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Multiple studies have consistently shown that many individuals with a history of mental health conditions, such as anxiety, depression and schizophrenia, have a greater tendency to smoke and are more prone to developing nicotine addiction than the general population. It’s estimated that approximately 30% of smokers in the UK have a mental health condition.

A study titled ‘Change in mental health after smoking cessation: systematic review and meta-analysis’ aimed to determine if there is a change in mental health after smoking cessation in comparison to continuing smoking.

Published in the BMJ, the study’s results indicated that anxiety, depression and stress significantly decreased between baseline and follow-up in those who quit compared with those who continued smoking, seeing an increase in overall psychological quality of life.

Another study published in The Lancet Psychiatry aimed to investigate the effectiveness of combined behavioural and pharmacological smoking cessation interventions, with people with a diagnosis of mental health conditions as the focus.

Titled ‘Smoking cessation for people with severe mental illness: a pragmatic randomised controlled trial’, the study’s authors cited that individuals with severe mental health conditions such as bipolar disorder and schizophrenia have a greater likelihood of smoking, beginning at an earlier age and consuming more cigarettes per day than the general population.

They recruited participants from 16 primary care and 21 community-based mental health sites across the UK, all of which were heavy smokers and diagnosed with bipolar disorder or schizophrenia. Eligible participants had to be 18 years or older, smoke at least 5 cigarettes a day and had expressed an interest in reducing their consumption or quitting smoking.

Participants were randomised to one of two groups: bespoke smoking cessation intervention or usual care. The bespoke smoking cessation intervention consisted of behavioural support from a mental health smoking cessation practitioner and pharmacological aids. Participants assigned to usual care were offered access to local smoking cessation services not specifically designed for individuals with severe mental health conditions.

Results showed that the proportion of participants assigned to the intervention group who quit smoking after six months was significantly greater (14%) than those in the usual care group (6%). The study’s authors concluded that smoking cessation can be achieved among people with mental health conditions with the influence of bespoke intervention, as they found an increased engagement and chance of successfully quitting compared to usual care.

Mental Health and Smoking Partnership

Alyssa Best, Cancer Research UK’s Policy Adviser said:

“E-cigarettes offer another opportunity for smokers with mental health conditions that haven’t been able to stop using other methods.”

The Mental Health and Smoking Partnership published a guide on the ‘Use of Electronic Cigarettes by People with Mental Health Problems’. They cited that smoking is one of the main contributors to the 10-20 year life expectancy gap between people with mental health problems and the wider general population, as they have a higher smoking rate of 40% than 14.4% respectively.

“E-cigarette use has not been found to worsen psychiatric symptoms. A review of the evidence found that stopping smoking is associated with decreased symptoms of poor mental health and may lead to improved positive mood and quality of life compared with continuing to smoke. Tobacco smoke interacts with some medications used for treating mental health and physical health problems, particularly clozapine.”

Peter Pratt, Specialist Pharmacist in Psychiatry at NHS England explained:

“The reason that clozapine is a concern is that smoking affects the metabolism through the cytochrome p450 system, specifically the 1a2 enzyme. It’s not the nicotine in cigarettes, it’s the hydrocarbons; they stimulate this drug metabolising enzyme, making it much more active in smokers.

If we stop smoking within about a week, the activity of that enzyme reduces and if we’re not breaking clozapine down as rapidly as we used to when we’re a smoker, it means the clozapine levels will gradually build up and in some people that can be almost double, which can lead to fatalities.”

Professor Ann McNeill, Co-chair of the Partnership and Professor of Tobacco Addiction at the National Addictions Centre, King’s College London said:

“People with a mental health condition are more than twice as likely to smoke as the general population. This is a great inequality leading to early death and years of chronic illness for many. E-cigarettes provide a new opportunity for people to move away from smoking and avoid the terrible burden of death and disease it causes.”

The Partnership aims to reduce smoking rates among people with mental health conditions to 5% by 2035, describing it as a national priority that will significantly reduce the burden of preventable morbidity and mortality.

Smokers Both With and Without Mental Health Conditions are Benefiting From the Same Cessation Aids

Recently, a study conducted by University College London and King’s College explored the effectiveness of smoking cessation aids between individuals with and without a history of mental health conditions.

Published in PLOS Mental Health, the cross-sectional survey conducted in England observed over 5,000 adults who smoked regularly and had attempted to quit at least once within the last year. Approximately 45% of participants reported having been diagnosed with a mental health condition; 16.8% reported a single mental health condition and 28.3% reported multiple.

Multiple cessation aids were used during the experiment including nicotine replacement therapy, vape products, hypnotherapy, self-help websites, behavioural support and nicotine pouches.

Post-experiment results found that participants with a history of mental health conditions were more likely to report using vaping products, e.g. E-cigarettes – 39% than those without, 31%. This was the most popular and effective aid used by individuals with and without mental health conditions. Over-the-counter NRTs such as nicotine gum and patches were another commonly used aid: 17% and 18%. Other cessation aids were used by less than 5% of participants, such as behavioural support interventions and nicotine pouches.

Study lead Dr Sarah Jackson and her colleagues concluded that there was no evidence to suggest that the effectiveness of any popular smoking cessation aids differed according to individuals history of mental health conditions. Jackson has previously vocalised that communication surrounding the health benefits of switching to vapes needs to improve when discussing the widespread misconception surrounding vape products in comparison to tobacco cigarettes.

New Research to Investigate E-cigarette Effectiveness in Aiding Smokers with Mental Health Conditions to Quit

The University of York and University College London announced that they were to lead a new trial, funded by Yorkshire Cancer Research, to determine if offering a vape starter kit to smokers with mental health conditions will help see an increase in successful smoking cessation.

Dr Elena Ratschen, study lead and Associate Professor in Health Sciences at the University of York said:

“There is an urgent need to address smoking-related inequalities in mental health. People with mental illness lose up to 20 years of life expectancy, mainly to consequences of smoking including cancer.

Until very recently, smoking has remained deeply embedded within the culture of mental health care and treatment settings, where it was commonly accepted as a coping mechanism for patients. We now know that smoking worsens mental illness symptoms and may even be linked to their development.

People with mental illness are just as motivated to quit as those without. However, giving up smoking can be difficult because of limited access to support and high dependence.”

Co-lead of the study, Professor Lion Shahab of Health Psychology at University College London said:

“There is growing evidence that e-cigarettes can help smokers kick the habit of a lifetime and that these devices may be particularly helpful for more disadvantaged smokers, including those with common mental health conditions.”