Smoking and mental health - NCSCT

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Smoking and mental health of the study indicated that they were smoking. This method has been shown to provide smoking prevalence estimates closely similar to national survey data. 18 We also used Read codes to identify patients whose notes contained a record of cessation advice having been delivered in the year to mid-2010, and BNF codes to identify patients prescribed one of the three smoking cessation medications (nicotine replacement therapy (NRT), bupropion and varenicline) in the study period. The major strength of the THIN dataset for this analysis is the large sample size and hence relatively high precision of estimates of smoking in relation to mental disorder. However, THIN data also have limitations. Not all patients with mental health conditions will be managed solely in the primary care setting, because those with diagnoses such as schizophrenia or bipolar disorder are also likely to be managed by specialist teams in secondary care. Details of treatments or diagnoses delivered to these patients in inpatient or outpatient secondary care settings are not necessarily entered into the primary care medical record. As a result, analyses using THIN data may underestimate the number of patients with mental health conditions. Conversely, many medications prescribed for mental disorders may also be used for other indications, such as anxiolytics as sleeping tablets, or antidepressants for relief of chronic pain, thus leading to potential overestimation of the proportion of patients receiving medication for mental disorder. Since the introduction of the Quality and Outcomes Framework (QOF) in 2004, GPs have received financial incentives to record and update patients’ smoking status. This has resulted in convergence, since 2006, of smoking prevalence estimates from THIN and those derived from representative national surveys, although there remains a shortfall in the recorded prevalence in some groups of patients, particularly young men. 18 Ex-smoking is less well recorded, so quit ratios cannot be calculated from THIN data with confidence. The QOF also incentivised GPs to document their delivery of cessation advice to smokers with particular chronic diseases, including schizophrenia, bipolar disorder and other psychoses, but, although rates of recording of advice increased as a result of this initiative, there is evidence that this documentation might not accurately represent advice given, remembered by the patient or acted upon. 21 Similarly, although rates of prescribing of smoking cessation medications in THIN are similar to levels of pharmacy dispensing, 22 a record of a medication being prescribed to a patient does not mean that medication was used as indicated or resulted in a successful quit attempt, and does not capture patients who purchase NRT over the counter. The relevant features of the three data sources used in this chapter are summarised in Table 2.1. 20 © Royal College of Physicians 2013
Smoking among people with mental disorders 2 Table 2.1 Description of data sources used in this chapter HSE APMS THIN Year of survey 2010 2007 2009–10 Sample size 8,369 7,393 2,493,085 Geographical coverage England England UK Outcome measures reported Smoking prevalence By self-reported longstanding mental health ✔ By specific diagnoses ✔ ✔ By prescription of psychoactive medications ✔ ✔ ✔ By GHQ-12 ✔ By CIS-R ✔ By self-reported mental health service use ✔ By self-reported suicide attempt ✔ Quit ratio ✔ Heaviness of Smoking Index ✔ ✔ Daily cigarette consumption ✔ ✔ Smokers reporting wanting to quit ✔ Smokers reporting quitting would be difficult ✔ Smokers receiving cessation advice ✔ Smokers receiving cessation medication ✔ prescription APMS, Adult Psychiatric Morbidity Survey; CIS-R, revised Clinical Interview Schedule; GHQ-12, 12-item General Health Questionnaire; HSE. Health Survey for England; THIN, The Health Improvement Network. 2.3 Smoking prevalence 2.3.1 HSE In 2010, HSE data estimate the prevalence of smoking among adults in England to be 20%, a figure almost identical to that estimated for the same year in the much larger General Lifestyle Survey of Great Britain. 23 However, smoking prevalence was significantly higher in those reporting indicators of mental disorder (Table 2.2). Among the 4% of HSE participants reporting longstanding anxiety, depression or another mental health issue, 37% were smokers, a significantly higher proportion than in participants not reporting these conditions. After taking into account differences in age, sex and social class, HSE data suggest that participants with a longstanding mental health condition are twice as likely to be smokers compared with those without (odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.7–2.8). Smoking prevalence was also significantly higher, at 27%, among the 19% of HSE participants who scored 3 or © Royal College of Physicians 2013 21
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
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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
Page 31 and 32: Smoking among people with mental di
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Epidemiology of the association bet
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Smoking cessation interventions for
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6 Population strategies to prevent
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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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