Smoking cessation in severe mental illness: what works?
Article first published online: 11 MAY 2010
© 2010 The Authors. Journal compilation © 2010 Society for the Study of Addiction
Volume 105, Issue 7, pages 1176–1189, July 2010
How to Cite
Banham, L. and Gilbody, S. (2010), Smoking cessation in severe mental illness: what works?. Addiction, 105: 1176–1189. doi: 10.1111/j.1360-0443.2010.02946.x
- Issue published online: 8 JUN 2010
- Article first published online: 11 MAY 2010
- Submitted 20 February 2009; initial review completed 27 April 2009; final version accepted 19 January 2010
- Health inequalities;
- severe mental illness;
- smoking cessation;
- systematic review;
- UK smoking ban
Aims The physical health of people with severe mental illness (SMI) is poor. Smoking-related illnesses are a major contributor to excess mortality and morbidity. An up-to-date review of the evidence for smoking cessation interventions in SMI is needed to inform clinical guidelines.
Methods We searched bibliographic databases for relevant studies and independently extracted data. Included studies were randomized controlled trials (RCTs) of smoking cessation or reduction conducted in adult smokers with SMI. Interventions were compared to usual care or placebo. The primary outcome was smoking cessation and secondary outcomes were smoking reduction, change in weight, change in psychiatric symptoms and adverse events.
Results We included eight RCTs of pharmacological and/or psychological interventions. Most cessation interventions showed moderate positive results, some reaching statistical significance. One study compared behavioural support and nicotine replacement therapy (NRT) to usual care and showed a risk ratio (RR) of 2.74 (95% CI 1.10–6.81) for short-term smoking cessation, which was not significant at longer follow-up. We pooled five trials that effectively compared bupropion to placebo giving an RR of 2.77 (95% CI 1.48–5.16), which was comparable to Hughes et al.'s 2009 figures for general population data; RR = 1.69 (95% CI 1.53–1.85). Smoking reduction data were too heterogeneous for meta-analysis, but results were generally positive. Trials suggest few adverse events. All trials recorded psychiatric symptoms and the most significant changes favoured the intervention groups over the control groups.
Conclusions Treating tobacco dependence is effective in patients with SMI. Treatments that work in the general population work for those with severe mental illness and appear approximately equally effective. Treating tobacco dependence in patients with stable psychiatric conditions does not worsen mental state.