VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
Addict Behav. 2017 Dec;75:103-107. doi: 10.1016/j.addbeh.2017.07.005. Epub 2017 Jul 10.
High prevalence rates of tobacco use, particularly cigarettes, pose a serious health threat for individuals with serious mental illness (SMI), and research has demonstrated the effectiveness of pharmacotherapy and psychosocial interventions to reduce tobacco use in this group. However, few studies have considered predictors of tobacco cessation treatment engagement among individuals with SMI. The current study examined predictors of engagement in smoking cessation groups among veterans with SMI engaged in mental health services at three VA medical centers. All veterans were participating in a smoking cessation treatment study. Of 178 veterans who completed baseline assessments, 127 (83.6%) engaged in treatment, defined as attending at least three group sessions. Forty-one (N=41) predictors across five domains (demographics, psychiatric concerns, medical concerns, smoking history, and self-efficacy to quit smoking) were identified based on previous research and clinical expertise. Using backward elimination to determine a final multivariable logistic regression model, three predictors were found to be significantly related to treatment engagement: marital status (never-married individuals more likely to engage); previous engagement in group smoking cessation services; and greater severity of positive symptoms on the Brief Psychiatric Rating Scale. When included in the multivariable logistic regression model, the full model discriminates between engagers and non-engagers reasonably well (c statistic=0.73). Major considerations based on these findings are: individuals with SMI appear to be interested in smoking cessation services; and serious psychiatric symptomatology should not discourage treatment providers from encouraging engagement in smoking cessation services.
烟草使用的高流行率，尤其是香烟，对患有严重精神疾病（SMI）的个体构成了严重的健康威胁，研究已经证明了药物治疗和心理社会干预在减少该群体吸烟方面的有效性。然而，很少有研究考虑过 SMI 个体戒烟治疗参与的预测因素。本研究考察了在三个退伍军人事务部医疗中心接受心理健康服务的患有 SMI 的退伍军人参与戒烟小组治疗的预测因素。所有退伍军人都参加了一项戒烟治疗研究。在完成基线评估的 178 名退伍军人中，有 127 名（83.6%）参与了治疗，定义为至少参加了三次小组会议。根据先前的研究和临床专业知识，确定了五个领域（人口统计学、精神健康问题、医疗问题、吸烟史和戒烟自我效能）的 41 个（N=41）预测因素。使用向后消除法确定最终的多变量逻辑回归模型，发现三个预测因素与治疗参与显著相关：婚姻状况（未婚个体更有可能参与）；以前参加过小组戒烟服务；以及简明精神病评定量表上阳性症状的严重程度更大。当纳入多变量逻辑回归模型时，整个模型在区分参与者和非参与者方面表现相当好（c 统计量=0.73）。基于这些发现的主要考虑因素是：患有 SMI 的个体似乎对戒烟服务感兴趣；严重的精神症状不应阻止治疗提供者鼓励参与戒烟服务。
