Cited by 301Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesBehavioral Health and Interventions

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Assessing motivation to quit smoking in people with mental illness: a review

Siru, Ranita, Hulse, Gary K., Tait, Robert J.·2009·Addiction

DOI 10.1111/j.1360-0443.2009.02545.x

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Abstract

Background People with mental health (MH) disorders smoke at higher rates, are more nicotine‐dependent and suffer greater morbidity and mortality from smoking‐related illnesses than the general population. Helping these people to quit smoking is a public health priority; however, many MH professionals assume that those with mental illness are not motivated to quit. Objectives To use predetermined criteria to identify, review critically and evaluate empirically all English language, peer‐reviewed data on motivation to quit smoking in MH populations. Methods A systematic search was conducted and key data on subject characteristics, measures of motivation and other variables abstracted. χ 2 analyses were used to compare motivation between MH and general populations, between in‐patients and out‐patients and between people with depression and people with psychotic disorders. Results Evidence suggests that people with MH disorders are as motivated to quit smoking as the general population, although those with psychotic disorders may be less motivated than individuals with depression. Although readiness to cease smoking was assessed in 14 studies, only two evaluated motivation to quit smoking in in‐patient populations. Conclusions People with MH disorders are motivated to quit smoking, although more research is needed looking at in‐patient populations. The commonly held false belief that people with MH disorders are not motivated to cease smoking means that opportunities to encourage smoking cessation among this disenfranchised group are being missed.

