Abstract
BackgroundPeople with severe mental ill health are more likely to smoke than those in the general population. It is therefore important that effective smoking cessation strategies are used to help people with severe mental ill health to stop smoking. This study aims to assess the effectiveness and cost –effectiveness of smoking cessation and reduction strategies in adults with severe mental ill health in both inpatient and outpatient settings.MethodsThis is an update of a previous systematic review. Electronic databases were searched during September 2016 for randomised controlled trials comparing smoking cessation interventions to each other, usual care, or placebo. Data was extracted on biochemically-verified, self-reported smoking cessation (primary outcome), as well as on smoking reduction, body weight, psychiatric symptom, and adverse events (secondary outcomes).ResultsWe included 26 trials of pharmacological and/or behavioural interventions. Eight trials comparing bupropion to placebo were pooled showing that bupropion improved quit rates significantly in the medium and long term but not the short term (short term RR = 6.42 95% CI 0.82–50.07; medium term RR = 2.93 95% CI 1.61–5.34; long term RR = 3.04 95% CI 1.10–8.42). Five trials comparing varenicline to placebo showed that that the addition of varenicline improved quit rates significantly in the medium term (RR = 4.13 95% CI 1.36–12.53). The results from five trials of specialised smoking cessation programmes were pooled and showed no evidence of benefit in the medium (RR = 1.32 95% CI 0.85–2.06) or long term (RR = 1.33 95% CI 0.85–2.08). There was insufficient data to allowing pooling for all time points for varenicline and trials of specialist smoking cessation programmes. Trials suggest few adverse events although safety data were not always reported. Only one pilot study reported cost effectiveness data.ConclusionsBupropion and varenicline, which have been shown to be effective in the general population, also work for people with severe mental ill health and their use in patients with stable psychiatric conditions. Despite good evidence for the effectiveness of smoking cessation interventions for people with severe mental ill health, the percentage of people with severe mental ill health who smoke remains higher than that for the general population.
Highlights
People with severe mental ill health are more likely to smoke than those in the general population
Inclusion criteria Types of studies Randomised controlled trials (RCTs), including clusterrandomised controlled trials, that assess the effects of smoking cessation and reduction interventions in people with severe mental ill health were included
An electronic search strategy based on that used in our previous review, combining search terms for severe mental ill health, smoking cessation and randomised controlled trials, adapted from terms developed by the Cochrane groups for schizophrenia and tobacco addiction was used to search the following database for potentially relevant studies: MEDLINE (PubMed), EMBASE, PsycINFO, CINAHL, Health Management Information Consortium (HMIC) and CENTRAL
Summary
People with severe mental ill health are more likely to smoke than those in the general population. It is important that effective smoking cessation strategies are used to help people with severe mental ill health to stop smoking. This study aims to assess the effectiveness and cost –effectiveness of smoking cessation and reduction strategies in adults with severe mental ill health in both inpatient and outpatient settings. The physical health of people with severe mental ill health (SMI) is poor, with people with a diagnosis of SMI dying 20–25 years earlier than those in the general population [1]. We have decided to update the 2010 review with the additional inclusion of e-cigarettes as a smoking cessation strategy to provide up to date information on the most effective and cost-effective strategies to help people with SMI cut down or quit smoking
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