Monash University
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A comprehensive assessment of factors related to smoking and other cardiovascular disease risk factors among people experiencing severe mental illness

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posted on 2017-03-02, 03:18 authored by Filia, Sacha Louise
The prevalence of smoking and the resultant impact on the health and well-being of people experiencing severe mental illness, is significantly disproportionate to smokers in the general population. Smokers experiencing severe mental illness are more likely to die, and at an earlier age, from smoking-related conditions, predominantly cardiovascular disease (CVD). Further, smoking among people experiencing severe mental illness is associated with a poorer clinical picture, and increases the financial stress already experienced by this group of smokers. The overall aim of this thesis was to explore various aspects of smoking behaviour among people experiencing severe mental illness. The first study explored CVD risk factors and associated variables among 43 smokers diagnosed with psychosis. Results indicated that smokers experiencing psychosis were generally overweight, physically inactive and had a poor diet. Participants reported smoking because they were addicted and to manage stress. They were motivated to quit smoking, improve their diet and increase their physical activity, but lacked confidence in their ability to make these changes. The next two studies explored gender differences in smokers diagnosed with psychosis. One study investigated gender differences among 298 smokers participating in a smoking cessation intervention. The other study examined the perceived risks and benefits of quitting in 200 people experiencing psychosis. Findings indicated that females were more likely than males to report smoking to prevent weight gain, and were particularly concerned that quitting would cause them to gain weight and experience negative emotions. Females reported more reasons for quitting and were more likely to be driven by extrinsic motivators to quit. Overall these studies revealed that smokers experiencing psychosis demonstrated fewer gender differences compared to smokers without mental illness. The next section focused on interventions addressing smoking and other CVD risk factors. One paper presented a case study of a female smoker diagnosed with bipolar disorder describing the experience, relevant literature and clinical challenges encountered during her involvement in a multi-component CVD risk factor intervention. Another paper demonstrated how the theoretical knowledge and clinical experience gained during this thesis could dispel some common myths regarding smoking cessation among people with severe mental illness. The final studies explored the patient perspective of being admitted to a psychiatric ward where smoking is banned. One study examined the views and experiences of 46 inpatients before, and 52 inpatients after, the implementation of a Totally Smokefree Policy in the psychiatry ward. Another study detailed the design, implementation, experience and evaluation of an inpatient group supporting a total smoking ban in the acute psychiatry setting, including data from 22 groups with 71 participants. Findings indicated that while smokers had the most negative views about the smoking ban, they smoked much less once admitted and were interested in quitting in the future. Following the smoking ban, patients described experiencing increased negative emotions, and struggled with losing smoking as their main coping strategy for stress. The results of this thesis provide new and important insights into smoking among people experiencing severe mental illness and can be directly translated into clinical practice.


Principal supervisor

Jayashri Kulkarni

Additional supervisor 1

Amanda Baker

Additional supervisor 2

Caroline Gurvich

Year of Award


Department, School or Centre

Monash Alfred Psychiatry Research Centre

Additional Institution or Organisation

Central Clinical School

Campus location


Degree Type



Faculty of Medicine Nursing and Health Sciences