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      Cessation support for smokers with mental health problems: a survey of resources and training needs

      brief-report

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          Abstract

          Aims

          Around thirty percent of smokers have a mental health problem. Smoking cessation has been associated with mental health benefits, but smoking prevalence remains high in populations with mental health problems. This study aimed to assess mental health related knowledge, practice, and training needs of practitioners supporting smoking cessation.

          Methods

          UK stop smoking practitioners ( n = 717) recruited via a database of a national provider of smoking cessation training in June 2016 sufficiently completed an online survey about available resources, knowledge, confidence, and training needs related to smoking cessation and mental health. Responses were described and compared between practitioners with a mental health lead and those without such a lead in their service using chi-square statistics and t-tests.

          Results

          A considerable proportion agreed (37%) or were undecided (28.9%) that smoking helped people with mental health problems feel better and agreed (17.2%) or were undecided (30.2%) that cessation would exacerbate mental health symptoms. Only 11.6% said their service had designated funding for smokers with mental health problems and 26.5% were or had a staff member who was a dedicated lead practitioner for mental health work. Practitioners from services that had a dedicated mental health lead were more confident in supporting smokers with different mental health problems and using different pharmacotherapies (all p < 0.001) and were more likely to disagree that cessation was detrimental ( p = 0.001). A majority of practitioners were interested in training, particularly about smoking cessation effects on psychiatric medication (84.3% of n = 632) and how to tailor stop smoking support to clients with mental health problems (82.4%).

          Conclusion

          Practitioners who support smoking cessation have limited knowledge about mental health and smoking but are willing to learn and improve. However, they are hindered by a lack of resources.

          Highlights

          • •

            Smokers with mental health problems benefit hugely from smoking cessation.

          • •

            However, these smokers encounter multiple barriers when looking for cessation support.

          • •

            Stop smoking clinics lack resources to provide tailored support for these smokers.

          • •

            Cessation practitioners want to expand their limited knowledge on mental health.

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          Most cited references42

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          Validation of the theoretical domains framework for use in behaviour change and implementation research

          James Cane, Denise O’Connor, Susan Michie (2012)
          Background An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research, has been applied across a wide range of clinical situations. This study tests the validity of this framework. Methods Validity was investigated by behavioural experts sorting 112 unique theoretical constructs using closed and open sort tasks. The extent of replication was tested by Discriminant Content Validation and Fuzzy Cluster Analysis. Results There was good support for a refinement of the framework comprising 14 domains of theoretical constructs (average silhouette value 0.29): ‘Knowledge’, ‘Skills’, ‘Social/Professional Role and Identity’, ‘Beliefs about Capabilities’, ‘Optimism’, ‘Beliefs about Consequences’, ‘Reinforcement’, ‘Intentions’, ‘Goals’, ‘Memory, Attention and Decision Processes’, ‘Environmental Context and Resources’, ‘Social Influences’, ‘Emotions’, and ‘Behavioural Regulation’. Conclusions The refined Theoretical Domains Framework has a strengthened empirical base and provides a method for theoretically assessing implementation problems, as well as professional and other health-related behaviours as a basis for intervention development.
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            Making psychological theory useful for implementing evidence based practice: a consensus approach.

            S Michie, M. Johnston, C. Abraham … (2005)
            Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience. Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a "psychological theory" group (n = 18), a "health services research" group (n = 13), and a "health psychology" group (n = 30). Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour. A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.
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              Change in mental health after smoking cessation: systematic review and meta-analysis

              Gemma Taylor, Ann McNeill, Alan Girling … (2014)
              Objective To investigate change in mental health after smoking cessation compared with continuing to smoke. Design Systematic review and meta-analysis of observational studies. Data sources Web of Science, Cochrane Central Register of Controlled Trials, Medline, Embase, and PsycINFO for relevant studies from inception to April 2012. Reference lists of included studies were hand searched, and authors were contacted when insufficient data were reported. Eligibility criteria for selecting studies Longitudinal studies of adults that assessed mental health before smoking cessation and at least six weeks after cessation or baseline in healthy and clinical populations. Results 26 studies that assessed mental health with questionnaires designed to measure anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect, and stress were included. Follow-up mental health scores were measured between seven weeks and nine years after baseline. Anxiety, depression, mixed anxiety and depression, and stress significantly decreased between baseline and follow-up in quitters compared with continuing smokers: the standardised mean differences (95% confidence intervals) were anxiety −0.37 (95% confidence interval −0.70 to −0.03); depression −0.25 (−0.37 to −0.12); mixed anxiety and depression −0.31 (−0.47 to −0.14); stress −0.27 (−0.40 to −0.13). Both psychological quality of life and positive affect significantly increased between baseline and follow-up in quitters compared with continuing smokers 0.22 (0.09 to 0.36) and 0.40 (0.09 to 0.71), respectively). There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders. Conclusions Smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. The effect size seems as large for those with psychiatric disorders as those without. The effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders.
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                Author and article information

                Contributors
                Erikas Simonavicius
                Journal
                Journal ID (nlm-ta): J Subst Abuse Treat
                Journal ID (iso-abbrev): J Subst Abuse Treat
                Title: Journal of Substance Abuse Treatment
                Publisher: Pergamon Press
                ISSN (Print): 0740-5472
                ISSN (Electronic): 1873-6483
                Publication date PMC-release: 1 September 2017
                Publication date (Print): September 2017
                Volume: 80
                Pages: 37-44
                Affiliations
                [a ]Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
                [b ]National Centre for Smoking Cessation and Training, 1 Great Western Industrial Centre, Dorchester, United Kingdom
                [c ]UK Centre for Tobacco and Alcohol Studies, United Kingdom
                Author notes
                [* ]Corresponding author at: Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London SE5 8BB, United Kingdom.Department of AddictionsInstitute of Psychiatry, Psychology and NeuroscienceKing's College London4 Windsor WalkLondonSE5 8BBUnited Kingdom erikas.simonavicius@ 123456kcl.ac.uk
                Article
                Publisher ID: S0740-5472(17)30034-X
                DOI: 10.1016/j.jsat.2017.06.008
                PMC ID: 5555355
                PubMed ID: 28755771
                SO-VID: 3ad110cb-9312-4d1b-bc1f-6305809c8ee0
                Copyright © © 2017 The Authors. Published by Elsevier B.V.
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 17 January 2017
                Date revision received : 27 June 2017
                Date accepted : 28 June 2017
                Categories
                Subject: Brief Article

                Keywords: smoking cessation,mental health,mental disorders,stop smoking services,preventive health services
                Data availability:
                Keywords: smoking cessation, mental health, mental disorders, stop smoking services, preventive health services

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