Smoking Cessation Associated with Improved Mental Health

Smoking cessation had long been associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. Yet many smokers who wish to quit are afraid to do so because they believe smoking decreases their feelings of depression, anxiety, and stress and improves their mood and promotes relaxation. This sentiment is reported by smokers both with and without diagnosed mental disorders.

In fact, evidence had been found of a strong association between smoking and poor mental health, and smokers with mental health disorders are more likely to be heavier smokers with greater dependence. Because smokers might be less likely to stop — and their clinicians might be less likely to encourage them to do so – if it is believed that their mental health will worsen if they quit smoking. UK researchers in tobacco addiction, epidemiology, and behavioral medicine set out to demonstrate whether there is a positive change in mental health among people who stop smoking versus people who continue to smoke. Their findings were published in the February 13, 2014, issue of BMJ.

They conducted a systematic review and meta-analysis of observational data from 26 relevant studies of adults that assessed mental health before smoking cessation and at least 6 weeks after cessation or baseline in health and clinical populations. Follow-up mental health scores were measured between 7 weeks and 9 years after baseline.

Anxiety, depression, mixed anxiety and depression, and stress significantly decreased between baseline and follow-up in quitters compared with continuing smokers. Standardized mean differences were as follows: anxiety, -0.37 (95% Confidence Interval [CI], -0.70 to -0.03); depression, -0.31 (-0.37 to -0.12); mixed anxiety and depression, -0.31 (-0.47 to -0.14); and stress, -0.27 (-0.40 to -0.13). Both psychological quality of life and positive affect significantly increased between baseline and follow-up in quitters compared with continuing smokers. The investigators also found that the effect estimates are equal to or larger than those of antidepressant treatments for mood disorders.

The researchers concluded that smokers can be reassured that stopping smoking is associated with mental health benefits, helping to motivate more smokers to stop.