Smoking and mental health - NCSCT

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Smoking and mental health The APMS uses several established and validated tools to identify patients with mental disorders. 9 The revised Clinical Interview Schedule 10 (CIS-R) was used to assess patients for the presence within the last week of several common mental disorders, including depressive episodes, phobias, generalised anxiety disorder, obsessive–compulsive disorder, panic disorder, and mixed anxiety and depression. A total CIS-R score of 12 or more is taken here to indicate the presence of a common mental disorder. The Trauma Screening Questionnaire 11 (TSQ) was used to screen participants for post-traumatic stress disorder (PTSD) within the last 2 weeks, the Adult Self-Report Scale–v1.1 12 (ASRS) assessed people for attention deficit hyperactivity disorder (ADHD) within the last 6 months and the SCOFF eating disorders questionnaire 13 assessed for an eating disorder within the last year. A subsample of participants was also screened by clinically trained interviewers to detect probable psychosis. 9 The label of ‘any mental disorder’ is used here to identify participants with at least one of the common mental disorders listed above, PTSD, ADHD, an eating disorder or probable psychosis. Several self-reported measures of mental health are also available in APMS data, including whether participants have made one or more suicide attempts in the last year, whether they have spoken to their GP in the past year about a mental, nervous or emotional problem, and whether they are currently receiving counselling or using a psychoactive medication for a mental, nervous or emotional problem. In relation to the objectives of this report, APMS and HSE data share three main limitations: first, their sample sizes are such that estimates of smoking prevalence within demographic or mental health subgroups are often based on small numbers and hence imprecise; second, the reliance on self-reported measures of mental health and smoking behaviour introduces the possibility of biased estimates of these outcomes; and, third, that as household surveys both the APMS and HSE exclude groups of people known to have higher rates of mental illness and a higher smoking prevalence, including those living in mental healthcare institutions, prisons and temporary housing, and homeless individuals. Both surveys are therefore likely to underestimate the true population prevalence of mental illness and smoking. However, as a supplement to the first household psychiatric morbidity survey, in 1994 a survey of 1,200 adults living in institutions specifically catering for people with mental illness 14 was carried out, as well as a survey of 1,100 adult homeless people (living in hostels or similar institutions or sleeping rough and using day centres). 15 In 1997, 3,500 prisoners in England and Wales were similarly surveyed. 16 At the end of this chapter we present headline findings from these surveys, with the caveat that the data are now over 15 years old (further data on smoking prevalence among homeless people and prisoner populations are presented in Chapter 7). 18 © Royal College of Physicians 2013
Smoking among people with mental disorders 2 2.2.3 The Health Improvement Network THIN is a dataset of electronic primary care medical records, established in 2003 by EPIC 6 licence holders of a historical part of the General Practice Research Database (GPRD). General practices using the Vision 17 electronic practice management software can choose to contribute their data to THIN, and data from contributing practices are uploaded electronically on a monthly basis. Ethics approval for the collection and use of these data has been granted by the NHS South-East Multicentre Research Ethics Committee. By September 2010, THIN contained records for almost 8 million patients from 495 practices throughout the UK; these patients are broadly representative of the UK population in terms of their age, sex, medical conditions and death rates. 18 THIN contains details of consultations with members of the primary healthcare team, investigation results, prescribed medications and lifestyle information such as smoking behaviour. Information is recorded using Read codes, a hierarchical dictionary of medical terminology. 19 The data used in this chapter are derived from 2,493,085 patients aged 16 and over who were registered with a THIN practice for the year from 1 July 2009 to 30 June 2010. Patients with mental disorders were identified in two ways: Read codes were used to identify those with a record of one or more of several specified mental disorders during the study period, corresponding to ICD-10 categories (Box 2.1), and British National Formulary (BNF) codes 20 were used to identify patients who had been prescribed a psychoactive medication (antipsychotic, antimanic, antidepressant or anxiolytic) during the study period. Patients who smoked during the study period were identified as those with a relevant smoking-related Read code recorded in their medical records during the study year. Patients were also classified as smokers if their smoking status was not recorded during the study period, but their last-recorded status before the start Box 2.1 ICD-10 codes for mental disorders identified in THIN patients F20–F29 F31 F32–F33 F40–F48 F50 F60 F90 Schizophrenia, schizotypal and delusional disorders Bipolar affective disorder Depression Neurotic, stress-related and somatoform disorders Eating disorders Specific personality disorders Hyperkinetic disorders, including ADHD ADHD, attention deficit hyperactivity disorder; ICD-10, International Classification of Diseases, 10th revision; THIN, The Health Improvement Network. © Royal College of Physicians 2013 19
Page 1 and 2: PDF not for circulation Smoking and
Page 3 and 4: Contents Members of the Tobacco Adv
Page 5 and 6: Contents 4.4.3 Attention deficit hy
Page 7 and 8: Contents 6.4.3 Staff knowledge 122
Page 9 and 10: Contents 10.5 Tobacco policy and me
Page 11 and 12: Contributors Anthony Aclet - Specia
Page 13 and 14: Contributors Jill Williams - Associ
Page 15 and 16: 1 Mental disorders 1.1 What is a me
Page 17 and 18: Mental disorders 1 1.3 Common menta
Page 19 and 20: Mental disorders 1 1.4.4 Somatisati
Page 21 and 22: Mental disorders 1 In addition to s
Page 23 and 24: Mental disorders 1 not diagnosed un
Page 25 and 26: Mental disorders 1 Similar to many
Page 27 and 28: Mental disorders 1 12 Chang CK, Hay
Page 29 and 30: Mental disorders 1 52 Young S, Toon
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Epidemiology of the association bet
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6 Population strategies to prevent
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Population strategies to prevent sm
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Ethical and legal aspects 9 pose co
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Ethical and legal aspects 9 patient
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10 Summary and conclusions 10.1 Smo
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11 Key conclusions and recommendati
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Key conclusions and recommendations
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