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Ferron JC, Brunette MF, Aschbrenner KA, ElSayed MW, Pratt SI. Tobacco, Alcohol, and Drug Use Among Young Adults with Serious Mental Illness. Community Ment Health J 2024; 60:945-954. [PMID: 38427276 DOI: 10.1007/s10597-024-01246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
To inform early intervention, this study describes correlates of substance use among young people with serious mental illness (SMI) enrolled in integrated care in community mental health settings. 227 adults ages 18-35 were assessed for clinical characteristics and substance use. Logistic regressions were used to describe relationships between substance use and participant characteristics. Over a third (38.9%) reported daily cannabis, 15.9% past month other illicit drug, 13.5% frequent/heavy alcohol and 47.4% any of these; 50.2% reported daily tobacco smoking and 23.3% current vaping. Daily cannabis and tobacco were the most common combination. Alcohol, drug, and cannabis with tobacco were associated with higher mental health symptoms but not with emergency room or hospital utilization. Cannabis and other substance use was common and associated with higher symptoms but not with greater hospital utilization, suggesting that early intervention could prevent long-term negative consequences.
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Affiliation(s)
- Joelle C Ferron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA.
- The Dartmouth Institute, Dartmouth College, Hanover, USA.
- Dartmouth Hitchcock Health System, Lebanon, USA.
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Department of Family Medicine, Geisel School of Medicine at Dartmouth College, Concord, USA
- The Dartmouth Institute, Dartmouth College, Hanover, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
| | - Mohamed W ElSayed
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
- New Hampshire Hospital, Concord, USA
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- The Dartmouth Institute, Dartmouth College, Hanover, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
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Szoke A, Pignon B, Godin O, Ferchiou A, Tamouza R, Leboyer M, Schürhoff F. Multimorbidity and the Etiology of Schizophrenia. Curr Psychiatry Rep 2024; 26:253-263. [PMID: 38625632 DOI: 10.1007/s11920-024-01500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE OF REVIEW A global study of multimorbidity in schizophrenia, especially of the association with physical conditions, might offer much needed etiological insights. RECENT FINDINGS Our review suggests that life-style factors and medication related to schizophrenia are only part of the explanation of the increase in risk for cardiovascular, metabolic, pulmonary disorders, and some cancers. Positive associations with autoimmune disorders (with the exception of rheumatoid arthritis) and epilepsy are promising avenues of research but to date have not been fully exploited. The same holds for the negative comorbidity seen for rheumatoid arthritis and some cancers (e.g., prostate). As a whole, our review suggests that most of the explored conditions have a different prevalence in schizophrenia than in the general population. Several hypotheses emerged from this review such as the role of immune and genetic factors, of sex hormones, and of more general variability factors.
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Affiliation(s)
- A Szoke
- UPEC, Univ Paris Est Creteil, 94000, Créteil, France
- Fondation Fondamental, 94000, Créteil, France
| | - B Pignon
- UPEC, Univ Paris Est Creteil, 94000, Créteil, France.
- DMU IMPACT Psychiatrie Et Addictologie, Hôpital Albert Chenevier, Pavillon Hartmann, 40, Rue de Mesly, 94000, Créteil, France.
- Fondation Fondamental, 94000, Créteil, France.
| | - O Godin
- UPEC, Univ Paris Est Creteil, 94000, Créteil, France
- Fondation Fondamental, 94000, Créteil, France
| | - A Ferchiou
- UPEC, Univ Paris Est Creteil, 94000, Créteil, France
- Fondation Fondamental, 94000, Créteil, France
| | - R Tamouza
- UPEC, Univ Paris Est Creteil, 94000, Créteil, France
- Fondation Fondamental, 94000, Créteil, France
| | - M Leboyer
- UPEC, Univ Paris Est Creteil, 94000, Créteil, France
- Fondation Fondamental, 94000, Créteil, France
| | - F Schürhoff
- UPEC, Univ Paris Est Creteil, 94000, Créteil, France
- Fondation Fondamental, 94000, Créteil, France
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Sanghvi DE, Chen MS, Bonanno GA. Prospective trajectories of depression predict mortality in cancer patients. J Behav Med 2024:10.1007/s10865-024-00485-3. [PMID: 38615300 DOI: 10.1007/s10865-024-00485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/14/2024] [Indexed: 04/15/2024]
Abstract
An ever-growing body of empirical evidence has demonstrated the relationship between depression and cancer. The objective of this study was to examine whether depression trajectories predict mortality risk above and beyond demographics and other general health-related factors. Participants (n = 2,345) were a part of the Health and Retirement Study. The sample consisted of patients who were assessed once before their cancer diagnosis and thrice after. Depressive symptoms and general health-related factors were based on self-reports. Mortality risk was determined based on whether the patient was alive or not at respective time points. Latent Growth Mixture Modeling was performed to map trajectories of depression, assess differences in trajectories based on demographics and general health-related factors, and predict mortality risk. Four trajectories of depression symptoms emerged: resilient (69.7%), emerging (13.5%), recovery (9.5%), and chronic (7.2%). Overall, females, fewer years of education, higher functional impairment at baseline, and high mortality risk characterized the emerging, recovery, and chronic trajectories. In comparison to the resilient trajectory, mortality risk was highest for the emerging trajectory and accounted for more than half of the deaths recorded for the participants in emerging trajectory. Mortality risk was also significantly elevated, although to a lesser degree, for the recovery and chronic trajectories. The data highlights clinically relevant information about the depression-cancer association that can have useful implications towards cancer treatment, recovery, and public health.
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Affiliation(s)
- Drishti Enna Sanghvi
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA.
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
- New York Presbyterian Hospital-Westchester Behavioral Health Center, White Plains, NY, USA.
| | - Mark Shuquan Chen
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - George A Bonanno
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
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4
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Cerci D, Vitzthum K. [Smoke-free in Psychiatry - A Qualitative Analysis of Staff Perspectives]. PSYCHIATRISCHE PRAXIS 2024; 51:157-162. [PMID: 37989202 DOI: 10.1055/a-2184-3979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND People with mental illness are more likely to be nicotine-dependent and they have a shorter life expectancy as a result of smoking. Although guidelines recommend smoking cessation support, this is rarely provided by psychiatric staff who often view the implementation of smoke-free policies critically. METHOD We undertook inductive thematic analysis of the free-text fields of a staff survey on smoking. RESULTS Feedback on the topic was often emotional and related to the areas patient care, staff and the protection of non-smokers. Participants were often concerned that smoking cessation could worsen the patient's psychiatric condition or lead to aggressive behavior. CONCLUSIONS There is no scientific evidence for these concerns. It is important to counteract false assumptions by providing the appropriate training on smoking cessation.
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Affiliation(s)
- Deniz Cerci
- Klinik für Forensische Psychiatrie, Universitätsmedizin Rostock
| | - Karin Vitzthum
- Institut für Tabakentwöhnung und Raucherprävention, Vivantes Klinikum Neukölln, Berlin
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Marchal-Mateos MI, López-Núñez C, Fernández-Artamendi S. Effectiveness of Contingency Management in Tobacco Smokers with Depressive Symptoms: A Systematic Review. Subst Use Misuse 2024; 59:792-804. [PMID: 38268117 DOI: 10.1080/10826084.2024.2302169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Background: Effective interventions are required to address tobacco smoking in people with depressive symptomatology. In this context, contingency management could be one useful therapeutic strategy. Objectives: This study is a systematic review of tobacco cessation interventions for smokers with depressive symptomatology including a contingency management component, evaluating their efficacy with regards to tobacco abstinence, depressive symptomatology, adherence to treatment and other variables related to tobacco use. For this purpose, a search was carried out in Pubmed, PsycINFO, Cochrane, Web of Science and ClinicalTrials.gov in September 2022. The quality of the studies was assessed using the Cochrane Risk of Bias tool. Results: Of the 208 articles identified, six were included in this review. Results: For the most part, the research included suggests that contingency management is an effective strategy for improving abstinence outcomes, adherence, and other smoking-related variables such as delay discounting and intensity of cigarette demand in smokers with depressive symptomatology. Conclusions: Although contingency management could be a promising intervention in tobacco smokers with depressive symptomatology, further research in this area is still required.
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Affiliation(s)
| | - Carla López-Núñez
- Department of Personality, Evaluation and Psychological Treatment, Universidad de Sevilla, Sevilla, Spain
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Sprenger S, Anderson JS. Dying to Quit: Understanding the Burden of Tobacco in Psychiatric Patients-A Clinical Review. J Psychiatr Pract 2024; 30:23-31. [PMID: 38227724 DOI: 10.1097/pra.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Smoking is the leading cause of preventable death worldwide and remains a critical public health challenge. The burden of disease caused by smoking is disproportionately borne by persons living with mental illness. Public health efforts to address smoking have not historically translated to a significant reduction in smoking prevalence among patients with mental illness. Smoking is a substantial cause of morbidity and mortality among psychiatric patients who smoke at 1.7 to 3.3 times the rate of the general population. Among those with serious mental illness, tobacco-related illness accounts for half of all deaths. Nicotine dependence also interferes with treatment and worsens many psychiatric symptoms. Interventions are underutilized due to persistent misunderstandings regarding tobacco cessation for patients who are mentally ill. Addressing these misunderstandings is crucial in targeting the disparate rates of smoking in this population. Therefore, it is incumbent on psychiatrists to address the outsized effect that smoking has on patients with mental illness.
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Affiliation(s)
- Steven Sprenger
- SPRENGER, ANDERSON: Deparment of Psychiatry, Tristar Centennial Medical Center, Nashville, TN
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Redmond BY, Salwa A, Bricker JB, Buckner JD, Garey L, Zvolensky MJ. Personalized feedback intervention for individuals with low distress tolerance who smoke cigarettes: A randomized controlled trial of a digital intervention. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209163. [PMID: 37717664 DOI: 10.1016/j.josat.2023.209163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/24/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Cigarette smoking remains the leading preventable cause of death and disability in the United States and frequently co-occurs with anxiety and depressive symptoms. A novel and integrative, theory-driven approach to address the heterogeneity of mood-related symptoms associated with cigarette use is to focus on transdiagnostic processes, such as distress tolerance, that underpin both mood-related symptoms and smoking behavior. The current study sought to develop and examine the feasibility, acceptability, and initial efficacy of a digitally delivered integrated personalized feedback intervention (PFI) that addresses smoking-distress tolerance relations. METHODS Participants included 121 adults (71.1 % male; Mage = 29.33 years, SD = 7.52) who smoked cigarettes daily and reported low distress tolerance. The study randomized participants to the Active PFI (feedback on distress tolerance and smoking) or the Control PFI (feedback on smoking only). RESULTS Results indicated feasibility and acceptability demonstrated by the ability to retain participants through the 1-month follow-up (98.2 % retention rate) and positive feedback from participants, including satisfaction regarding the Active PFI. The Active PFI (vs. Control PFI) was also a statistically significant predictor of change in motivation and intention to quit smoking and willingness to use adaptive coping strategies from baseline to 1-month follow-up. CONCLUSIONS For individuals with low distress tolerance who smoke cigarettes, this study's findings suggest that the current intervention may be a first-step to aid in increasing motivation/intention to quit smoking and willingness to use adaptive coping strategies.
