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Evidence summaries

Change in Mental Health after Smoking Cessation

Smoking cessation may be associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. Level of evidence: "C"

Information on the potential improvement in mental health after quitting is suggested to be a part of smoking cessation counselling.

Summary

A Cochrane review [Abstract] 3 examining the association between smoking cessation and change in mental health included 102 studies with over 169 500 participants. Smoking cessation was associated with an improvement in mental health symptoms compared with continuing to smoke: anxiety symptoms (SMD 0.28, 95% CI 0.43 to 0.13; 15 studies, n=3141); depression symptoms: (SMD 0.30, 95% CI 0.39 to 0.21; 34 studies, n=7156); mixed anxiety and depression symptoms (SMD 0.31, 95% CI 0.40 to 0.22; 8 studies, n=2829); stress (SMD 0.19, 95% CI 0.34 to 0.04; 4 studies, n=1792), and psychological quality of life (SMD 0.11, 95% CI 0.06 to 0.16; 19 studies, n=18 034).

A systematic review1and meta-analysis included 26 observational studies (11 cohort studies, 14 secondary analyses of cessation interventions, 1 RCT) in healthy and clinical populations. The aim was to investigate change in mental health after smoking cessation compared with continuing to smoke assessing mental health with questionnaires designed to measure anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect, and stress. Follow-up mental health scores were measured between 7 weeks and 9 years after baseline. The median length of follow up was 6 months. In 18 studies abstinence was biologically verified. In 7 studies participants received a psychological intervention as part of the cessation intervention. Anxiety significantly decreased between baseline and follow-up in quitters compared with continuing smokers (the standardised mean difference (SMD) 0.37 ;95% CI 0.70 to 0.03; 4 trials; I²=71%; P<0.03), so did depression (SMD 0.25;0.37 to 0.12; 10 trials; I²=30%; P<0.001), mixed anxiety and depression (0.31; 0.47 to 0.14; 5 trials, I²=0%; P<0.001), and stress (-0.27; 0.40 to 0.13; 3 trials; I²=0%; P<0.001). Both psychological quality of life and positive affect significantly increased between baseline and follow-up in quitters compared with continuing smokers 0.22 (0.09 to 0.36; 8 trials; I²=63%; P<0.001) and 0.40 (0.09 to 0.71; 3 trials;, I²=49%; P<0.01), respectively. There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders.

A meta-analysis 2 assessed smoking cessation interventions for smokers with current depression. 16 RCTs and 4 secondary studies were included. 3 types of intervention were examined: psychological (6/30%), pharmacological (6/30%) or combined (8/40%). Smoking cessation interventions appear to increase short-term (RR 1.26, 95% CI 1.12 to 1.41, p < .001, I²=64%) and long-term (RR 1.14, 95% CI 1.01 to 1.29, p = .048, I²=42%). Psychological treatments found a positive trend, although not significant, at both short and long-term follow-up. Smoking abstinence appears to be associated with an improvement in depressive symptoms.

Clinical comments

Note

Date of latest search: 2021-05-26

    References

    • Taylor G, McNeill A, Girling A et al. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ 2014;348:g1151. [PubMed]
    • Secades-Villa R, González-Roz A, García-Pérez Á et al. Psychological, pharmacological, and combined smoking cessation interventions for smokers with current depression: A systematic review and meta-analysis. PLoS One 2017;12(12):e0188849. [PubMed]
    • Taylor GM, Lindson N, Farley A et al. Smoking cessation for improving mental health. Cochrane Database Syst Rev 2021;(3):CD013522. [PubMed]

Primary/Secondary Keywords