Abstract
BackgroundPeople with depression/anxiety are twice as likely to smoke and are less responsive to standard tobacco treatments, leading to a reduced life expectancy of up to 13.6 years compared to people without depression/anxiety. However, this group of smokers is motivated to quit, and as a result of quitting smoking, their depression/anxiety is likely to improve. In England, people with depression/anxiety are referred to a primary care-based psychological therapies service known as ‘Improving Access to Psychological Therapies’ (IAPT), which could offer smoking cessation treatment as part of usual care but currently does not. In this study, we aim (1) to establish the feasibility and acceptability of delivering a smoking cessation treatment alongside IAPT usual care and (2) to establish the feasibility of a multi-centre randomised trial to compare the combined smoking cessation and IAPT treatment to usual IAPT treatment alone.MethodsA randomised and controlled, multi-centre trial to test the acceptability, feasibility and implementation of smoking cessation treatment as offered alongside usual IAPT care, compared to usual care alone, with nested qualitative methods. We will include adult daily smokers with depression/anxiety, who would like help to quit smoking and are about to start IAPT treatment. Follow-up will be conducted at 3-months after baseline. The main outcome will be retention in the smoking cessation treatment. Secondary outcomes are smoking-related (biochemically-verified 7-day point prevalence smoking cessation, number of cigarettes smoked per day, Heaviness of Smoking Index), mental health-related (PHQ-9), service-related (number of ‘Did Not Attends’, number of planned and completed IAPT sessions), acceptability and feasibility (participant and clinician acceptability and satisfaction of intervention as assessed by questionnaires and qualitative interviews, interviews will also explore acceptability and feasibility of data collection procedures and impact of smoking cessation treatment on usual care and mental health recovery) and implementation-related (intervention delivery checklist, qualitative analysis of intervention delivery).DiscussionIf the intervention is shown to be acceptable, feasible and suitably implemented, we can conduct a randomised controlled trial. In a future trial, we would examine whether adding smoking cessation treatment increases smoking abstinence and improves depression and anxiety more than usual care, which would lead to long-term health improvement.Trial registrationISRCTN99531779
Highlights
People with depression/anxiety are twice as likely to smoke and are less responsive to standard tobacco treatments, leading to a reduced life expectancy of up to 13.6 years compared to people without depression/anxiety
We aim to assess: (1) the feasibility of recruiting and retaining participants, collecting data required for a full-sized randomised controlled trial (RCT), and randomisation procedures; (2) the acceptability of data collection procedures and the smoking cessation treatment as delivered alongside usual Improving Access to Psychological Therapies’ (IAPT) care, as perceived by IAPT therapists and study participants; and (3) implementation of the smoking cessation treatment programme
Differences between National Centre for Smoking Cessation and Training (NCSCT)’s standard treatment programme for smoking cessation and the smoking cessation treatment offered in this study To tailor the smoking cessation treatment to IAPT usual care, we have interviewed psychological wellbeing practitioners’ (PWPs), service managers and service users (NHS National Research Ethics Service review ID:225399. i.e., under write-up) and consulted with current and prospective commissioners for IAPT services
Summary
People with depression/anxiety are twice as likely to smoke and are less responsive to standard tobacco treatments, leading to a reduced life expectancy of up to 13.6 years compared to people without depression/anxiety. In the UK, recent estimates indicate that 33.7% of people with depression, and 28.9% of people with anxiety smoke [7, 8] They are more heavily addicted, suffer from worse withdrawal [9, 10] and experience a 19% reduction in the odds of quitting (odds ratio 0.81, 95% CI 0.67 to 0.97) [10], even though they are motivated to quit [11]. These inequalities contribute to a reduction in life expectancy of up to 13.6 years for people with depression/anxiety compared to the general population [12, 13]
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