Smoking and mental health - NCSCT

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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
Smoking and mental disorders: special circumstances 7 > Women with mental disorders are more likely to smoke throughout pregnancy, but are also more likely to accept cessation support. > Smoking cessation interventions are effective among pregnant women but may be more so if tailored to the specific needs and co-morbidities of women with mental disorders. > Systematic and sustained intervention and support are necessary to maximise smoking cessation in this context. 7.6 Children and adolescents 7.6.1 Prenatal smoking and mental health in children and young people Smoking in pregnancy has been linked to deficits in child growth and neural development including: effects on speech processing, irritability and hypertonicity in infants; behaviour problems in children; and modulation of the cortex and white matter structure and nicotine dependence in adolescents. 157 Prenatal exposure has also been linked to attention deficit hyperactivity disorder (ADHD) and other behavioural or ‘externalising’ disorders (see also Chapter 2). The prevalence of mental disorders is also higher among children whose mothers smoked during pregnancy, at around 25% in those whose mothers smoked over 10 cigarettes per day, 21% with fewer than 10 cigarettes per day and 14% in those with non-smoking mothers. 158 A longitudinal study of children at ages 5, 10 and 18 found that maternal smoking was linked with both behavioural and emotional disorders that persisted through childhood into adolescence. 159 7.6.2 Passive smoking and mental health in children and young people In 2007 around 22% of children in the UK, or about 4 million children, lived in homes where adults smoked regularly indoors, and this proportion was substantially higher in lower socioeconomic groups. 120 Recent cross-sectional studies in Scotland and the USA have demonstrated an association between second-hand smoke exposure, as measured by levels of cotinine, and poor mental health in children and young people. The US study of nearly 3,000 children and young people found that high serum cotinine levels in nonsmokers were associated with symptoms of depressive disorder, generalised anxiety disorder, ADHD and conduct disorders, and that these associations were robust to adjustment for poverty, prenatal tobacco exposure, physical stress and other variables. 160 The Scottish study reported cross-sectional associations between passive smoking and mental health difficulty scores, and significant associations with hyperactivity and conduct disorder symptoms that were independent of socioeconomic status. 161 These findings are supported by a European cross-sectional study that reported an exposure–response relation © Royal College of Physicians 2013 149
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PDF not for circulation Smoking and
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Contents Members of the Tobacco Adv
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Contents 4.4.3 Attention deficit hy
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Contents 6.4.3 Staff knowledge 122
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Contents 10.5 Tobacco policy and me
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Contributors Anthony Aclet - Specia
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Contributors Jill Williams - Associ
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1 Mental disorders 1.1 What is a me
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Mental disorders 1 1.3 Common menta
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Mental disorders 1 1.4.4 Somatisati
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Mental disorders 1 In addition to s
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Mental disorders 1 not diagnosed un
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Mental disorders 1 Similar to many
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Mental disorders 1 12 Chang CK, Hay
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Mental disorders 1 52 Young S, Toon
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Smoking among people with mental di
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