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“People with a severe mental illness are as motivated to quit smoking as the general population [35] and motivation to quit smoking waxes and wanes throughout ongoing treatment for smoking cessation.”
Background
Evaluation of Community-Based Cessation Programs: How Do Smokers with Behavioral Health Conditions Fare?
Meernik, C., McCullough, A., Ranney, L. M., Walsh, B., & Goldstein, A. O. (2017) · Community Mental Health Journal · doi:10.1007/s10597-017-0155-2 · Cited by 7
Multimethod Formative Research to Improve the Training and Delivery of Tobacco-cessation Interventions in Behavioral Health Settings
Allen, A. M., Muramoto, M. L., Campbell, J., Connolly, T. E., McGuffin, B. A., & Bernstein, A. D. (2019) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000522 · Cited by 7
“It is estimated that significantly more clients are in the contemplation or preparation stage of change for smoking cessation as compared with the general population (57% vs 43%, respectively) (Siru et al., 2009).”
Background
Dying to Quit: Understanding the Burden of Tobacco in Psychiatric Patients—A Clinical Review
Sprenger, S., & ANDERSON, J. S. (2024) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000764 · Cited by 6
“41,42 Explaining the causes of the incongruity between provider beliefs and the data requires an understanding of historical explanations for the association between mental illness and smoking.”
BackgroundInfluential
Smoking and Mental Illness: Strategies to Increase Screening, Assessment, and Treatment
Ziedonis, D. M., Das, S., & Tonelli, M. E. (2015) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20150008 · Cited by 6
“Smokers with mental illness are often “heavy smokers,” consuming relatively larger amounts of nicotine per day and often requiring higher levels of nicotine replacement medication (Table 1 [26–44]).”
Background
Comparison of Perceptions and Smoking Cessation Experiences Between Smokers With and Without Serious Mental Illness in a Large Health Maintenance Organization
Kertes, J., Neumark, Y. D., Grunhaus, L. J., & Stein-Reisner, O. (2021) · Journal of Dual Diagnosis · doi:10.1080/15504263.2021.1979348 · Cited by 6
Staff perspectives on smoking cessation treatment in German psychiatric hospitals
Cerci, D. (2023) · Journal of Public Health · doi:10.1007/s10389-022-01811-2 · Cited by 6
“While studies show that psychiatric patients are just as motivated to quit smoking as smokers without a history of mental health problems (Siru et al. 2009), 90% of staff participating in the survey rated their patients’ motivation to quit smoking as low or very low.”
Screening for incontinence in a secure psychiatric service for women
Long, C. G., West, R., Siddique, R., Rigg, S., Banyard, E., Stillman, S., Butler, S. B., & Dolley, O. (2015) · International Journal of Mental Health Nursing · doi:10.1111/inm.12141 · Cited by 6
Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial
Ballbè, M., Martínez, C., Feliu, A., Torres, N., Nieva, G., Pinet, C., Raich, A., Mondón, S., Barrio, P., Hernández‐Ribas, R., et al. (2019) · Trials · doi:10.1186/s13063-018-3106-5 · Cited by 6
Proactive tobacco treatment for individuals with and without a mental health diagnosis: Secondary analysis of a pragmatic randomized controlled trial
Japuntich, S. J., Sherman, S. E., Joseph, A. M., Clothier, B. A., Noorbaloochi, S., Danan, E. R., Burgess, D. J., Rogers, E., & Fu, S. S. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.07.024 · Cited by 6
“…the proactive intervention among smokers with MHDX. Consistent with previous work (Aubin, Rollema, Svensson, &Winterer, 2012; Bowden et al., 2011; Siru et al., 2009), we found that smokers with MHDX reported similar motivation to quit as those without, suggesting that lack of motivation did not…”
Result
Addressing Tobacco Use Disorder in Individuals With Mental Health Disorders: The Critical Role of Nurses
Boonstra, N., & Spoelstra, S. K. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16646 · Cited by 5
“…health professionals, including nurses, that individuals with SMIs lack motivation to quit smoking, research shows that people with SMIs are often just as motivated, if not more motivated, to quit smoking compared to the general population (Szatkowski and McNeill 2015; Siru, Hulse, and Tait 2009).”
The prevalence of mental health problems among users of NHS stop smoking services: effects of implementing a routine screening procedure
McNally, L. M., Todd, C., & Ratschen, E. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-190 · Cited by 5
“Review level evidence suggests that levels of motivation to quit smoking among people with mental health conditions can be comparable to that found within the general population [4].”
Background
State Clean Indoor Air Laws and smoking among adults with poor mental health
Larson, A. E., Bovbjerg, V. E., & Luck, J. (2016) · Journal of Public Health Policy · doi:10.1057/jphp.2016.17 · Cited by 5
“Despite the slower decrease in rates of smoking between those with FMD as compared the general population, Siru et al found persons with mental illness to be as motivated to quit smoking as those without.(33) CIALs, however, appear to do little to support that behavior change.”
Method
Smokefree mental health inpatient settings – a matter of debate?
Ratschen, E. (2019) · SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice · doi:10.1024/0939-5911/a000576 · Cited by 5
Smoking-Related Health Beliefs in a Sample of Psychiatric Patients: Factors Associated with the Health Beliefs and Validation of the Health Belief Questionnaire
Asharani, P. V., Lau, J. H., Seet, V. A. L., Devi, F., Wang, P., Roystonn, K., Lee, Y. Y., Cetty, L., Teh, W. L., Verma, S. K., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18041571 · Cited by 5
“have similar motivations to quit smoking as the general population [31].”
Background
Le tabagisme en psychiatrie : réalités et implications pour sa prise en charge
Ketterer, F., Roelandt, J.-L., & Chevreul, K. (2022) · Santé Publique · doi:10.3917/spub.225.0643 · Cited by 5
Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Protocol for a Prepost Intervention Study
Dickerson, F., Goldsholl, S., Yuan, C. T., Dalcin, A., Eidman, B., Minahan, E., Gennusa, J. V., Mace, E., Cullen, B., Evins, A. E., et al. (2023) · JMIR Research Protocols · doi:10.2196/44787 · Cited by 5
“In general, US smoking rates have declined dramatically over the past 50 years, but smoking has persisted at consistently high rates among those with SMI [7,8], even though the majority of persons with SMI who smoke would like to quit [9].”
Using the lever of parity of esteem between mental and physical health to close the mental health gap -a call for action
Bailey, S., Thorpe, L. N., & Smith, G. (2013) · International Psychiatry · doi:10.1192/s1749367600003829 · Cited by 5
Smoking Cessation Among People Seeking Mental Health Treatment
Shi, Y. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300444 · Cited by 5