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Affiliation(s)
- Brooke Y Redmond
- Department of Psychology, University of Houston, Houston, TX, USA.
| | - Aniqua Salwa
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, USA; University of Washington, Department of Psychology, USA
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA
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Anthenelli RM, McKenna BS, Giannini J, Attaluri SV, Rubin M, O'Crowley E, Miller S, Heffner JL. Combining varenicline preloading with Acceptance and Commitment Therapy (ACT) in persons with serious mental illness who smoke: The randomized ACTSLow pilot feasibility trial. Drug Alcohol Depend 2023; 253:111012. [PMID: 37931328 DOI: 10.1016/j.drugalcdep.2023.111012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND People with serious mental illness (SMI; bipolar [BD] or schizophrenia spectrum disorders [SSD]) who smoke have 30-60% lower odds of quitting and are more prone to experience neuropsychiatric adverse events (NPSAEs) when quitting than smokers without SMI. We pilot-tested the feasibility of combining two different dosing strategies of varenicline preloading with Acceptance and Commitment Therapy (ACT) in persons with SMI in an attempt to bolster quit rates without increasing NPSAEs. METHODS Twelve-week, single center, randomized, double-blind, pilot feasibility trial of low (0.5mg twice daily, slower titration) versus standard dose (1.0mg twice daily, standard titration) varenicline in persons with BD or SSD with a 12-week follow-up. All participants received up to 10 sessions of ACT for smoking cessation. Participants were asked to preload with varenicline while still smoking and set a flexible target quit day (TQD) by day 35. RESULTS Recruitment was hampered by shutdowns related to COVID-19 and the worldwide varenicline recall, respectively. Retention goals were met. Treatment satisfaction was high across both dosing and diagnostic groups. Most participants (92.9%) adhered to preloading instructions and the flexible TQD. Seven-day point prevalence abstinence at week 12 was highest in BD participants (37.5%) but lowest in SSD participants (16.7%) who received the standard dose. Medication was well tolerated. CONCLUSIONS Although recruitment was hindered by unanticipated world events, feasibility was demonstrated. Participants adhered to and were highly satisfied with the combination of pre-cessation varenicline plus ACT. Findings support testing this combined treatment approach in a fully powered trial of persons with BD who smoke.
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Affiliation(s)
- Robert M Anthenelli
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States.
| | - Benjamin S McKenna
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States
| | - Jillian Giannini
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Saisantosh V Attaluri
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Matine Rubin
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Erin O'Crowley
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Sierra Miller
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109, United States
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Zvolska K, Tichopad A, Stepankova L, Pankova A, Adamcekova Z, Donin G, Rafl J, Kralikova E. Increasing prevalence of mental disorders in smokers seeking treatment of tobacco dependence: a retrospective observational study. BMC Psychiatry 2023; 23:621. [PMID: 37620772 PMCID: PMC10464239 DOI: 10.1186/s12888-023-05115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND There has been a noticeable relative increase in psychiatric comorbidities among smokers as opposed to the general population. This is likely due to comparatively slower decrease in smoking prevalence among individuals with mental health conditions. This study aims to assess the prevalence trend of past or current mental health disorders in individuals seeking specialized smoking cessation assistance. METHODS We conducted a retrospective single-centre observational study to assess the presence of mental disorders such as anxiety, depression, bipolar affective disorder, or schizophrenia in personal history of 6,546 smokers who sought treatment at the Centre for Treatment of Tobacco Dependence in Prague, Czech Republic between 2006 and 2019. The study examined the impact of gender, age, and the effect of successive years on the prevalence of the mental disorders using Poisson distribution regression. RESULTS In the studied cohort, 1,743 patients (26.6%) reported having one or more mental disorders. Compared to patients without a psychiatric disorder, they exhibited similar levels of carbon monoxide in expired air (mean 17 ppm, SD 11 ppm) and scored one point higher on the Fagerström Test of Cigarette Dependence. Among smokers with a mental disorder, women were more prevalent (62%) than men (38%). The prevalence of mental disorders increased on average by 4% every year, rising from 23% in 2006 to 35% in 2019. CONCLUSIONS Consistent with the observation that the prevalence of smoking among people with any mental disorder is higher and declining at a slower rate than in the general population, there is a steadily increasing percentage of these patients seeking specialized treatment over time. Professionals who offer tobacco dependence treatment should be aware of the upward trend in psychiatric disorders among smokers, as more intensive treatment may be needed. Similarly, psychiatric care should pay attention to smoking of their patients.
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Affiliation(s)
- Kamila Zvolska
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.
| | - Ales Tichopad
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Lenka Stepankova
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Alexandra Pankova
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Zuzana Adamcekova
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Gleb Donin
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Jakub Rafl
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Eva Kralikova
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
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Martinez Agulleiro L, Patil B, Firth J, Sawyer C, Amann BL, Fonseca F, Torrens M, Perez V, Castellanos FX, Kane JM, Guinart D. A systematic review of digital interventions for smoking cessation in patients with serious mental illness. Psychol Med 2023; 53:4856-4868. [PMID: 37161690 PMCID: PMC10476065 DOI: 10.1017/s003329172300123x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
Tobacco smoking is highly prevalent among patients with serious mental illness (SMI), with known deleterious consequences. Smoking cessation is therefore a prioritary public health challenge in SMI. In recent years, several smoking cessation digital interventions have been developed for non-clinical populations. However, their impact in patients with SMI remains uncertain. We conducted a systematic review to describe and evaluate effectiveness, acceptability, adherence, usability and safety of digital interventions for smoking cessation in patients with SMI. PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group Specialized Register were searched. Studies matching inclusion criteria were included and their information systematically extracted by independent investigators. Thirteen articles were included, which reported data on nine different digital interventions. Intervention theoretical approaches ranged from mobile contingency management to mindfulness. Outcome measures varied widely between studies. The highest abstinence rates were found for mSMART MIND (7-day point-prevalent abstinence: 16-40%). Let's Talk About Quitting Smoking reported greater acceptability ratings, although this was not evaluated with standardized measures. Regarding usability, Learn to Quit showed the highest System Usability Scale scores [mean (s.d.) 85.2 (15.5)]. Adverse events were rare and not systematically reported. Overall, the quality of the studies was fair to good. Digitally delivered health interventions for smoking cessation show promise for improving outcomes for patients with SMI, but lack of availability remains a concern. Larger trials with harmonized assessment measures are needed to generate more definitive evidence and specific recommendations.
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Affiliation(s)
- Luis Martinez Agulleiro
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Bhagyashree Patil
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Chelsea Sawyer
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Benedikt L. Amann
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francina Fonseca
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Torrens
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Universitat de Vic i Central de Catalunya, Vic, Spain
| | - Victor Perez
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - John M. Kane
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Daniel Guinart
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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11
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Rubenstein D, Pacek LR, Smith C, McClernon FJ, Enyioha C, Vilardaga R. Stagnant daily smoking prevalence between 2008 and 2019 among Black and Hispanic adults with serious psychological distress. Drug Alcohol Depend 2023; 248:109943. [PMID: 37247521 PMCID: PMC10330890 DOI: 10.1016/j.drugalcdep.2023.109943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Racial/ethnic minority status and mental illness independently drive inequity in cigarette smoking and related morbidity. Racial/ethnic minority groups suffer a disproportionate burden of tobacco-related diseases. People with serious mental illness (SMI) smoke at up to 7 times the rate of the general population. There is a need to quantify smoking prevalence and trends among people at the intersection of both groups. METHODS This study analyzes 2008-2019 data from the National Survey on Drug Use and Health. Linear time trends of daily smoking prevalence were assessed among people with serious psychological distress (SPD; marker for SMI) and people without SPD reporting White, Black, Hispanic, and Other race/ethnicity using logistic regression, with survey year as the predictor. Models with year-by-smoking status interaction terms and F-tests assessed differential time trends. RESULTS The prevalence of daily smoking among people without SPD decreased over time among people reporting White (aOR=0.96, p<0.001), Black (aOR=0.96, p<0.001), Hispanic (aOR=0.95, p<0.001), and Other (aOR=0.97, p=0.002) race/ethnicity. Among people with SPD, the smoking prevalence decreased among people with White race/ethnicity (aOR=0.95, p<0.001), with no significant changes among people of Black, Hispanic, and Other race/ethnicity. CONCLUSIONS Smoking among people with SPD who report Black and Hispanic race/ethnicity has not changed significantly in the past 11 years, despite decreasing among non-SPD and White groups. People who are Black/Hispanic and people with SPD struggle to quit smoking, which is amplified intersectionally. Tailored interventions may be a better mechanism to reduce barriers to smoking cessation in this population.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States; Clinical and Translational Science Institute, Duke University School of MedicineDurham, NC, 27701, United States
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States
| | - Caitlyn Smith
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States; Clinical and Translational Science Institute, Duke University School of MedicineDurham, NC, 27701, United States
| | - Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599United States
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States.
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12
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Vlasceanu AM, Gradinaru D, Stan M, Nitescu VG, Baconi DL. Relationships between Serum Biomarkers of Oxidative Stress and Tobacco Smoke Exposure in Patients with Mental Disorders. Antioxidants (Basel) 2023; 12:1299. [PMID: 37372029 DOI: 10.3390/antiox12061299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/11/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
The role of cigarette smoking as an aggravating factor of systemic oxidative stress in patients with mental disorders has not been extensively investigated, although significantly higher rates of smoking are recorded in these subjects in comparison with the general population. In the present study, we tested the hypothesis that smoking might be an exacerbator of systemic oxidative stress, being directly correlated with the degree of exposure to tobacco smoke. We analyzed, in 76 adult subjects from a public health care unit, the relationships between serum cotinine levels as a marker of tobacco smoke exposure, and three biomarkers of oxidative stress: the serum glutathione (GSH), the advanced oxidation protein products (AOPPs), and the total serum antioxidant status (FRAP). The results indicate that the degree of tobacco smoke exposure was inversely associated with GSH levels in both passive and active smokers, suggesting that smoke particulate components' toxicity is associated with a systemic GSH depletion. Paradoxically, the lowest AOPP levels which were positively associated with GSH, were recorded in active smoking patients whereas in passive smokers individual values of AOPPs decreased along with the increase in GSH levels. Our data suggest that an enhanced inhalation of particulate constituents of cigarette smoke could induce critical changes in systemic redox homeostasis and GSH can no longer exert its antioxidant role.
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Affiliation(s)
- Ana-Maria Vlasceanu
- Department of Toxicology, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Sector 2, 20021 Bucharest, Romania
| | - Daniela Gradinaru
- Department of Biochemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Sector 2, 20021 Bucharest, Romania
| | - Miriana Stan
- Department of Toxicology, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Sector 2, 20021 Bucharest, Romania
| | - Viorela G Nitescu
- Emergency Clinical Hospital for Children Grigore Alexandrescu, Pediatric Clinic 2, Ward ATI -Toxicology, 30-32 Iancu de Hunedoara Street, 20021 Bucharest, Romania
| | - Daniela Luiza Baconi
- Department of Toxicology, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Sector 2, 20021 Bucharest, Romania
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13
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Yang X, Zhang L, Lin H, Lin H, Cao W, Chang C. Psychiatric symptoms and intentions to quit smoking: How regularity and volume of cigarette consumption moderate the relationship. Tob Induc Dis 2023; 21:78. [PMID: 37323507 PMCID: PMC10266331 DOI: 10.18332/tid/163258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Smoking prevalence is disproportionately higher in those with psychiatric symptoms. Smokers with psychiatric symptoms are less likely to have an intention to quit smoking and attain eventual smoking abstinence. This study presents the relationship between depressive/anxiety symptoms and the intention to quit smoking and related influencing factors. METHODS A cross-sectional study recruited 931 current smoking individuals covering two provinces in China in July 2022. The online survey comprised questions concerning sociodemographic characteristics, smoking conditions and psychiatric symptoms. Chi-squared analyses and moderation analyses were applied. RESULTS The proportion of smokers who had the intention to quit smoking within six months was 46.1%. In comparison with subjects without depressive/anxiety symptoms, individuals who had both psychiatric symptoms were less likely to have the intention to quit smoking (39.3% vs 49.8%, χ2=9.130, p=0.028). As for the moderating model of depression, the interaction term of depressive symptoms and smoking regularly was significant (β=0.554, t=3.260, p=0.001). For those who were occasional smokers, depressive symptoms significantly lowered their quitting intentions. The regularity of smoking similarly moderated the effect of anxiety symptoms on quitting intentions. When the number of cigarettes used weekly served as the moderator, the interaction of this number and depressive symptoms was significant, as well as for anxiety (p<0.001), indicating that the volume of cigarette consumption moderated the relationship between depressive/anxiety symptoms and intention to quit smoking. CONCLUSIONS Psychiatric symptoms were significant factors in reducing the willingness of smokers to quit smoking, and the effects were moderated by smokers' cigarette consumption conditions. Interventions are urged to enhance quitting intentions of these vulnerable smokers.
