Change in mental health after smoking cessation: systematic review and meta-analysis

Gemma Taylor, Ann McNeill, Alan Girling, Amanda Farley, Nicola Lindson-Hawley, Paul Aveyard, Gemma Taylor, Ann McNeill, Alan Girling, Amanda Farley, Nicola Lindson-Hawley, Paul Aveyard

Abstract

Objective: To investigate change in mental health after smoking cessation compared with continuing to smoke.

Design: Systematic review and meta-analysis of observational studies.

Data sources: Web of Science, Cochrane Central Register of Controlled Trials, Medline, Embase, and PsycINFO for relevant studies from inception to April 2012. Reference lists of included studies were hand searched, and authors were contacted when insufficient data were reported.

Eligibility criteria for selecting studies: Longitudinal studies of adults that assessed mental health before smoking cessation and at least six weeks after cessation or baseline in healthy and clinical populations.

Results: 26 studies that assessed mental health with questionnaires designed to measure anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect, and stress were included. Follow-up mental health scores were measured between seven weeks and nine years after baseline. Anxiety, depression, mixed anxiety and depression, and stress significantly decreased between baseline and follow-up in quitters compared with continuing smokers: the standardised mean differences (95% confidence intervals) were anxiety -0.37 (95% confidence interval -0.70 to -0.03); depression -0.25 (-0.37 to -0.12); mixed anxiety and depression -0.31 (-0.47 to -0.14); 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 0.22 (0.09 to 0.36) and 0.40 (0.09 to 0.71), respectively). There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders.

Conclusions: Smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. The effect size seems as large for those with psychiatric disorders as those without. The effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: GT has received grants and personal fees from a National Coordinating Centre for Research Capacity Development scholarship, during the conduct of the study; and personal fees from UK Centre for Tobacco and Alcohol Studies, outside the submitted work. AMcN has received grants from UK Centre for Tobacco and Alcohol Studies, outside the submitted work. AF has received grants from National Prevention Research Initiative, during the conduct of the study; and sat on the professional development group for NICE guidance on stopping smoking in secondary care. NL-H has received personal fees from manufacturers of smoking cessation aids, outside the submitted work; and manages an NIHR HTA funded trial of nicotine patch preloading. The nicotine patches for the trial are provided free of charge by GlaxoSmithKline (GSK). GSK have no other involvement in the trial. PA has received personal fees from Pfizer, grants and personal fees from McNeil, outside the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793576/bin/tayg015306.f1_default.jpg
Fig 1 Flow and identification of studies to include in review of change in mental health after smoking cessation
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793576/bin/tayg015306.f2_default.jpg
Fig 2 Difference between change in mental health outcomes (anxiety, mixed anxiety and depression, depression, stress) from baseline to longest follow-up in people who stopped smoking or continued to smoke. Study by McDermott was in submission during search
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793576/bin/tayg015306.f3_default.jpg
Fig 3 Difference between change in mental health outcomes (positive affect, psychological quality of life) from baseline to longest follow-up in people who stopped smoking or continued to smoke

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