Pilot Implementation of a Wellness and Tobacco Cessation Curriculum in North Carolina Group Homes
Baker, H., Ranney, L. M., & Goldstein, A. O. (2015) · Community Mental Health Journal · doi:10.1007/s10597-015-9975-0 · Cited by 5
“Despite these barriers, research shows that adults with mental illness are motivated to quit and they quit with rates similar to the general population when evidence-based cessation interventions are used (Lasser et al. 2000; Siru et al. 2009; El-Guebaly et al. 2002).”
Background
Correlates of Tobacco Use Among People with Mental Illness Within Asia: A Scoping Review
Parul, P., Joseph, B., Datta, S., & Rahman, M. A. (2024) · Community Mental Health Journal · doi:10.1007/s10597-024-01336-w · Cited by 4
“…among people with mental illness, and the general population showed that people with mental illness were the least motivated to quit smoking (Siru et al., 2009) which was evident in the present scoping review among participants through statements such as the use of tobacco for pleasure or…”
Smoking cessation among people with mental illness: A South African perspective
Morar, T., & Robertson, L. J. (2022) · South African Family Practice · doi:10.4102/safp.v64i1.5489 · Cited by 4
Prevalence of depressive symptoms and cannabis use among adult cigarette smokers in Canada: cross-sectional findings from the 2020 International Tobacco Control Policy Evaluation Project Canada Smoking and Vaping Survey
Gravely, S. M. L., Driezen, P., McClure, E. A., Smith, D. M., & Fong, G. T. (2023) · CMAJ Open · doi:10.9778/cmajo.20220081 · Cited by 4
Associations of Cannabis Use, High-Risk Alcohol Use, and Depressive Symptomology with Motivation and Attempts to Quit Cigarette Smoking Among Adults: Findings from the 2020 ITC Four Country Smoking and Vaping Survey
Gravely, S. M. L., Driezen, P., Shahab, L., McClure, E. A., Hyland, A. J., Cummings, K. M., East, K. A., Chan, G., Walsh, H., Benowitz, N. L., et al. (2023) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-023-01214-8 · Cited by 4
“…are highly motivated to quit smoking (Cooper et al., 2016; Haukkala et al., 2000; Kastaun et al., 2022; Lembke et al., 2007; Mendelsohn, 2012; Siru et al., 2009; Yimsaard et al., 2023), but are less successful in maintaining abstinence and/or recovering after a relapse compared to those…”
Does Quitting Smoking Affect Depressive Symptoms? A Longitudinal Study Based on Treatment-Seeking Smokers with a History of Depressive Episode
Moss-Alonso, E., Martínez-Vispo, C., López‐Durán, A., & Becoña, E. (2024) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-024-01317-w · Cited by 4
“In contrast to all the factors that may hinder smoking cessation, smokers with mental health issues seem to be as motivated to quit as the general population (Siru et al., 2009).”
Effectiveness and Experience of Implementing Digital Interventions to Promote Smoking Cessation Among Adults With Severe Mental Illness: A Systematic Review and Meta-analysis
Huddlestone, L., Shoesmith, E., Pervin, J., Stevens, R., Gilbody, S. M., & Ratschen, E. (2024) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntae237 · Cited by 4
“9 In recent years, there has been an expansion in the development and use of digital interventions to improve mental health and well-being.”
A retrospective analysis of the comparative effectiveness of smoking cessation medication among individuals with mental illness in community‐based mental health and addictions treatment settings
Okoli, C. T. C., Wiggins, A. T., Fallin‐Bennett, A., & Rayens, M. K. (2017) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12408 · Cited by 4
Comparison of Smoking Cessation Program Registration, Participation, Smoking Cessation Medication Utilization, and Abstinence Rates Between Smokers With and Without Schizophrenia, Schizo-affective Disorder, or Bipolar Disorder
Kertes, J., Stein-Reisner, O., Grunhaus, L. J., Nezry, R., Alcalay, T., Azuri, J., & Neumark, Y. D. (2021) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntab202 · Cited by 4
Prevalence and severity of tobacco use and access to tobacco cessation among tertiary care psychiatric in-patients in India
Badekar, A., Rajalu, B. M., Muliyala, K. P., Sharma, P., Chand, P., & Murthy, P. (2022) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_405_22 · Cited by 4
“[27,28] Patients with mental illness are less likely to receive interventions and there are perceptions among health workers that because of multiple impairments, quitting may be difficult for them.”
Texas tobacco quitline knowledge, attitudes, and practices within healthcare agencies serving individuals with behavioral health needs: A multimethod study
Britton, M., Rogova, A., Chen, T. A., Leal, I. M., Kyburz, B., Williams, T., Patel, M., & Reitzel, L. R. (2023) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2023.102256 · Cited by 4
“Adults with BHCs are interested in quitting tobacco at rates equivalent to the general population (Siru et al., 2009).”
Background
Patient Management and Psychopharmacological Treatment Associated to Smoking Ban in an Acute Psychiatric Unit
Bergé, D., Mané, A., Fonseca, F., Toll, A., Merino, A., Pérez, V., & Bulbena, A. (2014) · Community Mental Health Journal · doi:10.1007/s10597-014-9823-7 · Cited by 4
The Convention on the Rights of Persons with Disabilities as a tobacco control tool in the mental health setting
van der Eijk, Y. (2017) · Tobacco Control · doi:10.1136/tobaccocontrol-2017-053954 · Cited by 4
Feasibility of a Consumer Centred Tobacco Management intervention in Community Mental Health Services in Australia
Johnson, S. E., Mitrou, F., Lawrence, D. M., Zubrick, S. R., Wolstencroft, K., Ennals, P., Hall, C., & McNaught, E. (2020) · Community Mental Health Journal · doi:10.1007/s10597-020-00573-z · Cited by 4
“Despite low cessation rates, people suffering mental disorders are just as motivated to quit smoking as people without mental illness (Annamalai et al. 2015; Prochaska et al. 2017; Siru et al. 2009).”
Background
The Biopsychosocial and Spiritual Perspective on the Readiness to Quit Smoking: A Comprehensive Review
Mohamed, M. H., Voo, P., Maakip, I., & Robinson, F. (2022) · Malaysian Journal of Social Sciences and Humanities (MJSSH) · doi:10.47405/mjssh.v7i3.1315 · Cited by 4
“Most worrying is that even though they are highly motivated, their mental health problems will prevent them from quitting smoking and cause the number of smokers to not decrease (Siru et al., 2009; Chesney 2014).”
Background
Treating nicotine dependence in mental health hospitals
Wye, P. M., Bowman, J., Wiggers, J. H., Freund, M., Wolfenden, L., & Stockings, E. (2011) · Mental Health and Substance Use · doi:10.1080/17523281.2011.555077 · Cited by 4
“In a review of hospitalised patients (both patients with mental illness and those without), motivation to cease smoking and use of nicotine replacement therapy (NRT) while hospitalised were similar across both groups; however, it was concluded that the low provision of post-discharge NRT may have contributed to the po…”
Result