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Affiliation(s)
- Xiaochen Yang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Lanchao Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Hao Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Haoxiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
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14
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Biazus TB, Beraldi GH, Tokeshi L, Rotenberg LDS, Dragioti E, Carvalho AF, Solmi M, Lafer B. All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis. Mol Psychiatry 2023; 28:2508-2524. [PMID: 37491460 PMCID: PMC10611575 DOI: 10.1038/s41380-023-02109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta-analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all-cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific-causes mortality. RESULTS Fifty-seven studies were included (BD; n = 678,353). All-cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89-2.16, k = 39). Specific-cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22-14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41-8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75-2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5-12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55-3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53-2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34-1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88-1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings. CONCLUSION Results presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.
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Affiliation(s)
- Taís Boeira Biazus
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Gabriel Henrique Beraldi
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Schizophrenia Research Program (Projesq), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Tokeshi
- Consultation Liaison, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Luísa de Siqueira Rotenberg
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, SE 58185, Linköping, Sweden
| | - André F Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Beny Lafer
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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15
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Jafry MZ, Martinez J, Chen TA, Britton M, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, Carter BJ, Reitzel LR. Behavioral health care provider's beliefs, confidence, and knowledge in treating cigarette smoking in relation to their use of the 5A's intervention. Addict Behav Rep 2023; 17:100493. [PMID: 37347047 PMCID: PMC10279772 DOI: 10.1016/j.abrep.2023.100493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/29/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Evidence-based smoking cessation interventions are underused settings where behavioral health treatment is provided, contributing to smoking-related health disparities in this patient group. This study assessed the relationship of provider's beliefs about patients' smoking, perceptions of treatment capability, and knowledge of referral options and their use of the 5A's (Ask, Advise, Assess, Assist, and Arrange) intervention for smoking cessation. Methods Surveys were collected from providers in healthcare settings in Texas where patients receive behavioral health care (N = 86; 9 federally qualified health centers, 16 Local Mental Health Authorities (LMHAs), 6 substance use treatment programs in LMHAs, and 55 stand-alone substance use treatment centers). Logistic regression analyses were used to assess the association between provider's beliefs about patients' concern and desire to quit smoking; perceptions of their confidence, skills, and effectiveness in treating smoking; their knowledge of referral options; and their use of the 5A's with patients who smoked. Results Providers who believed that patients were concerned about smoking and wanted to quit; who perceived themselves as confident in providing cessation care, having the required skills, and being effective in providing advice; and/or who had greater referral knowledge were more likely to use the 5A's with patients who smoked than their (respective) provider counterparts (ps < 0.05). Conclusion Provider-level constructs affect their 5A's provision for patients with behavioral health needs. Future work should train providers to correct misconceptions about patients' interest in quitting, bolster their confidence, and provide referral options to support tobacco provision efforts.
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Affiliation(s)
- Midhat Z. Jafry
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Biology and Biochemistry, Science & Research Building 2, 3455 Cullen Blvd Room 342, Houston, TX 77204, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Jayda Martinez
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
- The University of Texas Health Science Center, School of Public Health, 1200 Pressler St., Houston, TX 77030, USA
| | - Tzuan A. Chen
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Maggie Britton
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Isabel Martinez Leal
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Anastasia Rogova
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | - Mayuri Patel
- Texas Department of State Health Services, Tobacco Prevention and Control Branch, 1100 West 49th Street, Mail Code 1965, Austin, TX 78756, USA
| | - Brian J. Carter
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Lorraine R. Reitzel
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
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16
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Veldhuizen S, Behal A, Zawertailo L, Melamed O, Agarwal M, Selby P. Outcomes Among People With Schizophrenia Participating in General-Population Smoking Cessation Treatment: An Observational Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:359-369. [PMID: 36760089 PMCID: PMC10192823 DOI: 10.1177/07067437231155693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE People with schizophrenia are much more likely than others to smoke tobacco, raising risks of disease and premature mortality. These individuals are also less likely to quit successfully after treatment, but the few existing clinical and observational studies have been limited by small sample sizes, and have generally considered specialized treatment approaches. In this analysis, we examine outcomes, service use, and potential explanatory variables in a large sample of people with schizophrenia treated in a general-population cessation program. METHOD Our sample comprised 3,011 people with schizophrenia and 77,790 controls receiving free nicotine replacement therapy through 400 clinics and health centres. We analysed self-reported 7-day abstinence or reduction at 6-month follow-up, as well as the number of visits attended and self-reported difficulties in quitting. We adjusted for demographic, socioeconomic, and health variables, and used multiple imputation to address missing data. RESULTS Abstinence was achieved by 16.2% (95% confidence interval [CI], 14.5% to 17.8%) of people with schizophrenia and 26.4% (95% CI, 26.0% to 26.7%) of others (absolute difference = 10.2%; 95% CI, 8.5% to 11.9%; P < 0.001). After adjustment, this difference was reduced to 7.3% (95% CI, 5.4% to 9.3%; P < 0.001). Reduction in use was reported by 11.8% (95% CI, 10.3% to 13.3%) and 12.5% (95% CI, 12.2% to 12.8%), respectively; this difference was nonsignificant after adjustment. People with schizophrenia attended more clinic visits (incidence rate ratio [IRR] = 1.15, 95% CI = 1.12% to 1.18%, P < 0.001) and reported more difficulties related to "being around other smokers" (odds ratio [OR] = 1.28; 95% CI, 1.11% to 1.47%; P = 0.001). CONCLUSION There is abundant demand for tobacco cessation treatment in this population. Outcomes were substantially poorer for people with schizophrenia, and this difference was not explained by covariates. Cessation remained much better than for unaided quit attempts, however, and engagement was high, demonstrating that people with schizophrenia benefit from nonspecialized pharmacological treatment programs.
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Affiliation(s)
- Scott Veldhuizen
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, Canada
| | - Anjali Behal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Osnat Melamed
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, Canada
| | - Mahavir Agarwal
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Peter Selby
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
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17
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Pettey D, Rae J, Aubry T. An Examination of the Effectiveness of Smoking Cessation Treatment Interventions for Individuals with Severe Mental Illness: A Pilot Randomized Controlled Trial. Community Ment Health J 2023; 59:564-577. [PMID: 36327043 DOI: 10.1007/s10597-022-01041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
To evaluate the effectiveness of two different smoking cessation interventions for individuals with severe mental illness. Study participants (N = 61) randomly assigned to the SC-R group (n = 29) were offered 24 weeks of no cost Nicotine Replacement Treatment (NRT); participants assigned to the SC + group (n = 32) were offered 24 weeks of no cost NRT plus two initial individual counselling sessions of motivational interviewing and weekly psychosocial group support for 24 weeks. At 6 months the smoking cessation outcome was 7% for the SC-R group and 14% for the SC + group, but there was no statistically significant difference between the groups. Both groups showed a significant decrease in the number of cigarettes smoked per day and significant improvement in physical health functioning. Clients with severe mental illness, high prevalence of co-occurring substance use and experience of homelessness, are both interested and able to quit smoking and reduce cigarette use.
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Affiliation(s)
- Donna Pettey
- Centre for Research on Educational and Community Services, University of Ottawa, Vanier Hall, 136 Jean-Jacques Lussier Private, Ottawa, ON, K1N 6N5, Canada. .,Ottawa Branch, Canadian Mental Health Association, 311 McArthur Avenue, Ottawa, ON, K1L 8M3, Canada.
| | - Jennifer Rae
- Centre for Research on Educational and Community Services, University of Ottawa, Vanier Hall, 136 Jean-Jacques Lussier Private, Ottawa, ON, K1N 6N5, Canada.,School of Psychology, University of Ottawa, Vanier Hall, 136 Jean Jacques Lussier Private, Ottawa, ON, K1N 6N5, Canada
| | - Tim Aubry
- Centre for Research on Educational and Community Services, University of Ottawa, Vanier Hall, 136 Jean-Jacques Lussier Private, Ottawa, ON, K1N 6N5, Canada.,School of Psychology, University of Ottawa, Vanier Hall, 136 Jean Jacques Lussier Private, Ottawa, ON, K1N 6N5, Canada
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18
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White SA, Stone E, Murphy KA, Daumit GL, McGinty EE. Smoking Cessation Medication Prescribing for Smokers With and Without Mental Illness. Psychiatr Serv 2023; 74:332-340. [PMID: 36349496 PMCID: PMC10066821 DOI: 10.1176/appi.ps.202100690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study examined trends in receipt of smoking cessation medications among smokers with and without mental illness, including serious mental illness, from 2005 to 2019 and characterized physician attitudes and practices related to tobacco screening and cessation treatment. METHODS Medical Expenditure Panel Survey (MEPS) data (2005-2019) were examined for receipt of cessation medication prescriptions for bupropion, varenicline, and nicotine replacement therapy (NRT) among 55,662 smokers-18,353 with any mental illness and 7,421 with serious mental illness. Qualitative interviews with 40 general internists and psychiatrists between October and November 2017 used a semistructured guide. MEPS data were analyzed with descriptive statistics, and interviews were analyzed with hybrid inductive-deductive coding. RESULTS From 2005 to 2019, at least 83% of smokers with or without mental illness did not receive varenicline, NRT, or bupropion. Over 14 years, the proportion of smokers receiving varenicline peaked at 2.1% among those with no mental illness, 2.9% among those with any mental illness, and 2.4% among those with serious mental illness. The respective peak proportions for NRT were 0.4%, 1.1%, and 1.6%; for bupropion, they were 1.2%, 8.4%, and 16.7%. Qualitative themes were consistent across general internists and psychiatrists; providers viewed cessation treatment as challenging because of the perception of smoking as a coping mechanism and agreed on barriers to treatment, including lack of insurance coverage and contraindications for people with mental illness. CONCLUSIONS System- and provider-level strategies to support evidence-based smoking cessation treatment for people with and without mental illness are needed.
