Systematic Review: Smoking Cessation and Mental Health in UK

Running head: DISSERTATION: SYSTEMATIC REVIEW
DISSERTATION: SYSTEMATIC REVIEW: THE EFFECT OF SMOKING CESSATION ON
MENTAL HEALTH OF ACUTELY ILL PATIENTS IN A MENTAL HEALTH SETTING IN
THE UNITED KINGDOM
Name of the Student:
Name of the University:
Author note:

SYSTEMATIC REVIEW: SMOKING CESSATION AND MENTAL HEALTH IN UK1
Abstract
This thesis aims to critically review existing evidence based research exploring the impact of
smoking cessation on mental illness symptoms in patients with acute mental illnesses and
admitted across mental healthcare settings of the United Kingdom. Based on current literature
which were reviewed and analysed critically in this thesis, smoking cessation interventions were
found to facilitate the achievement of positive physiological and psychological outcomes across
patients with acute mental illnesses. The key psychological effects of smoking cessation were
found to be: reduced severity of depressive and anxiety symptoms and overall sympathetic
nervous system functioning, improvements in dopamine activity especially with regards to
schizophrenia and an overall enhancement of feelings of self-esteem. Additionally, smoking
cessation was also evidenced to result in beneficial metabolic and cardiovascular outcomes
which in turn, can significantly mitigate the risk of reduced life expectancy and high mortality
rates across patients with acute mental illness. Such findings demonstrate considerable
significance with regards to future nursing as well as mental health practice due to their ability to
inform and guide mental healthcare organizations on the factors, outcomes and facilitators to
look for when administering smoking cessation based interventions across mental health settings.
However, dearth of evidence based literature across the mental health settings of United
Kingdom raised significant difficulty in terms of applicability of these findings in practical,
mental healthcare scenarios. Additionally, the dearth of standardized mental health assessments
further made it difficult to analyze the association between findings and changes in mental health
outcomes, symptoms, wellbeing and quality of life across patients with acute mental illnesses in
the UK. It is recommended that nurses as well as healthcare organizations prioritize engagement

SYSTEMATIC REVIEW: SMOKING CESSATION AND MENTAL HEALTH IN UK2
in more comprehensive, robust and quantitative research specific to UK settings so as to acquired
clinical findings relevance to the management of acutely ill mental health patients.

SYSTEMATIC REVIEW: SMOKING CESSATION AND MENTAL HEALTH IN UK3
Table of Contents
Chapter 1: Introduction........................................................................................................6
1.1. Introduction........................................................................................................6
1.1.2. Research Background........................................................................................6
1.2. Research Rationale...................................................................................................7
1.2.1. Nursing Implications.........................................................................................8
1.3. Aims and Objectives.................................................................................................8
1.3.1. Objectives..........................................................................................................8
1.3.2. Research Question.............................................................................................9
1.4. Research Structure....................................................................................................9
Chapter 2: Literature Review.........................................................................................11
2.1. Introduction...........................................................................................................11
2.2. Health Effects of Smoking and associated perceptions.....................................11
2.3. Prevalence and mental health outcomes of smoking in the United Kingdom.13
2.4. Health Effects of Smoking Cessation..................................................................16
2.5. Health Effects of Smoking Cessation in Mental Health Patients.....................19
2.6. Theoretical Framework...........................................................................................20
2.7. Research Limitations and Implications..............................................................21
Chapter 3: Methodology.................................................................................................23
3.1. Literature Review Findings.................................................................................23

SYSTEMATIC REVIEW: SMOKING CESSATION AND MENTAL HEALTH IN UK4
3.2. Chosen Methodology: Systematic Review..........................................................23
3.3. PICOT Question...................................................................................................24
3.4. Search Strategy.....................................................................................................25
3.5. Inclusion and Exclusion Criteria.........................................................................25
3.5.1. Inclusion Criteria...........................................................................................25
3.5.2. Exclusion Criteria..........................................................................................26
3.6. PRISMA Flow Diagram.......................................................................................26
Figure A: PRISMA Flow Diagram............................................................................27
3.7. Critiquing the Articles..........................................................................................28
3.8. Research Validity..................................................................................................28
Chapter 4: Results...........................................................................................................29
4.1. Introduction...........................................................................................................29
4.2. Article 1: Royal College of Physicians (2013).....................................................29
4.3. Article 2: Knowles et al. (2016)............................................................................30
4.4. Article 3: Trainer and Leavey (2017)..................................................................31
4.5. Article 4: Osborn et al. (2018)..............................................................................32
4.6. Article 5: Richardson, McNeill and Brose (2019)..............................................33
4.7. Article 6: GillBody et al. (2019)...........................................................................34
4.8. Conclusion: Findings and Observations.............................................................35
Chapter 5: Discussion......................................................................................................37