Authors: Siru, R., Hulse, G. K., & Tait, R. J.
Affiliations: The University of Western Australia (AU)
Corresponding author: Hulse, Gary K.
ORCID: Siru, Ranita
Hulse, Gary K.
Tait, Robert J.
Venue: Addiction
Publisher: Wiley
Published: 2009-04-07
Volume: 104
Issue: 5
Pages: 719-733
ISSN: 0965-2140 (ISSN-L)
1360-0443
DOI: 10.1111/j.1360-0443.2009.02545.x
OpenAlex: W2033726919
Cited by: 301
References: 93
Citations by year: 2026: 8 · 2025: 14 · 2024: 14 · 2023: 22 · 2022: 26 · 2021: 16 · 2020: 20 · 2019: 18 · 2018: 21 · 2017: 19 · 2016: 23 · 2015: 21 · 2014: 19 · 2013: 20 · 2012: 12
FWCI: 8.61
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Addiction (publishedVersion)
PubMed (publishedVersion)
UWA Profiles and Research Repository (UWA) (submittedVersion)
eSpace (Curtin University) (submittedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords: smoking cessation, smoking cessation motivation, mental illness, nicotine dependence, depression, psychosis, hospitalized patients, outpatients, readiness to quit
MeSH terms: Smoking Prevention, Mental Disorders, Hospitalization, Humans, Motivation, Smoking, Randomized Controlled Trials as Topic, Smoking Cessation

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Assessing motivation to quit smoking in people with mental illness: a review

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