JMIR Publications

ABSTRACT

Background:

Smoking prevalence is disproportionately high among individuals with mental disorders, who also show reduced cessation success, suggesting that current cessation interventions may not fully address their specific needs. A barrier to smoking cessation is the fear that quitting may worsen mental health, yet little is known about how individuals with mental disorders experience guideline-conform cessation treatments, which may address such concerns.

Objective:

This qualitative study explored the perspectives of smoking individuals with comorbid mental disorders who participated in a standardized, manual-based smoking cessation program, to identify targets for optimizing guideline-conform interventions for this population.

Methods:

Semi-structured interviews were conducted with eleven participants representing diverse cessation trajectories (sustained abstinence, relapse, and no quit attempt) six months after treatment completion. Data were analyzed using reflexive thematic analysis.

Results:

Participants described smoking cessation as a complex, processual experience extending be-yond smoking behavior to psychological, social, and contextual domains. Despite reporting transient strain during early abstinence, participants experienced improvements in mental well-being and self-efficacy. However, pre-existing mental health-related fears largely persisted, with positive effects rarely interpreted as generalizable outcomes.

Conclusions:

These findings suggest that misconceptions regarding the mental health risks of smoking cessation may be maintained through cognitive immunization and highlight the need for targeted psychoeducation and individualized, context-sensitive strategies to improve cessation outcomes in this high-risk population. Clinical Trial: Prospectively registered on ISCRTN on 01.05.2024, reference number ISRCTN12859609.