A Systematic Review of Psychosocial Barriers and Facilitators to Smoking Cessation in People Living With Schizophrenia

Abstract

Background: People living with schizophrenia are less likely to quit smoking compared with the general population and people living with other psychiatric disorders. Understanding the schizophrenia-specific psychosocial barriers and facilitators to smoking cessation is important for designing effective smoking cessation interventions. We aimed to systematically review research examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia.Methods: We followed the PRISMA statement to conduct a systematic literature review examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia. We searched EMBASE, Medline, PsycINFO, and CINAHL databases from inception to 14 June 2018 to identify relevant articles. We included peer-reviewed original research articles that examined psychosocial barriers and facilitators to smoking cessation, as well as factors associated with maintenance of smoking habits in people living with schizophrenia spectrum disorders. Qualitative, quantitative, or mixed-methods study designs were included. Three authors screened titles, abstracts, and full-texts using the eligibility criteria. We conducted a narrative synthesis of the data to account for the heterogeneity of study designs. We analyzed qualitative and quantitative studies separately.Results: We identified 685 studies from our systematic search and screened the full-text of 134 articles. The final set of 23 articles included 20 quantitative studies and 3 qualitative studies. The most commonly cited barrier to smoking cessation in people living with schizophrenia was cravings and addiction, followed by a perceived increased risk of negative affect associated with quitting smoking. People living with schizophrenia reported smoking to manage stress and to maintain social relationships. People living with schizophrenia were found to be less likely to receive cessation support from health professionals than smokers without schizophrenia. Health concerns were the most commonly mentioned facilitator to quit smoking.Conclusions: People living with schizophrenia experience a wide range of barriers to smoking cessation. The influence of these barriers on smoking cessation likelihood may be greater among people living with schizophrenia than people without psychiatric disorders. Health professionals play an important role in smoking cessation for people living with schizophrenia and should consider barriers and facilitators identified in this review to support quitting in this vulnerable population.

Perceptions of Mobile Apps for Smoking Cessation Among Young People in Community Mental Health Care: Qualitative Study

“…Similar to other studies of adults with serious mental illness, in general [ 10 , 12 , 13 , 33 ], and young people with mental health conditions, in particular [ 47 ], participants described their main barriers to quitting as inability to resist cravings, using smoking to manage mental health symptoms, and smoking out of habit. Yet, only a few suggested that apps could teach strategies to overcome these barriers.…”

“…A significant body of literature [ 9 - 12 ] has described unique challenges faced by people with serious mental illness who wish to quit smoking, which include both sociocultural influences (such as lower education and income, as well as higher stress levels) and neurobiological influences (including the modulating effect of nicotine on dopaminergic pathways in schizophrenia). Additionally, people with serious mental illness may endorse using tobacco to manage challenging psychiatric symptoms and to overcome difficulties with socialization [ 10 , 12 , 13 ]. Furthermore, some cessation medications (eg, bupropion) may not be indicated for a subset of people with serious mental illness [ 14 ].…”

‘They’re Going to Smoke Anyway’: A Qualitative Study of Community Mental Health Staff and Consumer Perspectives on the Role of Social and Living Environments in Tobacco Use and Cessation

“…Social isolation (including alienation, stigma and loneliness) is commonly reported by people with SMI (35) and is a barrier to quitting smoking (36, 37). Evidence suggests that smoking behaviour is influenced by social networks and that groups of people quit together via social contagion (38).…”

Psychosocial Factors Affecting Smoking Cessation Among People Living With Schizophrenia: A Lived Experience Lens

“…In addition, they are often less likely to be formally supported in their efforts to stop smoking and are also less likely to be able to afford nicotine replacement products. Ongoing stigma, discrimination, inequality, and social exclusion are also considered to play a part in both why people smoke and add to the challenges of quitting (8, 9).…”

“…Therefore, supporting people to quit smoking is an important strategy to deal with this significant and potentially increasing mortality gap, especially where cessation treatments also encourage the adoption of a healthy lifestyle that may concurrently address other physical health risk factors that people living with schizophrenia commonly experience. Lum et al (8) found that for people living with schizophrenia, health concerns are the highest reason to quit, and in some cases, the perceived smoking related health implications are the most negative consequence of smoking.…”