Abstract

Objective

Tobacco smoking is a major driver of premature mortality in people with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder). This systematic literature review described randomized control trials of psychosocial smoking cessation interventions for people with SMI, rated their methodological rigor, evaluated the inclusion of racial/ethnic and sexual/gender minorities, and examined smoking cessation outcomes. Methods: Eligible studies included peer-reviewed articles published between 2009 and 2020 that examined psychosocial smoking cessation interventions in people with SMI. We used the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines to conduct our review and the Methodological Quality Rating Scale to evaluate methodological rigor. Results: Eighteen studies were included. Ten were categorized as high methodological rigor given their study characteristics (e.g., longer follow-up) and eight as lower methodological rigor based on their characteristics (e.g., not intent-to-treat). Racial/ethnic and sexual/gender minorities were under-represented in these studies. A range of psychosocial interventions were examined including motivational enhancements, smoking cessation education, cognitive behavioral strategies, and contingency management. Most studies also provided smoking cessation medications (e.g., NRT, bupropion), although provision was not always uniform across treatment conditions. Three studies found the intervention condition achieved significantly higher abstinence from smoking compared to the comparison group. Seven studies found the intervention condition achieved significantly higher reductions in smoking compared to the comparison group. Conclusions: Studies finding significant differences between the intervention and comparison groups shared common evidenced-based components, including providing smoking cessation medications (e.g., NRT, bupropion), motivational enhancement techniques, and cessation education and skills training, but differed in intensity (e.g., number and frequency of sessions), duration, and modality (e.g., group, individual, technology). Methodological limitations and a small number of studies finding significant between-group differences prevent the identification of the most effective psychosocial smoking cessation interventions. Clinical trial designs (e.g., SMART, factorial) that control for the provision of psychosocial medications and allow for the identification of optimal psychosocial treatments are needed. Future studies should also ensure greater inclusion of racial/ethnic and sexual/gender minorities and should be culturally/linguistically adapted to improve treatment engagement and study outcomes.

中文翻译：

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对严重精神疾病患者的社会心理戒烟干预的系统评价

摘要

客观的

吸烟是严重精神疾病（SMI；例如精神分裂症、双相情感障碍）患者过早死亡的主要驱动因素。这篇系统的文献综述描述了对 SMI 患者进行心理社会戒烟干预的随机对照试验，评估了他们的方法严谨性，评估了种族/民族和性/性别少数群体的纳入，并检查了戒烟结果。方法：符合条件的研究包括 2009 年至 2020 年间发表的同行评议文章，这些文章检查了 SMI 患者的心理社会戒烟干预措施。我们使用系统评价的首选报告项目和荟萃分析指南进行审查，并使用方法学质量评定量表来评估方法学的严谨性。结果：包括十八项研究。鉴于其研究特征（例如，较长的随访时间），10 人被归类为方法学严谨性高，8 人根据其特征（例如，非意向治疗）被归类为方法学严谨性较低。在这些研究中，种族/族裔和性/性别少数群体的代表性不足。研究了一系列社会心理干预措施，包括动机增强、戒烟教育、认知行为策略和应急管理。大多数研究还提供了戒烟药物（例如，NRT、安非他酮），尽管在不同治疗条件下提供的药物并不总是一致的。三项研究发现，与对照组相比，干预条件显着提高了戒烟率。结论：发现干预组和对照组之间显着差异的研究具有共同的循证成分，包括提供戒烟药物（例如，NRT、安非他酮）、动机增强技术以及戒烟教育和技能培训，但强度不同（例如，数量和会议的频率）、持续时间和方式（例如，小组、个人、技术）。方法学上的限制和少数发现显着组间差异的研究阻碍了确定最有效的心理社会戒烟干预措施。需要控制提供心理社会药物并允许确定最佳心理社会治疗的临床试验设计（例如，SMART、阶乘）。