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Affiliation(s)
- Sarah A White
- Department of Health Policy and Management (White, Stone, McGinty), Johns Hopkins Bloomberg School of Public Health, and Division of General Internal Medicine, Johns Hopkins School of Medicine (Murphy, Daumit), Baltimore
| | - Elizabeth Stone
- Department of Health Policy and Management (White, Stone, McGinty), Johns Hopkins Bloomberg School of Public Health, and Division of General Internal Medicine, Johns Hopkins School of Medicine (Murphy, Daumit), Baltimore
| | - Karly A Murphy
- Department of Health Policy and Management (White, Stone, McGinty), Johns Hopkins Bloomberg School of Public Health, and Division of General Internal Medicine, Johns Hopkins School of Medicine (Murphy, Daumit), Baltimore
| | - Gail L Daumit
- Department of Health Policy and Management (White, Stone, McGinty), Johns Hopkins Bloomberg School of Public Health, and Division of General Internal Medicine, Johns Hopkins School of Medicine (Murphy, Daumit), Baltimore
| | - Emma E McGinty
- Department of Health Policy and Management (White, Stone, McGinty), Johns Hopkins Bloomberg School of Public Health, and Division of General Internal Medicine, Johns Hopkins School of Medicine (Murphy, Daumit), Baltimore
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19
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Levit JD, Meyers JL, Georgakopoulos P, Pato MT. Risk for alcohol use problems in severe mental illness: Interactions with sex and racial/ethnic minority status. J Affect Disord 2023; 325:329-336. [PMID: 36587907 PMCID: PMC9942932 DOI: 10.1016/j.jad.2022.12.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 12/22/2022] [Accepted: 12/25/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) is exceedingly common among individuals with bipolar disorder and schizophrenia. However, studies on alcohol use in psychiatric illness rely largely on population surveys with limited representation of severe mental illness (SMI); schizophrenia and bipolar disorder. METHODS Using data from the Genomic Psychiatry Cohort (GPC) (Pato MT, 2013), associations of bipolar disorder and schizophrenia with alcohol use problems were examined in a diverse US based sample, considering the influence of self-described race (African Ancestry (AA), European Ancestry (EA), or Latinx Ancestry (LA)), sex, and tobacco use. Participants answered alcohol use problem items derived from the CAGE instrument, yielding a summed "probable" alcohol use disorder (pAUD) risk score. RESULTS This study included 1952 individuals with bipolar disorder with psychosis (BDwP), 409 with bipolar disorder without psychosis (BD), 9218 with schizophrenia (SCZ), and 10,416 unaffected individuals. We found that SMI (BDwP, BD, SCZ) was associated with elevated AUD risk scores (B = 0.223, p < 0.001), an association which was strongest in females, particularly those of AA and LA, and in tobacco users. Schizophrenia was associated with the greatest increase in pAUD score (B = 0.141, p < 0.001). pAUD risk scores were increased among participants with bipolar disorder, with greater increases in BDwP (B = 0.125, p < 0.001) than in BD without psychosis (B = 0.027, p < 0.001). LIMITATIONS Limitations include reliance on self-report data, screening items for AUD, voluntary recruitment bias, and differences in race/sex distribution between groups, which were statistically adjusted for in analytic models. CONCLUSIONS SMI is associated with risk for AUD, particularly among females from racial minority groups, smokers, and those with psychotic disorders.
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Affiliation(s)
- Jeremy D Levit
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Jacquelyn L Meyers
- Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Michele T Pato
- Department of Psychiatry, Rutgers University, Piscataway, NJ, USA.
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Psychological Experience of Smoking Addiction in Family and Friends of Schizophrenic Adults Who Smoke Daily: A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11050644. [PMID: 36900649 PMCID: PMC10000785 DOI: 10.3390/healthcare11050644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
The smoking addiction of patients with severe mental disorders has consequences not only for the patients but also for the people around them. This is qualitative research on family and friends of patients with Schizophrenia spectrum disorders to investigate their perception and vision of smoking, its impact on the patients' physical and mental health, and the possible attempts to combat addiction. The research also investigates the participants' views on electronic cigarettes as a means of replacing traditional cigarettes and helping the patient to quit smoking. The survey method used was a semi-structured interview. The answers were recorded, transcribed and analyzed with the technique of thematic analysis. The results of this study show that the view of most participants on smoking is negative (83.3%), although not all of them consider smoking cessation treatments for these patients of primary importance (33.3%). Nevertheless, a good number of them have tried to intervene spontaneously with their own resources and strategies (66.6%). Finally, low-risk products, and in particular electronic cigarettes, are considered by many participants as a useful alternative to traditional cigarettes in patients with schizophrenia spectrum disorders. About the meaning that cigarettes can assume for the patient, recurring themes emerge: they are considered as a way to manage nervousness and tension or as a means to contrast daily monotony and boredom or repeat usual gestures and habits.
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21
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Küçükaksu MH, van Meijel B, Jansen L, Hoekstra T, Adriaanse MC. A smoking cessation intervention for people with severe mental illness treated in ambulatory mental health care (KISMET): study protocol of a randomised controlled trial. BMC Psychiatry 2023; 23:108. [PMID: 36797709 PMCID: PMC9933801 DOI: 10.1186/s12888-023-04599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and effectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. METHODS A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18-65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verified by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical fitness, cardiovascular risks, substance use, quality of life, and health-related self-efficacy at 12 months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. DISCUSSION The results of the KISMET trial will contribute to the evidence gap of effective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. TRIAL REGISTRATION Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
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Affiliation(s)
- Müge H. Küçükaksu
- grid.12380.380000 0004 1754 9227Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Science, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
| | - Berno van Meijel
- grid.16872.3a0000 0004 0435 165XDepartment of Psychiatry, Amsterdam UMC and Amsterdam Public Health research institute, Amsterdam, Netherlands ,grid.448984.d0000 0003 9872 5642Department of Health, Sports & Welfare, Inholland University of Applied Sciences, De Boelelaan 1109, 1081HV Amsterdam, The Netherlands ,grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Lola Jansen
- grid.12380.380000 0004 1754 9227Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Science, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
| | - Trynke Hoekstra
- grid.12380.380000 0004 1754 9227Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Science, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
| | - Marcel C. Adriaanse
- grid.12380.380000 0004 1754 9227Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Science, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
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22
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Creedon TB, Wayne GF, Progovac AM, Levy DE, Cook BL. Trends in cigarette use and health insurance coverage among US adults with mental health and substance use disorders. Addiction 2023; 118:353-364. [PMID: 36385708 DOI: 10.1111/add.16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 09/10/2022] [Indexed: 11/18/2022]
Abstract
AIMS To estimate recent trends in cigarette use and health insurance coverage for United States adults with and without mental health and substance use disorders (MH/SUD). DESIGN Event study analysis of smoking and insurance coverage trends among US adults with and without MH/SUD using 2008-19 public use data from the National Survey on Drug Use and Health, an annual, cross-sectional survey. SETTING USA. PARTICIPANTS A nationally representative sample of non-institutionalized respondents aged 18-64 years (n = 448 762). MEASUREMENTS Outcome variables were three measures of recent cigarette use and one measure of past-year health insurance coverage. We compared outcomes between people with and without MH/SUD (MH disorder: past-year mental illness, predicted from Kessler-6 and the World Health Organization-Disability Assessment Schedule impairment scale; SUD: met survey-based DSM-IV criteria for past-year alcohol, cannabis, cocaine or heroin use disorder) and over time. FINDINGS Comparing pooled data from 2008 to 2009 and from 2018 to 2019, current smoking rates of adults with MH/SUD decreased from 37.9 to 27.9% while current smoking rates of adults without MH/SUD decreased from 21.4 to 16.3%, a significant difference in decrease of 4.9 percentage points (pts) [95% confidence interval (CI) = 3.3-6.6 pts]. Daily smoking followed similar patterns (difference in decrease of 3.9 pts (95% CI = 2.3-5.4 pts). Recent smoking abstinence rates for adults with MH/SUD increased from 7.4 to 10.9%, while recent smoking abstinence rates for adults without MH/SUD increased from 9.6 to 12.0%, a difference in increase of 1.0 pts (95% CI = -3.0 to 0.9 pts). In 2018-19, 11% of net reductions in current smoking, 12% of net reductions in daily smoking and 12% of net increases in recent smoking abstinence coincided with greater gains in insurance coverage for adults with MH/SUD compared to those without MH/SUD. CONCLUSIONS Improvements in smoking and abstinence outcomes for US adults with mental health and substance use disorders appear to be associated with increases in health insurance coverage.
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Affiliation(s)
- Timothy B Creedon
- Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC, USA
| | | | - Ana M Progovac
- Health Equity Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Douglas E Levy
- Mongan Institute, Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin Lê Cook
- Health Equity Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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23
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Brunette MF, Gowarty MA, Gaughan-Maher AE, Pratt SI, Aschbrenner KA, Considine-Sweeny S, Elliott J, Almeida M, L'Esperance AM. Health status of young adults with serious mental illness enrolled in integrated care. Early Interv Psychiatry 2023; 17:167-176. [PMID: 35672918 DOI: 10.1111/eip.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/07/2021] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS People with serious mental illness (SMI) are more likely to develop chronic health conditions and die prematurely. Timely identification of modifiable health risk factors may enable early intervention. We aimed to describe the physical health characteristics and service utilization of young people with SMI. METHODS Young people with SMI enrolled in an integrated community mental health clinic (CMHC) and primary care program were assessed for physical and mental health history and past year service utilization. RESULTS A total of 122 participants, ages 16-35 (m = 27.0 ± 5.0 years), half male, 78.3% White were assessed. Half smoked cigarettes, half had obesity, almost half (47.5%, n = 56) had hypertension, and about a third had laboratory metabolic abnormalities. The group averaged 10.7 ± 5.1 h of sedentary behavior per day. Obesity was associated with high blood pressure, prediabetes, poor self-rated health abilities, sedentary behavior and low health satisfaction. Over half had been to the emergency department (ED) for a medical reason (55.0%, n = 66) and 24.6% had been hospitalized for a health condition in the past year. Over half had a lifetime cardiovascular risk score indicating a 50-67% chance of having a cardiovascular event; simply quitting smoking would reduce the number with this risk by almost half. Most physical health diagnoses were not recorded in the CMHC record. CONCLUSION Young people with SMI newly enrolled in integrated care had high rates of smoking, obesity, hypertension, and other cardio-metabolic abnormalities contributing to high risk for future disease. Research is needed to examine appealing, scalable interventions to improve health, reduce unnecessary medical care, and prevent disparate chronic disease in this group.
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Affiliation(s)
- Mary F Brunette
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Bureau of Mental Health Services, New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA
| | - Minda A Gowarty
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Sarah I Pratt
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kelly A Aschbrenner
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | | | - Margaret Almeida
- The Mental Health Center of Greater Manchester, Manchester, New Hampshire, USA
- Harvard University, Cambridge, Massachusetts, USA
| | - Alicia M L'Esperance
- Bureau of Mental Health Services, New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA
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24
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Staff perspectives on smoking cessation treatment in German psychiatric hospitals. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-022-01811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract
Aim
Although people with mental illness show a greater severity of nicotine dependence and have a significantly reduced life expectancy because of it, psychiatric staff rarely offer their patients smoking cessation support and are reluctant to encourage patients to quit. In order to improve smoking cessation treatment for psychiatric patients, such staff resistance must be better understood.
Subjects and methods
A total of 448 members of staff in eight psychiatric units in Berlin were surveyed in relation to their attitudes towards smoking cessation.
Results
Although most participants recognize the importance of smoking cessation in psychiatric patients, they state that they do not adhere to international guidelines which recommend regularly asking patients about their smoking habits and offering cessation support. Staff have little knowledge about how to facilitate smoking cessation treatment and about the influences of smoking on the metabolism of drugs. They also harbor misconceptions about how smoking affects their patients’ mental well-being. Many express concern that a quit attempt might thwart psychiatric treatment and lead to aggressive behavior—assumptions unsupported by scientific evidence. The overwhelming majority does not believe it to be realistic that patients can manage to give up smoking during treatment.
