University of Southern Denmark Effectiveness of the Gold Standard Programme (GSP) for smoking cessation on smokers with and without a severe mental disorder

Objectives We compared the effectiveness of an intensive smoking cessation intervention among smokers with and without a severe mental disorder (SMD) and identified factors associated with successful quitting. The main hypothesis was that smokers with an SMD would be less likely to stay continuously smoke-free for 6 months. Design A prospective cohort study. setting In all, 302 smoking cessation clinics in Denmark from municipal clinics, pharmacies, hospitals, midwives, primary care facilities and other private providers who reported data to the national Danish Smoking Cessation Database from 2006 to 2016 participated in this study. Participants A total of 38 293 patients from the Danish Smoking Cessation Database. Patients with an SMD were identified by linking data to the Danish National Patient Register. Diagnoses of organic mental disorders (F0 chapter) or intellectual disabilities (F7 chapter) were not included. Smokers ≥18 years old who were attending a Gold Standard Programme (GSP) with planned followup were included. Smokers not wanting contact after 6 months were excluded. Interventions A comprehensive manual-based smoking cessation intervention comprising five meetings over a 6-week period (the GSP). Main outcome measures Self-reported continuous abstinence at the 6-month follow-up. results In all, 69% of the participants participated in the follow-up after 6 months. The overall rate of successful quitting was high but significantly lower in SMD smokers (29% vs 38%; OR 0.74; 95% CI 0.68 to 0.80). Variables associated with successful quitting were compliance (defined as attending ≥75% of the planned meetings), older age and male gender as well as not being disadvantaged, heavy smoking or recommendation of intervention by health professionals. Conclusions Only 29% of smokers with an SMD successfully quit smoking which was significantly lower than the 38% of smokers without an SMD. Compliance was the most important predictor for successful quitting. IntrODuCtIOn The prevalence of smoking among patients with mental illness is relatively high. 2 A Danish survey showed that 39% of patients with a mental illness were daily smokers compared with 20% of the general population. Furthermore, patients with mental illness were 2.5 times more likely to be heavy smokers. Overall, patients with a severe mental illness had reduced life expectancies of 15 and 20 years in women and men, respectively, and a recent study found that one-third of the 15 lost life years in smokers with a severe mental disorder (SMD) may be attributed to smoking. Based on observational studies, successful smoking cessation has been shown to improve mental health and reduce mortality and morbidity in patients with psychiatric issues. 6 Most smoking cessation interventions combine behavioural and pharmacological support. A recent review on the efficacy of smoking cessation intervention in patients with a severe mental illness concluded that bupropion and varenicline appear to be as effective in populations with psychiatric issues as in the strengths and limitations of this study ► This was a prospective cohort study based on 38 293 smokers with or without mental disorder(s). ► Quit rates at the 6-month follow-up were based on unvalidated self-reporting. ► When identifying smokers with psychiatric issues in this study, only smokers with a mental disorder severe enough to justify hospitalisation (inpatient or outpatient) were recognised. This cohort might contain patients with less severe mental disorder(s) (SMD/SMDs), who (in this study) were categorised as smokers without SMD. ► Participants with an SMD were included independent of the time span from diagnoses to intervention