Abstract
Background: Specific approaches for smokers presenting with psychiatric disorders are scarce, even though the prevalence of smoking does not tend to decline in mental health settings, in contrast with general populations of most western countries. Methods: Inpatient smokers (n=69) in a public mental health hospital participated in a multicomponent motivational intervention based on a temporary 26 h abstinence period. Evaluations, performed 1 week pre-, during and 1 week post-intervention, included cigarette consumption, carbon monoxide level, stage of change, craving, as well as anxiety, depression, well-being and smoking cessation self-efficacy. Results: Carbon monoxide level significantly decreased during the intervention (median 16 to 6 ppm, p<0.001), with 76.8% of participants using nicotine replacement therapy. Craving decreased (MPSS 5 to 4, p=0.01), together with anxiety (STAI-State 47 to 38, p<0.001) and depression (BDI-21 18 to 13, p<0.001), whereas well-being increased (WHO-5 11 to 16, p<0.001). During the proposed 26 h abstinence period, 45.6% of participants successfully abstained from smoking, of which 58.1% subsequently attempted quitting. Ten participants (14.5% of 69) decided to stop smoking even though they had no intention to quit before the program. Self-efficacy for permanent cessation did not change, but self-efficacy for temporary abstinence increased (median 8 at pre- to 9 at post-evaluation, p=0.003). Conclusion: A short multicomponent motivational intervention based on temporary abstinence can be a positive experience for patients with severe psychiatric disorders, contribute to increase self-efficacy and trigger quit attempts. The present study suggests that integration of such a program in mental health care is feasible and wellaccepted.
Highlights
Smoking and poor mental health appear tightly entangled, as smoking prevalence, morbidity and mortality are clearly higher in psychiatric patients than in the general population [1,2]
We developed a tailored intervention, consisting in a short 26 h smoking abstinence period, allowing patients to build up a positive experience and increase self-efficacy towards smoking cessation [12]
We studied central issues related to smoking cessation, such as self-efficacy, motivational changes (TTM) and quit attempts
Summary
Smoking and poor mental health appear tightly entangled, as smoking prevalence, morbidity and mortality are clearly higher in psychiatric patients than in the general population [1,2]. Despite smoke-free policies, mental health settings still face tobacco-related difficulties. Smoking rates decline less among individuals with mental health problems than in the general population [4,5,6]. According to the trans theoretical model (TTM) or stages of change model, a large number of psychiatric patients are “precontemplators” who do not consider stopping [8]. Specific approaches for smokers presenting with psychiatric disorders are scarce, even though the prevalence of smoking does not tend to decline in mental health settings, in contrast with general populations of most western countries
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