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Smoking cessation in severe mental ill health: what works? an updated systematic review and meta-analysis
Open accessAbstract
BACKGROUND: People with severe mental ill health are more likely to smoke than those in the general population. It is therefore important that effective smoking cessation strategies are used to help people with severe mental ill health to stop smoking. This study aims to assess the effectiveness and cost -effectiveness of smoking cessation and reduction strategies in adults with severe mental ill health in both inpatient and outpatient settings. METHODS: This is an update of a previous systematic review. Electronic databases were searched during September 2016 for randomised controlled trials comparing smoking cessation interventions to each other, usual care, or placebo. Data was extracted on biochemically-verified, self-reported smoking cessation (primary outcome), as well as on smoking reduction, body weight, psychiatric symptom, and adverse events (secondary outcomes). RESULTS: We included 26 trials of pharmacological and/or behavioural interventions. Eight trials comparing bupropion to placebo were pooled showing that bupropion improved quit rates significantly in the medium and long term but not the short term (short term RR = 6.42 95% CI 0.82-50.07; medium term RR = 2.93 95% CI 1.61-5.34; long term RR = 3.04 95% CI 1.10-8.42). Five trials comparing varenicline to placebo showed that that the addition of varenicline improved quit rates significantly in the medium term (RR = 4.13 95% CI 1.36-12.53). The results from five trials of specialised smoking cessation programmes were pooled and showed no evidence of benefit in the medium (RR = 1.32 95% CI 0.85-2.06) or long term (RR = 1.33 95% CI 0.85-2.08). There was insufficient data to allowing pooling for all time points for varenicline and trials of specialist smoking cessation programmes. Trials suggest few adverse events although safety data were not always reported. Only one pilot study reported cost effectiveness data. CONCLUSIONS: Bupropion and varenicline, which have been shown to be effective in the general population, also work for people with severe mental ill health and their use in patients with stable psychiatric conditions. Despite good evidence for the effectiveness of smoking cessation interventions for people with severe mental ill health, the percentage of people with severe mental ill health who smoke remains higher than that for the general population.
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Smoking cessation treatments, such as nicotine replacement therapy, varenicline and bupropion, are well-established, safe and effective interventions.
“Smoking cessation treatments, such as nicotine replacement therapy, varenicline and bupropion are well-established, safe and effective interventions (Gilbody et al., 2019; Peckham et al., 2017).”
From The impact of cigarette smoking on life expectancy in schizophrenia, schizoaffective disorder and bipolar affective disorder: An electronic case register cohort study (2021) · cites this paper as Peckham et al., 2017
The Abstract Results and Discussion report that bupropion and varenicline improved quit rates in people with severe mental ill health. The claim is broader than the evidence for all three treatments: the review included only one NRT study, and its Results say adverse-event reporting was incomplete, so it does not establish that all three are safe and effective. (LLM, conf=0.86)
Experimental — accuracy not yet measuredStopping smoking does not cause deterioration in mental health among those with mental illness.
“a consistent body of work shows that stopping smoking does not cause deterioration in mental health among those with mental illness (an assumption which can sometimes be a barrier towards implementation in clinical settings) 98”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [98]
The Results (Secondary outcomes; page not provided) report no significant worsening of psychiatric symptoms in the intervention groups, and the Discussion says quitting did not appear to worsen participants’ mental state. The claim is more definitive and broader than the review: it concerns mainly psychiatrically stable people with severe mental ill health, and the authors say generalisation to acutely unwell people is unclear. (LLM, conf=0.88)
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Metadata
- Authors
- Peckham, E., Brabyn, S., Cook, L., Tew, G., & Gilbody, S.
- Affiliations
- University of York (GB)
- Northumbria University (GB)
- Corresponding author
- Peckham, Emily
- Venue
- BMC Psychiatry
- Published
- 2017-07-14
- Volume
- 17
- Issue
- 1
- Pages
- 252-252
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC5513129
- OpenAlex
- W2735454909
- Cited by
- 169
- References
- 50
- Citations by year
- 2026: 8 · 2025: 20 · 2024: 22 · 2023: 28 · 2022: 24 · 2021: 17 · 2020: 21 · 2019: 18 · 2018: 10 · 2017: 1
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Northumbria Research Link (Northumbria University) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Research at York St John (York St John 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
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- smoking cessation, severe mental illness, bupropion, varenicline, smoking cessation interventions, smoking reduction, cost-effectiveness, body weight, psychiatric symptoms, adverse events, pharmacological interventions, behavioral interventions, inpatient and outpatient settings, quit rates, nicotine dependence, mental health services funding
- MeSH terms
- Varenicline, Mental Disorders, Cost-Benefit Analysis, Drug Therapy, Combination, Humans, Smoking, Smoking Cessation, Bupropion, Antidepressive Agents, Second-Generation, Nicotinic Agonists
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