Smoking and mental health - NCSCT

Smoking and mental health
health professionals, pregnant women with mental disorders are more likely to
accept an offer of referral to smoking cessation services. 146 Similar to other
smokers with mental disorder therefore 148 (see also Chapter 2), pregnant women
are no less and may be more motivated to stop smoking, but are less likely to
succeed. 146 Smoking cessation treatment outcome is also low among smokers
with depression, particularly those with recurrent depressive disorders. 149–151 As
discussed in earlier chapters (see Chapters 5 and 6), several authors allude to
negative perceptions and attitudes of healthcare professionals as barriers to
treating nicotine addiction together with mental health problems, 152 although
there is limited specific research exploring this in pregnancy.
Smoking cessation interventions for pregnant women are thus in urgent need of
research and development. One of few available studies, which comprises a
randomised controlled trial of an integrated cognitive–behavioural therapy (CBT)
intervention during pregnancy, addressing depression, partner violence, smoking
and environmental tobacco smoke exposure in high-risk African–American
women, reported that, although the intervention did not impact on smoking rates
during pregnancy (possibly because there was a high spontaneous quit rate in the
intervention and control arms), mothers in the CBT intervention arm were less
likely to be smoking in the postpartum period and were more likely to reduce
their environmental tobacco smoke exposure during pregnancy. 153 The
intervention also significantly reduced the occurrence of very-low-birthweight
and very pre-term birth. 154 These findings indicate that treatments could be
particularly beneficial if integrated to address mental health problems in the
context of problems such as domestic violence. 129 Tailoring of interventions to
risk factors present in pregnant women who smoke seems important, because a
randomised trial of an intensive depression-focused intervention for smoking
cessation in pregnancy found that women with high levels of depressive
symptoms receiving the depression-focused treatment achieved higher abstinence
and improved depressive symptoms, whereas women with low levels of depressive
symptoms had better outcomes if they received a control intervention. 155
Although recent drivers such as the various NICE guidelines on perinatal
care 119,133 have advocated routine screening by midwives for smoking, antenatal
mental health problems and domestic violence, it appears that pregnant women
with mental health problems need more support that is tailored to their needs.
One strategy would be to target women with mental disorders before pregnancy
by providing preconception counselling via mental health services; 156 this and
other innovations to improve ascertainment, uptake and efficacy of cessation
support are urgently needed.
7.5.5 Summary points
> Smoking during pregnancy has significant adverse effects on fetal and child
health.
148 © Royal College of Physicians 2013