Conclusions
Staff training should be directed to heighten awareness of the international guidelines and treatment options for smoking cessation and impart knowledge on how smoking impacts both the physical and mental health of psychiatric patients.
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25
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Black Pepper (Piper nigrum) for Tobacco Withdrawal: A Case Report. Case Rep Psychiatry 2022; 2022:5908769. [DOI: 10.1155/2022/5908769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Tobacco use continues to be one of humanity’s most significant public health concerns, causing more than 8-million deaths annually. Existing treatments for tobacco use disorder are limited in efficacy and there is a strong need for identifying effective novel treatments. Small clinical trials indicate that black pepper (Piper nigrum) essential oil may be helpful for treating nicotine withdrawal and craving. However, we are unaware of any cases reporting the use of black pepper for these purposes in nonresearch settings. Here we present the case of a patient who inhaled combusted black pepper to self-medicate nicotine withdrawal when lacking access to tobacco cigarettes while incarcerated. Based on our patient’s report, inhalation of combusted black pepper may have alleviated his tobacco withdrawal and cravings by reducing his automatic motor urge to smoke, quelling withdrawal-associated anxiety, and mimicking the sensorimotor experience of smoking tobacco cigarettes. Notably, our patient reported that inhalation of combusted black pepper for treatment of nicotine craving and withdrawal was common in his correctional facility. Though combusted black pepper is highly unlikely to be an appealing treatment outside of a correctional setting, this case suggests that further investigation of vaporized black pepper essential oil for tobacco cessation may be warranted.
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26
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Caponnetto P, Maglia M, Mangione M, Vergopia C, Prezzavento GC, Polosa R, Quattropani MC, DiPiazza J, Signorelli MS. Smoking Addiction in Patients with Schizophrenia Spectrum Disorders and Its Perception and Intervention in Healthcare Personnel Assigned to Psycho-Rehabilitation Programs: A Qualitative Research. Healthcare (Basel) 2022; 10:2275. [PMID: 36421599 PMCID: PMC9690727 DOI: 10.3390/healthcare10112275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 08/30/2023] Open
Abstract
Patients with schizophrenia spectrum disorders have a higher prevalence and frequency of smoking rates when compared to the rest of the population; to this, it must be added that they develop a greater dependence and have some worse health consequences than the general population. This is qualitative research on the perception of smoking in healthcare professionals assigned to psycho-rehabilitation programs for patients with schizophrenia spectrum disorders. The point of view of health personnel (Psychologists, Psychiatrists, Pedagogists, and Nurses) about cigarette smoking in these patients was analyzed, focusing on their implications in disturbance and comparing them with e-cigarettes too. The methodology used to collect the data was a semi-structured interview with five questions. The research path was carried out in two assisted therapeutic communities that are clinics for the rehabilitation of serious mental illness in the period between November and July 2022. The results showed that the opinion of health professionals on smoking is very negative. Research has also shown that nearly all patients are smokers; however, their high grade of addiction is caused by periods of high stress due to various factors that lead patients to consume a greater number of cigarettes. Almost all respondents have a positive opinion of the e-cigarette, which was defined as an excellent substitute for traditional cigarettes.
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Affiliation(s)
- Pasquale Caponnetto
- Department of Educational Sciences, Section of Psychology, University of Catania, 95121 Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (COEHAR), University of Catania, 95121 Catania, Italy
| | - Marilena Maglia
- Department of Educational Sciences, Section of Psychology, University of Catania, 95121 Catania, Italy
- CTA-Villa Chiara Psychiatric Rehabilitation Clinic and Research, 95030 Mascalucia, Italy
| | - Marta Mangione
- ECLAT Srl, Spin-Off of the University of Catania, 95121 Catania, Italy
| | - Chiara Vergopia
- Department of Educational Sciences, Section of Psychology, University of Catania, 95121 Catania, Italy
| | | | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction (COEHAR), University of Catania, 95121 Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, 95121 Catania, Italy
| | - Maria Catena Quattropani
- Department of Educational Sciences, Section of Psychology, University of Catania, 95121 Catania, Italy
| | - Jennifer DiPiazza
- Hunter Bellevue School of Nursing, Hunter College, City University of New York, New York, NY 10065, USA
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27
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Morar T, Robertson L. Smoking cessation among people with mental illness: A South African perspective. S Afr Fam Pract (2004) 2022; 64:e1-e9. [PMID: 36073100 PMCID: PMC9453116 DOI: 10.4102/safp.v64i1.5489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Tobacco use is recognised as a serious, worldwide public health concern. Smoking cessation is of great interest across a wide range of medical specialities, including family medicine. However, smoking cessation among people with mental illness (PWMI) has attracted scant attention in South African literature. This is despite PWMI suffering disproportionately from the damages of tobacco. The harms of smoking are not limited to physical health but extend to mental health. This article discusses the need for multifaceted smoking cessation treatments for PWMI in the public health sector, taking into consideration the prevalence and unique drivers of smoking in this population. A brief overview of patterns of tobacco use, associated harms and smoking cessation interventions in South Africa is given; all within the context of mental illness.
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Affiliation(s)
- Tejil Morar
- Department of Psychiatry, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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28
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Benny A, McLay M, Callaghan RC, Bates A, Olson R. Population-based comparison of cancer survival outcomes in patients with and without psychiatric disorders. BMC Psychiatry 2022; 22:543. [PMID: 35953787 PMCID: PMC9373539 DOI: 10.1186/s12888-022-04191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Individuals with psychiatric disorders (PD) have a high prevalence of tobacco use. Patients with PD also potentially receive substandard care in comparison to the general population. Previous research has shown that individuals with PD have a decreased risk of receiving a tobacco related (TR) cancer diagnosis. To further assess this trend, this study assesses the survival of patients with a TR cancer with or without a PD. MATERIALS AND METHODS Our study utilized multiple databases, with methods described elsewhere,6 to identify people in British Columbia that have been diagnosed with psychiatric disorders and appendicitis (our control group). From these groups, we selected individuals who also had a TR cancer. We subsequently extracted information pertaining to these patients from these databases. RESULTS Thirty-nine thousand eight hundred forty-one patients with cancer were included in our study. Analyses of these patients were controlled for by age, gender, cancer type and diagnosis year. This analysis displayed shorter survival time among patients who were diagnosed with depression (HR = 1.16; p = 0.01; 95% CI: 1.04-1.29), schizophrenia (HR = 1.62; p < 0.01; 95% CI: 1.43-1.84), or bipolar disorder (HR = 1.35; p < 0.01; 95% CI: 1.12-1.64) compared to the cancer patients without a PD, all of which were statistically significant. People that were diagnosed with anxiety disorders did not have a survival time that was significantly different from our control population (HR = 1.07; p = 0.22; 95% CI: 0.96-1.19). CONCLUSIONS Individuals with PD, except for those with anxiety, were found to have a shorter survival time following diagnosis with a TR cancer as compared to our control group. We hypothesize several factors, which may account for this statistically significant difference: (1) delayed diagnosis, (2) poor access to care, (3) poor assessment or follow-up, or (4) physician beliefs of poor treatment adherence.
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Affiliation(s)
- Alexander Benny
- grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mary McLay
- grid.17091.3e0000 0001 2288 9830Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Russell C. Callaghan
- grid.266876.b0000 0001 2156 9982Division of Medical Sciences, University of Northern British Columbia, Prince George, Canada
| | - Alan Bates
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, BC Cancer, University of British Columbia, Vancouver, Canada
| | - Robert Olson
- Department of Surgery, BC Cancer, University of British Columbia, 1215 Lethbridge Street, Prince George, BC V2M7E9, Canada.
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29
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Nagawa CS, Pbert L, Wang B, Cutrona SL, Davis M, Lemon SC, Sadasivam RS. Association between family or peer views towards tobacco use and past 30-day smoking cessation among adults with mental health problems. Prev Med Rep 2022; 28:101886. [PMID: 35855923 PMCID: PMC9287352 DOI: 10.1016/j.pmedr.2022.101886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/16/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
Adults with mental health problems have a higher prevalence of cigarette smoking. Our findings suggest that neutral or positive family or peer views towards tobacco use may deter cessation efforts. Efforts to modify views family or peers are needed to improve quit rates in this population.
Adults with mental health problems have a higher prevalence of cigarette smoking. We examined the association between family or peer views towards tobacco use and past 30-day cessation among adult with mental health conditions who smoke. We used nationally representative data from the Population Assessment of Tobacco and Health Study. We included individuals who currently smoked and reported mental health symptoms over the past year (n = 4201). We used the Global Appraisal of Individual Needs Short Screener questionnaire to assess mental health conditions. Logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (95%CI) in the association between family and peer views towards tobacco use and past 30-day smoking cessation. Compared to participants who had family or peers with negative views towards tobacco use, those with family or peers with neutral or positive views were 32% less likely (adjusted OR: 0.68, 95%CI: 0.51 – 0.93) to report past 30-day smoking cessation. The association between family/peer views towards tobacco use and smoking cessation was statisitcally significant for individuals with symptoms on the both internalizing and externalizing sub-scales (adjusted OR: 0.62, 95%CI: 0.42 – 0.92), but not for those reporting symptoms on a single sub scale. Our findings suggest that having family members or peers who hold neutral or positive views towards tobacco use may deter cessation efforts of people with mental health conditions who smoke. Efforts to modify these views are needed to improve quit rates in people with mental health conditions who smoke.
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Affiliation(s)
- Catherine S. Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Corresponding author at: University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sarah L. Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- Center of Innovation, Edith Nurse Rogers Memorial Hospital Veterans Health Administration, USA
| | - Stephenie C. Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rajani S. Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- Center of Innovation, Edith Nurse Rogers Memorial Hospital Veterans Health Administration, USA
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30
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Martinez Leal I, Martinez J, Britton M, Chen TA, Correa-Fernández V, Kyburz B, Nitturi V, Obasi EM, Drenner K, Williams T, Casey K, Carter BJ, Reitzel LR. Collaborative Learning: A Qualitative Study Exploring Factors Contributing to a Successful Tobacco Cessation Train-the-Trainer Program as a Community of Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137664. [PMID: 35805323 PMCID: PMC9266255 DOI: 10.3390/ijerph19137664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
Individuals with behavioral health conditions account for 50% of annual smoking-related deaths, yet rarely receive tobacco dependence treatment within local mental health authorities (LMHAs). As lack of training and knowledge are key barriers to providing tobacco dependence treatment, Taking Texas Tobacco-Free (TTTF) developed an iterative, 4–6-months train-the-trainer program to embed expertise and delivery of sustained education on tobacco-free workplace policies and practices in participating centers. We explore the employee “champions’” train-the-trainer program experiences using a community of practice (CoP) model to identify key contributors to successful program implementation. Across 3 different LMHAs, we conducted semi-structured individual and group interviews online at 2 time points. We interviewed each champion twice (except for 1 champion who dropped out between measurements); pre-implementation (3 group interviews; N = 4 + 4 + 3 = 11 champions); post-implementation (7 individual interviews and 1 group interview; 7 + 3 = 10 champions). Therefore, 11 champions participated in pre- and post-implementation interviews from July 2020–May 2021. Guided by an iterative, thematic analysis and constant comparison process, we inductively coded and summarized data into themes. Five factors contributed to successful program implementation: value of peer support/feedback; building knowledge, champion confidence, and program ownership; informative curriculum, adaptable to targeted populations; staying abreast of current tobacco/nicotine research and products; and TTTF team responsiveness and practical coaching/assistance. Champions reported the TTTF train-the-trainer program was successful and identified attitudes and CoP processes that effectively built organizational capacity and expertise to sustainably address tobacco dependence. Study findings can guide other agencies in implementing sustainable tobacco-free training programs.
