George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA.
Department of Community Medicine, Mercer University School of Medicine, Savannah, Georgia, USA.
J Dual Diagn. 2021 Jul-Sep;17(3):216-235. doi: 10.1080/15504263.2021.1944712. Epub 2021 Jul 19.
Tobacco smoking is a major driver of premature mortality in people with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder). This systematic literature review described randomized control trials of psychosocial smoking cessation interventions for people with SMI, rated their methodological rigor, evaluated the inclusion of racial/ethnic and sexual/gender minorities, and examined smoking cessation outcomes. Eligible studies included peer-reviewed articles published between 2009 and 2020 that examined psychosocial smoking cessation interventions in people with SMI. We used the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines to conduct our review and the Methodological Quality Rating Scale to evaluate methodological rigor. Eighteen studies were included. Ten were categorized as high methodological rigor given their study characteristics (e.g., longer follow-up) and eight as lower methodological rigor based on their characteristics (e.g., not intent-to-treat). Racial/ethnic and sexual/gender minorities were under-represented in these studies. A range of psychosocial interventions were examined including motivational enhancements, smoking cessation education, cognitive behavioral strategies, and contingency management. Most studies also provided smoking cessation medications (e.g., NRT, bupropion), although provision was not always uniform across treatment conditions. Three studies found the intervention condition achieved significantly higher abstinence from smoking compared to the comparison group. Seven studies found the intervention condition achieved significantly higher reductions in smoking compared to the comparison group. Studies finding significant differences between the intervention and comparison groups shared common evidenced-based components, including providing smoking cessation medications (e.g., NRT, bupropion), motivational enhancement techniques, and cessation education and skills training, but differed in intensity (e.g., number and frequency of sessions), duration, and modality (e.g., group, individual, technology). Methodological limitations and a small number of studies finding significant between-group differences prevent the identification of the most effective psychosocial smoking cessation interventions. Clinical trial designs (e.g., SMART, factorial) that control for the provision of psychosocial medications and allow for the identification of optimal psychosocial treatments are needed. Future studies should also ensure greater inclusion of racial/ethnic and sexual/gender minorities and should be culturally/linguistically adapted to improve treatment engagement and study outcomes.
吸烟是导致严重精神疾病(SMI;例如精神分裂症、双相情感障碍)患者过早死亡的主要原因。本系统文献综述描述了针对 SMI 患者的心理社会戒烟干预的随机对照试验,评估了其方法学严谨性,评估了纳入种族/民族和性/性别少数群体的情况,并检查了戒烟结果。合格的研究包括 2009 年至 2020 年期间发表的、检查 SMI 患者心理社会戒烟干预的同行评议文章。我们使用系统评价和荟萃分析的首选报告项目指南进行综述,并使用方法学质量评分量表评估方法学严谨性。共纳入 18 项研究。其中 10 项研究因其研究特征(例如,随访时间较长)被归类为方法学严谨性高,8 项研究因研究特征(例如,未进行意向治疗)被归类为方法学严谨性低。这些研究中代表性不足的是少数族裔和性/性别少数群体。研究考察了多种心理社会干预措施,包括动机增强、戒烟教育、认知行为策略和条件管理。大多数研究还提供了戒烟药物(例如,NRT、安非他酮),尽管并非在所有治疗条件下都能统一提供。三项研究发现干预组的戒烟率明显高于对照组。七项研究发现干预组的吸烟量明显低于对照组。研究发现干预组与对照组之间存在显著差异的研究具有共同的循证组成部分,包括提供戒烟药物(例如,NRT、安非他酮)、动机增强技术、戒烟教育和技能培训,但在强度(例如,次数和频率)、持续时间和模式(例如,小组、个人、技术)上存在差异。方法学上的限制和少数研究发现组间存在显著差异,这使得无法确定最有效的心理社会戒烟干预措施。需要设计临床试验设计(例如 SMART、因子)来控制心理社会药物的提供,并确定最佳的心理社会治疗方法。未来的研究还应确保更大程度地纳入种族/民族和性/性别少数群体,并进行文化/语言上的调整,以提高治疗参与度和研究结果。
Cochrane Database Syst Rev. 2015-12-22
Cochrane Database Syst Rev. 2013-8-21
Cochrane Database Syst Rev. 2015-2-23
Addiction. 2010-5-11
Cochrane Database Syst Rev. 2012-1-18
Drug Alcohol Depend Rep. 2025-7-22
Psychiatry Res Commun. 2023-3
Front Psychiatry. 2023-5-19
J Health Care Poor Underserved. 2020
Prog Community Health Partnersh. 2019
MMWR Morb Mortal Wkly Rep. 2019-11-15
Community Ment Health J. 2020-2
Health Psychol. 2018-11-29
Subst Use Misuse. 2017-11-21
Psychiatr Serv. 2017-9-15