Efectividad de una intervención enfermera sobre abordaje al tabaquismo en diferentes servicios de la Red de Salud Mental

Abstract

INTRODUCTION There is an important relationship between tobacco consumption and various disorders related to mental health, observing between people with severe mental disorder a higher prevalence of tobacco habit, greater dependence on nicotine, fewer quit attempts and greater difficulty in achieving abstinence. According to the scientific literature, no psychiatric pathology is incapacitating to stop smoking and in all of them there is a percentage that has achieved sustained abstinence. OBJECTIVE To evaluate the effectiveness of an intervention on the approach to smoking in order to achieve a reduction in the consumption of tobacco or a complete smoking cessation for people with serious mental disorder. METHODOLOGY Quasi-experimental study of pre-post type. The participants are linked to three services of the Mental Health Network (medium and long stay rehabilitation service, partial hospitalization and community care). The intervention is divided into three differential parts; In the first place an initial interview is carried out, after a group intervention for 10 weekly sessions and a follow-up after 3, 6 and 12 months. The measurement instruments used were: the Fagerström Nicotine Dependence Test, the Richmond Quit Smoking Motivation Test, the number of cigarettes, the degree of self-efficacy and the URICA Change Stages Scale. For the statistical analysis, possible associations between categorical variables were evaluated by Pearson chi-square test, possible differences between study periods with the Wilcoxon rank test. The differences between the 3 groups were evaluated by the non-parametric Kruskal-Wallis test and the Dunnett test. RESULTS The sample size is 25 participants, 10 (56%) linked to the medium and long stay rehabilitation service, 6 (24%) partial hospitalization and 9 (36%) to community care. 14 (56%) of them are men, with an average age of 47.52 years. The results reveal a moderate initial physical and social dependence (6.28 and 4.16 points respectively), a high psychological dependence (11.92 points) and a slight gestural dependence (11.16 points). The level of craving according to the QSU scale was 37.48 points, there being significant differences between the groups and a value for the abstinential symptomatology of 11.08 points. After the intervention, an average of 9.4 cigarettes / day was reduced, which subsequently increased during the annual follow-up, although a reduction of 5.32 cigarettes / day persisted at the end of the intervention. The level of motivation increased after the intervention by 0.70 points and subsequently remained stable during the follow-up, as well as the degree of self-efficacy it. CONCLUSIONS An intervention on the approach to smoking is effective in people with a mental disorder since they are motivated to abandon and/or reduce their consumption of tobacco. The prohibition of smoking during hospitalization is an opportunity to address and provide treatment to achieve cessation.