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Affiliation(s)
- Isabel Martinez Leal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6444
| | - Jayda Martinez
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
| | - Maggie Britton
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.); (K.C.)
| | - Vijay Nitturi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Kelli Drenner
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
| | - Teresa Williams
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.); (K.C.)
| | - Brian J. Carter
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
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Chene M, Sánchez-Rico M, Blanco C, De Raykeer RP, Hanon C, Vandel P, Limosin F, Hoertel N. Psychiatric symptoms and mortality in older adults with major psychiatric disorders: results from a multicenter study. Eur Arch Psychiatry Clin Neurosci 2022; 273:627-638. [PMID: 35723739 DOI: 10.1007/s00406-022-01426-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
Prior research suggests that certain psychiatric symptoms could be associated with increased risk of death. However, it remains unclear whether this association could rely on all or specific symptoms. In this report, we used data from a multicenter 5-year prospective study (N = 641) of older adults with an ICD-10 diagnosis of schizophrenia, bipolar disorder or major depressive disorder, recruited from French community psychiatric departments. We used a latent variable approach to disentangle the effects shared by all psychiatric symptoms (i.e., general psychopathology factor) and those specific to individual psychiatric symptoms, while adjusting for sociodemographic and clinical factors. Psychiatric symptoms were assessed face-to-face by psychiatrists trained to semi-structured interviews using the Brief Psychiatric Rating Scale (BPRS). Among older adults with major psychiatric disorders, we found that all psychiatric symptoms were associated with increased mortality, and that their effect on the 5-year mortality were exerted mostly through a general psychopathology dimension (β = 0.13, SE = 0.05, p < 0.05). No BPRS item or lower order factor had a significant effect on mortality beyond and above the effect of the general psychopathology factor. Greater number of medical conditions, older age, male sex, and being hospitalized or institutionalized at baseline were significantly associated with this risk beyond the effect of the general psychopathology factor. Since psychiatric symptoms may affect mortality mainly through a general psychopathology dimension, biological and psychological mechanisms underlying this dimension should be considered as promising targets for interventions to decrease excess mortality of older individuals with psychiatric disorders.
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Affiliation(s)
- Margaux Chene
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France. .,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.
| | - Marina Sánchez-Rico
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Madrid, Spain
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Rachel Pascal De Raykeer
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Pierre Vandel
- Department of Adult Psychiatry, Laboratory of Neurosciences, University Hospital of Besançon, UBFC, EA-481, Besançon, France
| | - Frédéric Limosin
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Nicolas Hoertel
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Results of a Qualitative Study Aimed at Building a Programme to Reduce Cardiovascular Risk in People with Severe Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116847. [PMID: 35682429 PMCID: PMC9180728 DOI: 10.3390/ijerph19116847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 12/10/2022]
Abstract
People with severe mental illness (PSMI) have a shorter life expectancy and are more likely to have cardiovascular disease than the general population. Patients, carers, psychiatric professionals and primary care providers can all play a role in increasing PSMI physical health. The present qualitative exploratory study aimed to explore the views of these four populations as part of the multi-phase COPsyCAT project, whose objective is to build and test a cardiovascular risk prevention programme for PSMI. Overall, 107 people participated in the study's 16 focus groups, which were transcribed and analysed in a thematic analysis. With a view to building the health promotion programme, major themes identified in the corpus were translated into a list of needs as follows: communication, information, training and support. Results show that it is essential to improve communication between all the different stakeholders in mental health. The greatest challenge facing this programme will be to adapt it to the needs and expectations of PSMI while facilitating work between the various mental health stakeholders. Simple and inexpensive actions could be taken to improve the cardiovascular health of PSMI and will be experimented with during the programme's feasibility study which will start in September 2022.
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DeAtley T, Sokolovsky AW, Snell ML, Tidey J. Mediational pathways of tobacco use among adult daily smokers with psychiatric symptoms in the Population Assessment of Tobacco and Health (PATH) survey. Addict Behav 2022; 129:107249. [PMID: 35104739 PMCID: PMC8969557 DOI: 10.1016/j.addbeh.2022.107249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Individuals with psychiatric conditions suffer disproportionately from tobacco-related morbidity and mortality, but the factors driving this relationship remain unclear. We used data from the Population Assessment of Tobacco and Health (PATH) to investigate whether associations between internalizing psychiatric symptoms and change in smoking heaviness (as measured by cigarettes per day (CPD) were mediated by self-reported respiratory symptoms, smoking risk perceptions, and cigarette dependence. METHODS This study used data from PATH Waves 1 through 4 (2013-2017, n = 4,152). Psychiatric symptoms were indexed with the internalizing sub-scale of the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) among daily smokers. We fit auto-regressive structural equation models (SEM) to data from Wave 1-3 and 2-4 to determine the direct and indirect associations between internalizing symptom scores and CPD through each mediator. RESULTS The association between internalizing symptoms and CPD was mediated by cigarette dependence (indirect: B = 0.004, SE = 0.041, p = 0.023) and respiratory symptom severity (indirect: B = 0.018, SE = 0.097, p < 0.001). Internalizing symptoms predicted higher harm perceptions (B = 0.056, SE = 0.035, p < 0.001) but the indirect relationship with CPD was non-significant. Findings from Waves 2-4 replicated these results. CONCLUSION Our results indicate that cigarette dependence and respiratory symptom severity partially mediate the relationship between internalizing symptoms and CPD but risk perceptions were not significant predictors in our models. This suggests that efforts to reduce smoking among people with internalizing disorders should focus on decreasing nicotine dependence and increasing awareness of respiratory symptoms to encourage a quit attempt or switch to a less harmful source of nicotine.
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Affiliation(s)
- Teresa DeAtley
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA.
| | - Alexander W Sokolovsky
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Morgan L Snell
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Jennifer Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
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Effects of Very Low Nicotine Content Cigarette use on Cigarette Reinforcement among Smokers with Serious Mental Illness. Addict Behav 2022; 133:107376. [PMID: 35671553 DOI: 10.1016/j.addbeh.2022.107376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/29/2022] [Accepted: 05/20/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Among people without psychiatric disorders who smoke, very low nicotine content (VLNC) cigarette use reduces cigarette reinforcement. Whether this is true of people with serious mental illness (SMI) who smoke is unknown. Using a hypothetical purchase task, we compared the effects of 6-week use of VLNC versus normal nicotine content (NNC) cigarettes on study cigarette and usual brand (UB) cigarette reinforcement among people with SMI who smoke. METHODS After a baseline period of UB cigarette use, participants with SMI (n = 58) were randomized to use NNC cigarettes (15.8 mg nicotine/g tobacco) or VLNC cigarettes (0.4 mg/g) for 6 weeks. At Week 6, they completed the CPT for both their assigned study cigarette and UB. The groups were compared on demand intensity (number of cigarettes purchased at no cost) and elasticity (rate of decline in demand as price increases) using extra sum-of-squares F-tests. The effects of treatment on demand indices while controlling for covariates were assessed using hierarchical regression. RESULTS At Week 6, intensity of demand for study cigarettes was lower and elasticity was higher for the VLNC group relative to the NNC group (p < 0.0001). Furthermore, intensity of demand for UB cigarettes was lower for participants in the VLNC group relative to participants in the NNC group (p < 0.01). When controlling for baseline cigarettes per day, intensity remained significantly different for study cigarettes and usual brand cigarettes at Week 6. CONCLUSION A nicotine reduction policy may reduce cigarette reinforcement in this vulnerable population.
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Cinciripini PM, Kypriotakis G, Green C, Lawrence D, Anthenelli RM, Minnix J, Blalock JA, Beneventi D, Morris C, Karam-Hage M. The effects of varenicline, bupropion, nicotine patch, and placebo on smoking cessation among smokers with major depression: A randomized clinical trial. Depress Anxiety 2022; 39:429-440. [PMID: 35535436 PMCID: PMC9705120 DOI: 10.1002/da.23259] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/08/2022] [Indexed: 11/07/2022] Open
Abstract
IMPORTANCE Improving treatment outcomes for smokers with major depressive disorder (MDD) can have significant public health implications. OBJECTIVE To evaluate the safety and efficacy of smoking cessation pharmacotherapy among smokers with MDD. DESIGN Secondary analysis of a randomized, double-blind, active- (nicotine patch) and placebo-controlled trial of 12 weeks of either varenicline or bupropion with a 12-week follow-up. PARTICIPANTS Community volunteers 18-75 years of age; smoke 10+ cigarettes/day; with clinically stable MDD (N = 2635) or no psychiatric disorder (N = 4028), from 140 sites in 16 countries. INTERVENTION Twelve weeks of pharmacotherapy (placebo [PLA], nicotine replacement therapy [NRT], bupropion [BUP], varenicline [VAR]) plus brief cessation counseling. MEASURE(S) Primary safety outcome: the occurrence of ≥1 treatment-emergent, moderate to severe neuropsychiatric adverse event (NPSAE). Primary efficacy outcome: biochemically confirmed continuous abstinence (CA) during the final 4 weeks of treatment (Weeks 9-12). RESULTS A total of 6653 participants (56% female; 39% MDD) ~47 years old. Risk of NPSAEs did not differ by medication for MDD. MDD had higher risk (p < .0001) for NPSAEs than the NPC. Efficacy (6653; intent-to-treat): CA rates for MDD versus NPC respectively were 31.2% versus 38.0% VAR; 23.0% versus 26.1% BUP; 22.6% versus 26.4% NRT; and 13.4% versus 13.7% PLA but no differential treatment effect was noted within the cohorts. All active treatments differed from PLA but VAR showed the largest effect. CONCLUSIONS Results suggest that for MDD smokers, inclusive of those with recurrent episode, varenicline plus counseling may be the best pharmacological option for the treatment of smoking given its greater efficacy effect size and similar risk of NPSAEs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01456936. https://clinicaltrials.gov/ct2/show/NCT01456936.
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Affiliation(s)
- Paul M. Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George Kypriotakis
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles Green
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA
| | | | - Robert M. Anthenelli
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Jennifer Minnix
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice A. Blalock
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Beneventi
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chad Morris
- Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - Maher Karam-Hage
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Covell NH, Foster F, Lipton N, Kingman E, Tse J, Aquila A, Williams JM. Self- Evaluation Tool to Support Implementation of Treatment for Tobacco Use Disorder in Behavioral Health Programs. Community Ment Health J 2022; 58:812-820. [PMID: 34518927 PMCID: PMC8437659 DOI: 10.1007/s10597-021-00890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
Tobacco use in people with behavioral health conditions remain two to three times higher than the general population causing premature death and impacting recovery negatively across several domains. Intermediary organizations can provide practical tools, training, and technical assistance to help programs improve capacity to treat tobacco use. This report describes the construction and application of the Tobacco Integration Self-Evaluation Tool (TiSET) for behavioral health programs, a 20-item scale inspired by the DDCMHT and additional content from the Facility Tobacco Policy and Treatment Practices Self-Evaluation tool that one of the study authors (JW) used previously with addiction treatment programs. Completing the TiSET is an important step for behavioral health programs to evaluate their ability to effectively treat people that use tobacco. An important next step is to use those results to facilitate a quality improvement process. We include large agency example illustrating how the TiSET can be applied in real-world practice.
