, this group of individuals will die an average of 20-25 years sooner than their non-smoking counterparts.

Indeed, smoking is one of the largest modifiable risk factor when addressing health inequality between those with a severe mental illness and those without (Champion et al., 2014). Therefore, understanding the underlying mechanisms and causes for this, particularly in schizophrenia and bipolar disorder, is compulsory to bettering healthcare and recovery outcomes for these individuals.

Unfortunately, many individuals with or without mental illness believe that smoking relieves depression and anxiety, however, recent evidence has indicated that this is not true (Addington, el-Guebaly, & Addington, 1997; Taylor et al., 2014). In general, regardless of mental illness or not, smoking contributes to poor health outcomes overall. Those with schizophrenia or bipolar disorder are particularly vulnerable to this common misconception given that they may be under the impression that smoking will alleviate them from some of the symptoms related to having a mental illness.

A recent study by Gilbody and colleagues (2019) sought out to address the ongoing inequality seen in individuals with schizophrenia or bipolar disorder compared to the general population. As part of a collective initiative, they designed a smoking cessation program tailored specifically to people with a severe mental illness. The program was called SCIMITAR+ and included a total of 526 participants. Each participant was required to smoke an average of 5 or more cigarettes per day. Although, it is important to note that intermittent or casual smokers are vulnerable to same health effects as heavy or daily smokers (Schane, Ling, & Glantz, 2011). Those with other substance abuse problems were excluded from the study in order to control for variables.

Each participant wa randomly assigned to a treatment group or a control group. Those in the latter received care as usual, and those assigned to the treatment group were enrolled in the SCIMITAR+ smoking cessation program. This differed from their care as usual in that these individuals received behavioural support from both a mental health smoking cessation practitioner and pharmacological aids for smoking cessation. Sessions with these practitioners were adapted for people with severe mental illness, and included home visits, pre-quit sessions, and assistance with cutting down. Further, individuals in the treatment group had access to pharmacotherapy to aid with their smoking cessation. Participants in both groups were monitored over the subsequent twelve months.

During the initial 6-month follow-up, researchers found that significantly more people in the treatment group had quit smoking (14%) compared to the treatment as usual group (6%). This contrast remained after one year with 15% of individuals in the treatment group having quit, compared to 10% of the individuals receiving treatment as usual. However, it was not deemed significant and the effects began to wane. Indeed, there was an increase in overall health in the treatment group at the 6-month follow up compared to their counterparts, however, this difference once again waned at the 12-month follow-up. Gilbody and colleagues (2019) interpreted this as confirmation that the SCIMITAR+ program is effective, but it is only effective in the short-term.

Given these findings, it is evident that more extensive smoking cessation programs are necessary, especially for those living with severe mental illness. The literature surrounding smoking cessation and mental illness is making advances, and researchers and practitioners are becoming better educated (Evins, Cater, & Daumit, 2019).

The government of Canada has many smoking cessation initiatives and resources available. In particular, you may wish to dial “811” from your telephone and speak to a smoking counselor today. In more challenging situations, please do not hesitate to speak to a counselor at Sobriety Home today: 1-877-777-4386. Informed and evidence-based decision-making is our strategy.

References

1. Addington J, el-Guebaly N, Addington D, Hodgins D. Readiness to stop smoking in schizophrenia. Can J Psychiatry. 1997 Feb;42(1):49-52.
2. Campion J, Shiers D, Britton J, Gilbody S, Bradshaw T. Primary care guidance on smoking and mental disorders—update 2014. London: Royal College of General Practitioners and Royal College of Psychiatrists, 2014.
3. Evins AE, Cather C, Daumit GL. Smoking cessation in people with serious mental illness. Lancet Psychiatry. 2019 Apr 10. pii: S2215-0366(19)30139-7. doi: 10.1016/S2215-0366(19)30139-7
4. Royal College of Physicians, Royal College of Psychiatrists. Smoking and mental health. London: Royal College of Physicians, Royal College of Psychiatrists, 2013
5. Šagud M, Vuksan-Ćusa B, Jakšić N, Mihaljević-Peleš A, Rojnić Kuzman M, Pivac N. Smoking in Schizophrenia: an Updated Review. Psychiatr Danub. 2018 Jun;30(Suppl 4):216-223.
6. Schane, R. E., Ling, P. M., & Glantz, S. A. (2010). Health effects of light and intermittent smoking: a review. Circulation, 121(13), 1518–1522. doi:10.1161/CIRCULATIONAHA.109.904235
7. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ 2014; 348: g1151.