Do people with mental illness receive adequate smoking cessation advice? A systematic review and meta-analysis

Background: Prevalence rates of smoking in people with mental illness are high, and premature mortality attributed to tobacco related physical comorbidity is a major concern. We conducted a meta-analysis comparing rates of receipt of smoking cessation advice among people with and without mental illness. Method: Major electronic databases were searched from inception till August 2014 for studies comparing rates of receipt of smoking cessation advice of people with and without a mental illness. Two independent authors completed methodological appraisal and extracted data. A random-effects meta-analysis was utilized. Results: Seven studies of satisfactory methodological quality (n mental illness=68,811, n control=652,847) were included. Overall there was no significant difference in smoking cessation advice rates between those with and without a mental illness [relative risk (RR)=1.02, 95% confidence interval (CI)=0.94-1.11, n=721,658, Q=1421, Pb<.001]. Subgroup analyses demonstrated people with severe mental illness (SMI) received comparable rates of smoking cessation advice to those without SMI (RR=1.09, 95% CI=0.98-1.2, n=559,122). This remained true for people with schizophrenia (RR=1.09, 95% CI=0.68-1.70) and bipolar disorder (RR=1.14, 95% CI=0.85-1.5). People with non-SMIs were slightly more likely to receive smoking cessation advice (RR=1.16, 95% CI=1.04-1.30, Q=1364, Pb<.001, n=580,206). Conclusions: People with SMI receive similar smoking cessation advice rates to people without mental illness, while those with non-SMI are slightly more likely to receive smoking cessation advice. While progress has been made, offering smoking cessation advice should receive a higher priority in everyday clinical practice for patients with a mental health diagnosis. (C) 2015 Elsevier Inc. All rights reserved.