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Affiliation(s)
- Nancy H Covell
- Columbia University Vagelos College of Physicians and Surgeons, Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA.
| | - Forrest Foster
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Noah Lipton
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Emily Kingman
- The Institute for Community Living (ICL), Inc. New York, New York, NY, USA
| | - Jeanie Tse
- The Institute for Community Living (ICL), Inc. New York, New York, NY, USA.,New York University and Fountain House, New York, NY, USA
| | - Annie Aquila
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Jill M Williams
- Rutgers University-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Porcu M, Urbano MR, Verri WA, Machado RCR, Vargas HO, Nune SOV. Comparison of the severity of depressive and anxiety symptoms, biomarkers, and childhood trauma among bipolar smokers and non-smokers, and controls. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hogan TH, Quisenberry A, Breitborde N, Moe A, Ferketich A. An evaluation of the feasibility of implementing a novel tobacco dependence treatment program for high-risk individuals into clinical practice within a community mental health center. Int J Ment Health Syst 2022; 16:15. [PMID: 35184758 PMCID: PMC8858522 DOI: 10.1186/s13033-022-00517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Individuals with serious mental illnesses experience deaths related to smoking at a higher prevalence than individuals without a psychotic-spectrum disorders. Traditional smoking cessation programs are often not effective among individuals with chronic mental disorders. Little is known about how to implement a tobacco cessation treatment program for this at-risk population within a community health center. The current study used qualitative methods to examine the factors that may enhance or impede the delivery of a novel tobacco cessation treatment for smokers with a psychotic-spectrum disorder diagnosis in an integrated care community health center. Methods Using a case study design, we conducted 22 semi-structured interviews with primary care providers, mental health providers, addiction counselors, case managers, intake specialists, schedulers, pharmacists, and administrative staff employed at the organization. Interviews were transcribed and themes were identified through a rich coding process. Results We identified environmental factors, organizational factors, provider factors and patient factors which describe the potential factors that may enhance or impede the implementation of a smoking cessation program at the integrated care community health center. Most notably, we identified that community mental health centers looking to implement a smoking cessation program for individuals with chronic mental health disorders should ensure the incentives for providers to participate align with the program’s objectives. Additionally, organizations should invest in educating providers to address stigma related to smoking cessation and nicotine use. Conclusions The findings of our study provide valuable insight for administrators to consider when implementing a smoking cessation program in an integrated care community health center. Our findings provide public health practitioners with potential considerations that should be discussed when designing and implementing a smoking cessation program for individuals with chronic mental disorders. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00517-y.
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Baker AL, Forbes E, Pohlman S, McCarter K. Behavioral Interventions to Reduce Cardiovascular Risk Among People with Severe Mental Disorder. Annu Rev Clin Psychol 2022; 18:99-124. [PMID: 35175861 DOI: 10.1146/annurev-clinpsy-072720-012042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among people with severe mental disorder (SMD). CVD risk factors occur at the individual, health system, and socio-environmental levels and contribute not only to high rates of CVD but also to worsening mental health. While acknowledging this wider context, this review focuses on behavioral interventions for seven CVD risk behaviors-smoking, physical inactivity, excessive alcohol consumption, low fruit and vegetable intake, inadequate sleep, poor social participation, and poor medication adherence-that are common among people with SMD. We survey recent meta-reviews of the literature and then review additional key studies to provide clinical recommendations for behavioral interventions to reduce CVD risk among people with SMD. A transdiagnostic psychological approach from the start of mental health treatment, drawing upon multidisciplinary expertise to address multiple risk behaviors, is recommended. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia;
| | - Erin Forbes
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia;
| | - Sonja Pohlman
- School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kristen McCarter
- School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
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Küçükaksu MH, Hoekstra T, Jansen L, Vermeulen J, Adriaanse MC, van Meijel B. Developing a Smoking Cessation Intervention for People With Severe Mental Illness Treated by Flexible Assertive Community Treatment Teams in the Netherlands: A Delphi Study. Front Psychiatry 2022; 13:866779. [PMID: 35873255 PMCID: PMC9301140 DOI: 10.3389/fpsyt.2022.866779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is still limited evidence on the effectiveness and implementation of smoking cessation interventions for people with severe mental illness (SMI) in Dutch outpatient psychiatric settings. The present study aimed to establish expert consensus on the core components and strategies to optimise practical implementation of a smoking cessation intervention for people treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. DESIGN A modified Delphi method was applied to reach consensus on three core components (behavioural counselling, pharmacological treatment and peer support) of the intervention. The Delphi panel comprised five experts with different professional backgrounds. We proposed a first intervention concept. The panel critically examined the evolving concept in three iterative rounds of 90 min each. Responses were recorded, transcribed verbatim and thematically analysed. RESULTS Overall, results yielded that behavioural counselling should focus on preparation for smoking cessation, guidance, relapse prevention and normalisation. Pharmacological treatment consisting of nicotine replacement therapy (NRT), Varenicline or Bupropion, under supervision of a psychiatrist, was recommended. The panel agreed on integrating peer support as a regular part of the intervention, thus fostering emotional and practical support among patients. Treatment of a co-morbid cannabis use disorder needs to be integrated into the intervention if indicated. Regarding implementation, staff's motivation to support smoking cessation was considered essential. For each ambulatory team, two mental health care professionals will have a central role in delivering the intervention. CONCLUSIONS This study provides insight into expert consensus on the core components of a smoking cessation intervention for people with SMI. The results of this study were used for the development of a comprehensive smoking cessation program.
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Affiliation(s)
- Müge H Küçükaksu
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lola Jansen
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Marcel C Adriaanse
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Berno van Meijel
- Department of Psychiatry, Amsterdam University Medical Centre (UMC) and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Health, Sports and Welfare, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Parnassia Psychiatric Institute, Parnassia Academy, The Hague, Netherlands
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Grunze A, Mosolov S, Grunze H, Born C. The detrimental effects of smoking on the course and outcome in adults with bipolar disorder-A narrative review. Front Psychiatry 2022; 13:1114432. [PMID: 36699491 PMCID: PMC9870053 DOI: 10.3389/fpsyt.2022.1114432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Smoking is a substantial and avoidable risk for physical disability and premature death. Despite a declining tobacco use in the community of developed countries, smoking remains abundant in people with mental disorders. This narrative review highlights the epidemiology, consequences and treatment options of tobacco use disorder (TUD) and nicotine dependence (ND) in people with bipolar disorder (BD). METHODS The authors conducted a Medline literature search from 1970 to November 2022 using MeSH terms "bipolar disorder" x "smoking" or "nicotine" or "tobacco" that retrieved 770 results. Search results were complemented by additional literature retrieved from examining cross references and by hand search in text books. Finally, 92 references were considered as essential and selected for the educational purpose of this review. SUMMARY OF FINDINGS Lifetime and point prevalence of smoking in people with BD is in the range of 45-70% and thus about 2-3 times more frequent in BD than in community samples. Smoking, TUD and ND have a detrimental impact both on mental and physical health as well as mortality in people with BD. In the absence of large controlled studies in comorbid BD and TUD or ND, pharmacological treatment follows the individual guidance for each disorder. Community-based psychosocial interventions for TUD and ND appear to be suitable in people with BD, too, as well as Cognitive Behavioral (CBT) or Acceptance and Commitment (ACT) based psychotherapies. CONCLUSIONS Smoking is a modifiable risk factor causing increased risks both for mental and physical health in BD, and deserves more attention in treatment. More treatment research into pharmacological and psychosocial interventions in comorbid BD and TUD or ND are still needed to deliver evidence-based recommendations to physicians.
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Affiliation(s)
- Anna Grunze
- Psychiatrisches Zentrum Nordbaden, Wiesloch, Germany
| | - Sergey Mosolov
- Moscow Research Institute of Psychiatry, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.,Paracelsus Medical University, Nuremberg, Germany
| | - Christoph Born
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.,Paracelsus Medical University, Nuremberg, Germany
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Chesney E, Robson D, Patel R, Shetty H, Richardson S, Chang CK, McGuire P, McNeill A. The impact of cigarette smoking on life expectancy in schizophrenia, schizoaffective disorder and bipolar affective disorder: An electronic case register cohort study. Schizophr Res 2021; 238:29-35. [PMID: 34563995 PMCID: PMC8653908 DOI: 10.1016/j.schres.2021.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 12/02/2022]
Abstract
Severe mental disorders are associated with a life expectancy that is 10-20 years shorter than the general population's. The prevalence of cigarette smoking in these populations is very high. We examined the effect of smoking on life expectancy and survival in patients with a diagnosis of schizophrenia, schizoaffective disorder or bipolar affective disorder from 2007 to 2018 in South East London, UK. Smoking status was determined using unstructured text data extracted from electronic health records. A total of 21,588 patients were identified of which 16,717, (77.4%) were classified as current smokers and 3438 (15.9%) as non-smokers. In female participants, life expectancy at birth was 67.6 years in current smokers (95% CI: 66.4-68.8) and 74.9 years in non-smokers (95% CI: 72.8-77.0), a difference of 7.3 years. In male participants, life expectancy at birth was 63.5 years in current smokers (95% CI: 62.5-64.5) and 68.5 years in non-smokers (95% CI, 64.4-72.6), a difference of 5.0 years. Adjusted survival models found that current smoking status was associated with an increased mortality risk for both females (aHR: 1.42, 95% CI: 1.21-1.66, p < 0.001) and males (aHR: 1.49; 95% CI: 1.25-1.79, p < 0.001). In terms of the effect sizes, these risks were similar to those associated with a diagnosis of co-morbid alcohol or opioid use disorder. Smoking may account for a substantial proportion of the reduced life expectancy in patients with psychotic disorders. Increased emphasis on reducing cigarette smoking in these populations may be the most effective way to reduce the mortality gap with the general population.
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Affiliation(s)
- Edward Chesney
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Deborah Robson
- King's College London, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK,SPECTRUM Consortium, UK
| | - Rashmi Patel
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, UK
| | - Sol Richardson
- King's College London, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Chin-Kuo Chang
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, UK,Global Health Program, College of Public Health, National Taiwan University, Taipei City, Taiwan,King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Philip McGuire
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ann McNeill
- King's College London, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK,SPECTRUM Consortium, UK
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Machado RCBR, Vargas HO, Zazula R, Urbano MR, Verri Jr WA, Rossaneis AC, Porcu M, Barbosa DS, Reis ADMF, Nunes SOV. Implications for comorbidities, maternal smoking during pregnancy, and inflammation in current smokers. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Olson R, McLay M, Hamm J, Callaghan RC. Identification of Tobacco-Related Cancer Diagnoses among Individuals with Psychiatric Disorders: A Population-Based Matched Cohort Study Using a Competing Risks Approach from British Columbia. Curr Oncol 2021; 28:4953-4960. [PMID: 34898588 PMCID: PMC8628717 DOI: 10.3390/curroncol28060415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/15/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Individuals with psychiatric disorders (PD) have a high prevalence of tobacco use. Therefore, we assessed the hazard of receiving a tobacco-related (TR) cancer diagnosis among individuals with PD. METHODS Several population-based provincial databases were used to identify individuals in BC diagnosed with depression, schizophrenia, bipolar disorder, anxiety disorders, or multiple PD between 1990 and 2013. A primary population proxy comparison group (appendicitis) was also identified and matched to the psychiatric cohort based on age at cohort entry, gender, year of cohort entry, and postal code. We linked individuals in the cohort and comparison groups with the BC Cancer Registry. Using a competing risks approach, we estimated the effect of having a PD on the risk of receiving a TR cancer diagnosis, in light of the competing risk of mortality. RESULTS In total, 165,289 patients were included. Individuals with depression (HR = 0.81; p < 0.01; 95% CI: 0.73-0.91), anxiety disorders (HR = 0.84; p = 0.02; 95% CI: 0.73-0.97), or multiple PD (HR = 0.74; p < 0.01; 95% CI: 0.66-0.83) had a statistically significant lower risk of a TR cancer diagnosis compared to the comparison group. Individuals with schizophrenia (HR = 0.86; p = 0.40; 95% CI: 0.62-1.21) or bipolar disorder (HR = 0.58; p = 0.12; 95% CI: 0.29-1.14), however, showed no evidence of a statistically significant difference from the comparison group. INTERPRETATION We found that individuals with depression, anxiety disorders, or multiple PD diagnoses had a significantly reduced risk of receiving a tobacco-related cancer diagnosis. These results were unexpected and could be explained by individuals with a PD having barriers to a cancer diagnosis rather than a true decreased incidence.
