Time trends in access to smoking cessation support for people with depression or severe mental illness: a cohort study in English primary care

Abstract

ObjectivesTo investigate delivery of smoking cessation interventions, recorded quit attempts and successful quitting rates within primary care in smokers with depression or severe mental illness (SMI) compared with those without.DesignLongitudinal cohort study using primary healthcare records.SettingEnglish primary care.Participants882 849 patients registered with participating practices recorded as current smokers during 2007–2014, including three groups: (1) 13 078 with SMI, (2) 55 630 with no SMI but recent depression and (3) 814 141 with no SMI nor recent depression.OutcomesRecorded advice to quit smoking, referrals to smoking cessation services, prescriptions for smoking cessation medication, recorded quit attempts and changes of smoking status.ResultsThe majority (>70%) of smokers had recorded smoking cessation advice. This was consistently higher in those with SMI than the other cohorts of patients, although the gap greatly reduced in more recent years. Increases in smoking cessation advice over time were not accompanied by increases in recorded attempts to quit or changes of smoking status. Overall nicotine replacement therapy prescribing by general practitioners (GPs) was higher in those with SMI (10.1%) and depression (8.7%) than those without (5.9%), but a downward time trend was observed in all groups. Bupropion and varenicline prescribing was very low and lower for those with SMI. Few smokers (<5%) had referrals to stop smoking services, though this increased over time, but no significant differences were observed between those with and without mental health problems.ConclusionsThere was no evidence of consistent inequalities in access to GP-delivered smoking cessation interventions for people with mental health conditions. Smoking cessation advice was widely reported as taking place in all groups. In order to address the widening gap in smoking prevalence in those with poor mental health compared with those without, the emphasis should be on addressing the quality of advice and support given.

Why should we prioritise smoking cessation for people with mental health conditions?

“… 23 Furthermore, only 8.7% of smokers with depression, 10.1% of smokers with severe mental illness (SMI), and 5.9% of the general population received NRT from primary care, with very- low provision of bupropion or varenicline and <5% of smokers referred to stop smoking services. 24 Increases in advice over recent years was not accompanied by recorded attempts to quit or smoking status. Primary care prescription items for smoking cessation pharmacotherapies per 100 smokers in England during 2021/2022 were 8.9, including 6.8 for NRT, 1.3 for varenicline, and 0.9 for bupropion.…”

Smoking and mental health conditions: What you need to know

“…Cohort studies in England reveal that the proportion of smokers with mental disorder receiving Nicotine Replacement Therapy (NRT) fell from 14.4% in 2007 to 3.9% in 2015 (Taylor et al., 2020). Furthermore, only 5% of smokers received NRT from primary care, including 8.7% of smokers with depression and 10.1% of smokers with SMI with very low provision of bupropion or varenicline and less than 5% of smokers were referred to stop smoking services (Falcaro et al., 2021). Primary care prescription items for smoking cessation pharmacotherapies in 2020–21 per 100 population were 1.3 including 0.7 for NRT, 0.5 for varenicline and zero for bupropion (Falcaro et al., 2021).…”