A team of scientists estimates that providing patients with depression with the tools to quit smoking could save as many as 125,000 lives in the United States over the next 80 years. That number jumps to 203,000 when extended to people with depression who are not yet in mental health care settings, reports Yale University.
Led by the Yale School of Public Health, the study underscores the potential benefits of smoking cessation in a population that suffers disproportionately from tobacco-related disease and death.
It’s also the first known study to estimate the population health effects of integrating smoking cessation treatments with standard mental health care, according to material written by Matt Kristoffersen and published by Yale on 2 August 2021.
To build their model, the scientists used more than a decade of data from the National Survey on Drug Use and Health. They then used the model to project the effectiveness of smoking-cessation treatments into the future, and assessed how the benefits varied based on different rates of treatment adoption over the next 80 years.
Simulating the health benefits reveals that, at minimum, 32,000 deaths could be averted by 2100 if a significant number of patients with depression adopted any kind of cessation treatment. With 100% mental health service utilisation and pharmacological cessation treatment, the number of potential lives saved rose to 203,000.
“We’ve known for a long time that people with depression smoke more than the general population, and that mental health care settings often don’t have cessation treatment as part of standard care,” said Dr Jamie Tam, an assistant professor and the study’s lead author.
“Our study asks: what is that missed opportunity? What do we have to gain when mental health care and smoking cessation treatment are fully integrated?” The findings are published in the American Journal of Preventive Medicine.
The researchers wrote in the study that such high benefits would be a best-case scenario. Still, they explained, the model’s results line up with what public health experts have long predicted if smoking-cessation treatment were to become a routine part of mental health care.
The findings show that even less-than-optimal cessation treatments would make a sizable impact in the quality of life – and length of life – for patients living with depression.
“Beyond reducing the risk of early death, smoking cessation improves quality of life and increases productivity,” Tam added. “Decision makers should remove barriers to mental health care and smoking cessation treatments for people with mental health conditions.”
Study authors concluded that while existing treatments, such as nicotine replacement therapy, varenicline, and bupropion, can increase cessation rates by nearly 60%, health gains would be even larger if cessation treatments became more effective in the future.
The study was co-authored by researchers from the University of Michigan and the University of Bath in England.
The potential impact of widespread cessation treatment for smokers with depression
Jamie Tam, Kenneth E Warner, Kara Zivin, Gemma MJ Taylor and Rafael Meza
Author affiliations: Yale School of Public Health, University of Michigan and the University of Bath.
Published in the American Journal of Preventive Medicine on 6 July 2021.
Experts recommend integrating smoking-cessation treatments within U.S. mental health settings, but the population health benefits of doing so have not been estimated. This study simulates the impact of widespread cessation treatment for patients with depression under best-case treatment and maximum potential cessation scenarios.
Cessation interventions were simulated for U.S. adult smokers seeing a health professional for depression from 2020 to 2100. Interventions included (1) Any Treatment (behavioral counseling, pharmacological, combination) and (2) Pharmacological Treatment (including counseling), combined with increased mental health service utilisation each.
These were compared with a maximum potential cessation scenario where all patients with major depression quit smoking. Analyses were conducted in 2016–2020.
Widespread uptake of Any Treatment among patients with depression would avert 32,000 deaths and result in 138,000 life-years gained by 2100; Any Treatment combined with 100% mental health service utilization would result in 53,000 and 231,000, respectively. Pharmacological Treatment would avert 125,000 deaths, with 540,000 life-years gained.
Pharmacological Treatment combined with 100% mental health service utilization would result in 203,000 deaths averted and 887,000 life-years gained.
Health gains under best-case treatment scenarios represent modest fractions of those projected under maximum potential cessation scenarios at current mental health service utilization levels (835,000 deaths averted, 3.73 million life-years gained) and at 100% utilization (1.11 million deaths averted, 5.07 million life years gained).
Providing smoking-cessation treatment to patients with depression and increasing mental health service utilization would reduce the toll of tobacco on this population. These gains would be considerably larger if cessation treatments were more effective.
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