SYSTEMATIC REVIEW: SMOKING CESSATION AND MENTAL HEALTH IN UK5
5.1. Introduction and Brief Overview........................................................................37
5.2. Smoking Cessation effects on Mental Health.....................................................37
5.3. Smoking cessation effects on Cardiovascular Health........................................38
5.4. Smoking Cessation effects on Social and Emotional Outcomes.......................39
Chapter 6: Limitations....................................................................................................40
Chapter 7: Conclusion.....................................................................................................41
References..........................................................................................................................42
Appendices........................................................................................................................50
Appendix 1: PRISMA Table.........................................................................................50
Appendix 2: Inclusion and Exclusion Table..................................................................50
Appendix 3: CASP Tool for Cohort Studies (Richardson, McNeill and Brose 2019). .51
Appendix 4: CASP Tool for Qualitative Studies (Knowles et al. 2016).......................52
Appendix 5: CASP Tool for Systematic Reviews.........................................................53
Appendix 6: CASP Tools for Randomized Controlled Trials.......................................53
Appendix 7: Summary Table...........................................................................................0
Appendix 8: Gantt chart...................................................................................................4
Appendix 8: Search terms/results used for each Database..............................................5

SYSTEMATIC REVIEW: SMOKING CESSATION AND MENTAL HEALTH IN UK6
Chapter 1: Introduction
1.1. Introduction
Understandably, smoking is a preventable and modifiable risky health behaviour which
can be addressed in patients with mental health conditions to improved health outcomes (Bailey
et al., 2017). There is, however, limited research and exploration of the ways in which the
compliance to smoking by patients with acute and acute mental disorders can be reduced and
resultant impact on their wellbeing and mental health, especially within the context of the United
Kingdom (UK). The author thus aims to review current evidence-based literature on the effect
and effect of smoking cessation upon the wellbeing and mental health in patients with acute
mental disorders, admitted across mental health unit across healthcare organizations in the UK.
1.1.2. Research Background
Patients admitted with an acute mental illness are also susceptible to have shorter spans
of life expectancy due to prevalent co-morbidities like cardiovascular conditions or respiratory
illness (Evins, Cather and Daumit, 2019). It has been evidenced in the data presented by Public
Health England that approximately 40.5% of adults, with an acute mental illness, engage in
smoking (Forman et al. 2017). Such debilitating lifestyle behaviours thus contribute to further
aggravation of the pre-existing physiological co-morbidities impacting this population. Such
high rates of smoking by an already-vulnerable population thus demonstrates the need for
developing comprehensive and efficient smoking cessation strategies (Gilbody et al. 2019).
The findings by Public Health England (2016) also report deaths due to smoking-
associated conditions across approximately 78, 200 individuals within the UK. It has further
been postulated that smoking is one of the strongest contributors to decreased rates of life

SYSTEMATIC REVIEW: SMOKING CESSATION AND MENTAL HEALTH IN UK7
expectancy across mental health patients with mental health issues like personality disorders (18
years for females and males), depression (11 years for males and 7 years for females
respectively), alcohol misuse (10.8 years for females and 17.1 years for males) and opioid
misuse associated disorders (9.0 years for males and 17.3 years for females). According to the
findings by the WHO (2019), approximately 8 million individuals across the globe are inflicted
as a result of prolonged contact with tobacco smoke or engagement in associated detrimental
lifestyle habits such as cigarette smoking.
1.2. Research Rationale
Smoking cessation causes withdrawal symptoms such as anxiety, irritability, depression
and emotional distress, which in turn, hinders an individual’s eagerness and enthusiasm to quit
the same. Such issues may be aggravated in acute mental health illness due to inability to engage
in self-regulation of depressive or anxiety symptoms (Roberts et al. 2016). The addictive effects
of smoking is largely associated with nicotine which in turn, has been evidenced to facilitate the
production of dopamine. Individuals with mental illnesses demonstrate low amounts of essential
neurotransmitters like dopamine, which thus results in smoking instilling feelings of relaxation
and wellbeing with a potency greater than that observed across the healthy population (Sharma et
al. 2018). Thus, it is unsurprising to find higher rates of prevalence and relapse in smoking
behaviours as well as physiological health issues across patients with acute mental illness, which
in turn, impacts their ability to achieve long term positive health outcomes. The high risk of
smoking and its associated consequences across patients with acute mental illness as well as lack
of sufficient research in the UK context thus form the rationale underlying the need to develop
comprehensive and efficient smoking cessation strategies and thus, the formulation of this
research topic (Jaén-Moreno et al. 2019).