Smoking and Smoking Cessation in those with Mental Health Difficulties in Ireland

Background: There is a higher prevalence of smoking among individuals with mental health difficulties (MHDs) internationally. This thesis aimed to establish impact of smoking on those with MHDs in Ireland in terms of smoking-related diseases and to evaluate current cessation care in both secondary and community mental health (MH) settings, using three interrelated studies guided by the Medical Research Council framework.

Methods: Study 1, a cross-sectional retrospective secondary analysis (n=8,175), established the prevalence of smoking and smoking-related disease in a nationally representative sample of community living adults aged 50 and over. Individuals with evidence of MHDs were compared to their general population counterparts through adjusted regression analyses, including mediation and moderation assessments. In study 2 cessation care in MH settings was explored. A survey of inpatients (n=246) with 3-month follow-up established current levels of care and quit rates in a private inpatient setting. Finally, study 3 involved a qualitative process evaluation of the recent implementation of a community-based smoking cessation service in public adult MH centres, involving interviews with 20 service users and 4 focus groups with 17 facilitators.

Results: Older adults with MHDs had increased prevalence of smoking ((25-39%) RRRs 1.84 [1.50 to 2.26] to 4.31 [2.47 to 7.53]) and of smoking-related disease ((53-60%) ORs 1.24 [1.01 to 1.51] to 1.62 [1.00 to 2.62]). Very few psychiatric inpatients report cessation advice from any HCP in the past year (13%), but numbers wanting to quit (75%) and 3-month quit rates (17%) are similar to non-psychiatric inpatient samples. Key enablers and barriers emerged at facilitator and participant levels in community MH centres, which also have implications for other settings.

Conclusions: Individuals with MHDs are disproportionately impacted by smoking yet remain undertreated. While cessation care is improving in community settings, a joined-up approach across all sectors of the health service is needed.