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Affiliation(s)
- Robert Olson
- Department of Radiation Oncology, BC Cancer—Prince George, 1215 Lethbridge Street, Prince George, BC V2M 7E9, Canada
- Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Northern Medical Program, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada;
| | - Mary McLay
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Jeremy Hamm
- Department of Statistics, BC Cancer—Vancouver, Vancouver, BC V5Z 4E6, Canada;
| | - Russell C. Callaghan
- Northern Medical Program, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada;
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Szeliga A, Stefanowski B, Meczekalski B, Snopek M, Kostrzak A, Smolarczyk R, Bala G, Duszewska A, Smolarczyk K, Maciejewska-Jeske M. Menopause in women with schizophrenia, schizoaffective disorder and bipolar disorder. Maturitas 2021; 152:57-62. [PMID: 34674808 DOI: 10.1016/j.maturitas.2021.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 01/07/2023]
Abstract
The transition to menopause, usually occurring between the ages of 40 and 55, is a time when women are particularly vulnerable. When preexisting mental illness is present, symptoms are often amplified during this period. Moreover, women with mental illnesses experience menopausal symptoms similarly to healthy women. In this narrative review we summarize the current data regarding menopause in women with schizophrenia, schizoaffective disorder, and bipolar disorder, as well as current standards of management and care. The management of chronic disease in women suffering from severe mental illness is also considered.
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Affiliation(s)
- Anna Szeliga
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Bogdan Stefanowski
- First Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland.
| | - Milena Snopek
- First Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
| | - Anna Kostrzak
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Roman Smolarczyk
- Department of Gynecological Endocrinology, Warsaw Medical University, 00-315 Warsaw, Poland
| | - Gregory Bala
- Appletree Medical Group, 2150 Robertson Rd., Ottawa, Ontario, Canada
| | - Anna Duszewska
- Division of Histology and Embryology, Department of Morphological Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, Warsaw, Poland
| | - Katarzyna Smolarczyk
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland.
| | - Marzena Maciejewska-Jeske
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
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Schnitzer K, AhnAllen C, Beck S, Oliveira Y, Fromson J, Evins A. Multidisciplinary barriers to addressing tobacco cessation during an inpatient psychiatric hospitalization. Addict Behav 2021; 120:106988. [PMID: 34051645 DOI: 10.1016/j.addbeh.2021.106988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
Tobacco use and resultant health complications disproportionately impact individuals with psychiatric disorders. Inpatient psychiatric hospitalizations provide an opportunity to initiate tobacco treatment. In this study, electronic medical record review identified demographic and clinical information, smoking status, and tobacco cessation treatment offered for adults hospitalized on two acute, non-smoking psychiatric units in Massachusetts from January 2016 to March 2018. We additionally conducted semi-structured interviews with 15 inpatient nursing, psychiatry, psychology and social work providers regarding their tobacco cessation treatment practices and perceived facilitators and barriers to addressing tobacco use on psychiatric inpatient units. Chart review identified 1099 of 3140 (35%) people admitted reporting daily tobacco smoking. On discharge, 5 (0.005%) of inpatient smokers received a prescription for varenicline, 43 (0.04%) for dual-nicotine replacement therapy, 211 (19.2%) for nicotine patch, and 5 (0.005%) for bupropion. Barriers to inpatient smoking cessation treatment initiation identified in qualitative interviews included: 1) smoking cessation as low priority, 2) smoking cessation as the responsibility of outpatient providers, 3) lack of education about tobacco treatment, and 4) treatment discussions framed as preventing withdrawal. Given the potential to impact a large percentage of psychiatric tobacco users, future interventions should investigate provision of tobacco cessation counseling and pharmacotherapy in inpatient settings, with interventions that take into account the barriers and opportunities presented in this study.
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Moe AM, Keller-Hamilton B, Lee A, Breitborde NJK, Ferketich AK. Perceptions of smoking cessation and a novel psychosocial intervention for quitting among individuals with psychosis: A qualitative study. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2738-2752. [PMID: 34021909 DOI: 10.1002/jcop.22607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
Individuals diagnosed with psychosis have high rates of smoking-related morbidity and early mortality. Only a small proportion of these smokers will attempt to quit, and many existing cessation interventions have limited effectiveness. To explore the unique and potentially unmet cessation needs of individuals with psychosis, we sought first-person experiences with smoking cessation and reactions to a proposed intervention. Twenty-four smokers with psychosis participated in focus group interviews. Multiple participants reported previous quit attempts using pharmacotherapy or behavioral methods, but few indicated they had previously tried cessation counseling. Though some individuals reported modest success with cessation, most participants tended to express negative perceptions of many available cessation approaches. When informed about the development of a novel smoking cessation intervention, participants had mixed but generally positive perceptions. Smokers diagnosed with psychosis are interested in sustained, individualized delivery of cessation services as part of their broader mental health care.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | | | - Angela Lee
- College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Amy K Ferketich
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
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An Open Trial of Metacognitive Remediation Therapy and Pharmacotherapy to Promote Smoking Cessation among Individuals with Psychotic-Spectrum Disorders. J Smok Cessat 2021; 2021:6617716. [PMID: 34429783 PMCID: PMC8337155 DOI: 10.1155/2021/6617716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/22/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Individuals with psychotic-spectrum disorders may smoke due to the ameliorating effect of nicotine on the cognitive deficits that accompany these illnesses. Metacognitive remediation therapy (MCR) has been shown to produce improvements in cognitive functioning among individuals with psychotic-spectrum disorders and provides a foundation for a novel smoking cessation intervention for this population. Aims To complete an open investigation of pharmacotherapy and a modified version of MCR [MCR to Quit (MCR-Q)] in promoting smoking cessation among individuals with psychotic-spectrum disorders. Methods Forty-nine individuals with a psychotic-spectrum disorder and who currently smoke cigarettes participated in MCR-Q while also receiving evidence-based smoking cessation pharmacotherapy. Tobacco use was assessed as follows: (i) prior to MCR-Q, (ii) immediately after completing MCR-Q, and (iii) six weeks after completion of MCR-Q. Results /Findings. During participation in MCR-Q, nearly 80% of participants made a 24-hour quit attempt. Following the completion of MCR-Q, participants experienced reductions in level of nicotine dependency and exhaled carbon monoxide, with reductions in nicotine dependency sustained six weeks after completion of MCR-Q. Over the course of their participation in MCR-Q, participants reported strong therapeutic alliance with their MCR-Q therapist and high levels of intrinsic motivation with regard to completing MCR-Q exercises. Conclusions The results from the current study suggest cautious optimism with regard to the use of MCR-Q in combination with medication for individuals with psychotic-spectrum disorders who want to quit smoking.
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Tobacco Use Predicts Treatment Dropout and Outcome in an Acute, Transdiagnostic Psychiatric Treatment Setting. Behav Ther 2021; 52:897-906. [PMID: 34134829 DOI: 10.1016/j.beth.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022]
Abstract
Tobacco use is consistently associated with greater levels of depression and anxiety, broadly, and preliminary evidence suggests that current tobacco use is a significant predictor of dropout from psychiatric treatment. The current study extends past work to examine the impact of tobacco use on treatment dropout and outcomes in an acute psychiatric treatment setting. Upon intake to a partial hospitalization program (PHP), patients completed a battery of measures assessing sociodemographic characteristics, current tobacco use, depression and generalized anxiety, and substance use. Patients at the PHP also completed measures assessing levels of depression and generalized anxiety again upon discharge from the program. In line with hypotheses, current tobacco use was a significant predictor of dropout from treatment at the PHP. Importantly, this relationship remained significant when statistically controlling for demographic variables and psychiatric and substance use severity (such as number of previous inpatient psychiatric hospitalizations and degree of alcohol or drug problems). Results from the current study indicate that tobacco use is a significant risk factor for treatment dropout. Further research is needed to replicate these findings and to determine the mechanism underlying this link between tobacco use and treatment dropout for people receiving intensive psychiatric care.
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50
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Hawes MR, Roth KB, Cabassa LJ. Systematic Review of Psychosocial Smoking Cessation Interventions for People with Serious Mental Illness. J Dual Diagn 2021; 17:216-235. [PMID: 34281493 PMCID: PMC8647929 DOI: 10.1080/15504263.2021.1944712] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tobacco smoking is a major driver of premature mortality in people with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder). This systematic literature review described randomized control trials of psychosocial smoking cessation interventions for people with SMI, rated their methodological rigor, evaluated the inclusion of racial/ethnic and sexual/gender minorities, and examined smoking cessation outcomes. Methods: Eligible studies included peer-reviewed articles published between 2009 and 2020 that examined psychosocial smoking cessation interventions in people with SMI. We used the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines to conduct our review and the Methodological Quality Rating Scale to evaluate methodological rigor. Results: Eighteen studies were included. Ten were categorized as high methodological rigor given their study characteristics (e.g., longer follow-up) and eight as lower methodological rigor based on their characteristics (e.g., not intent-to-treat). Racial/ethnic and sexual/gender minorities were under-represented in these studies. A range of psychosocial interventions were examined including motivational enhancements, smoking cessation education, cognitive behavioral strategies, and contingency management. Most studies also provided smoking cessation medications (e.g., NRT, bupropion), although provision was not always uniform across treatment conditions. Three studies found the intervention condition achieved significantly higher abstinence from smoking compared to the comparison group. Seven studies found the intervention condition achieved significantly higher reductions in smoking compared to the comparison group. Conclusions: Studies finding significant differences between the intervention and comparison groups shared common evidenced-based components, including providing smoking cessation medications (e.g., NRT, bupropion), motivational enhancement techniques, and cessation education and skills training, but differed in intensity (e.g., number and frequency of sessions), duration, and modality (e.g., group, individual, technology). Methodological limitations and a small number of studies finding significant between-group differences prevent the identification of the most effective psychosocial smoking cessation interventions. Clinical trial designs (e.g., SMART, factorial) that control for the provision of psychosocial medications and allow for the identification of optimal psychosocial treatments are needed. Future studies should also ensure greater inclusion of racial/ethnic and sexual/gender minorities and should be culturally/linguistically adapted to improve treatment engagement and study outcomes.
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Affiliation(s)
- Mark R Hawes
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kimberly B Roth
- Department of Community Medicine, Mercer University School of Medicine, Savannah, Georgia, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
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