Abstract
Background: People living with schizophrenia are less likely to quit smoking compared with the general population and people living with other psychiatric disorders. Understanding the schizophrenia-specific psychosocial barriers and facilitators to smoking cessation is important for designing effective smoking cessation interventions. We aimed to systematically review research examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia.Methods: We followed the PRISMA statement to conduct a systematic literature review examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia. We searched EMBASE, Medline, PsycINFO, and CINAHL databases from inception to 14 June 2018 to identify relevant articles. We included peer-reviewed original research articles that examined psychosocial barriers and facilitators to smoking cessation, as well as factors associated with maintenance of smoking habits in people living with schizophrenia spectrum disorders. Qualitative, quantitative, or mixed-methods study designs were included. Three authors screened titles, abstracts, and full-texts using the eligibility criteria. We conducted a narrative synthesis of the data to account for the heterogeneity of study designs. We analyzed qualitative and quantitative studies separately.Results: We identified 685 studies from our systematic search and screened the full-text of 134 articles. The final set of 23 articles included 20 quantitative studies and 3 qualitative studies. The most commonly cited barrier to smoking cessation in people living with schizophrenia was cravings and addiction, followed by a perceived increased risk of negative affect associated with quitting smoking. People living with schizophrenia reported smoking to manage stress and to maintain social relationships. People living with schizophrenia were found to be less likely to receive cessation support from health professionals than smokers without schizophrenia. Health concerns were the most commonly mentioned facilitator to quit smoking.Conclusions: People living with schizophrenia experience a wide range of barriers to smoking cessation. The influence of these barriers on smoking cessation likelihood may be greater among people living with schizophrenia than people without psychiatric disorders. Health professionals play an important role in smoking cessation for people living with schizophrenia and should consider barriers and facilitators identified in this review to support quitting in this vulnerable population.
Highlights
65% of people living with schizophrenia smoke cigarettes [1, 2]
People living with schizophrenia are significantly less likely to quit smoking compared with the general population and those living with other psychiatric disorders, such as bipolar disorder and depression [1]
We systematically reviewed original research examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia
Summary
People living with schizophrenia are significantly less likely to quit smoking compared with the general population and those living with other psychiatric disorders, such as bipolar disorder and depression [1]. Given the elevated prevalence of tobacco smoking and low cessation rates, people living with schizophrenia are at higher risk of developing smokingrelated malignancies, cardiovascular disease, and respiratory disease and are more likely to experience premature mortality than the general population [3]. Pharmacological smoking cessation interventions appear to be appropriate for people living with schizophrenia, the percentage of successful quitters is reportedly small, between 12 and 19% [7]. We aimed to systematically review research examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia
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