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 follow-up 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.
- cessation intervention
- mental illness
- dual diagnoses
- gold standard programme
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Contributors MR, MK and HT contributed to the study conception and design. MR and HT headed the data acquisition. MR contributed to the data analysis. MR, MK, JK, MN and HT contributed to the data interpretation. MR drafted the manuscript, and MK, JK, MN and HT revised it critically for important intellectual content. All the authors gave final approval of the version to be published. MR is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval This project was approved by the Danish Data Protection Agency (2014-41-3370/2010-41-5463/2000-54-0013) and was registered with the National Committee on Health Research Ethics (H-C-FSP-2010–049).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The protocol, anonymised data and statistical codes are available from the corresponding author.
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