Smokers experience irritability, anxiety, and depression when they have not smoked for a while, 21 22 and these feelings are reliably relieved by smoking 20 thus creating the perception that smoking has psychological benefits, while in fact it is smoking that caused these psychological disturbances in the first place. 20 Although smokers with and without mental disorders think that smoking provides mental health benefits, they might be misattributing the ability of cigarettes to abolish nicotine withdrawal as a beneficial effect on mental health. 16 17 Three broad explanations have been proposed to explain these associations: smoking and poor mental health might have common causes 18 people with poor mental health smoke to regulate feelings such as low mood and anxiety 19 or smoking might cause or exacerbate mental health problems. 15Īlthough smokers think that smoking offers mental health benefits, there is a strong association between smoking and poor mental health, and smokers with mental health disorders tend to be heavier smokers and more dependent. 9 12 13 Unsurprisingly, views about smoking predict whether or not people attempt to quit 14 and whether or not they are successful. 7 8 9 10 11 12 13 This pattern of behaviour occurs in smokers with and without diagnosed mental disorders. Both quantitative and qualitative analyses indicate that regular smokers report smoking cigarettes to alleviate emotional problems and feelings of depression and anxiety, to stabilise mood, and for relaxation as well as relieving stress. Although most smokers report wanting to quit, 6 many continue as they report that smoking provides them with mental health benefits. 4 5 The association between smoking and mental health, however, is less clear cut. 2 Smoking is a major risk factor for the development of cancers and cardiovascular and respiratory diseases 3 stopping smoking substantially reduces these health risks.
1 The worldwide cost of healthcare from tobacco use has been estimated within the billion dollar range. Tobacco is the leading global cause of preventable death, estimated to cause more than five million deaths a year, and this is predicted to rise. The effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders. The effect size seems as large for those with psychiatric disorders as those without. There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders.Ĭonclusions Smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. 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). 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). Follow-up mental health scores were measured between seven weeks and nine years after baseline. 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. Reference lists of included studies were hand searched, and authors were contacted when insufficient data were reported.Įligibility 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. Objective To investigate change in mental health after smoking cessation compared with continuing to smoke.ĭesign Systematic review and meta-analysis of observational studies.ĭata sources Web of Science, Cochrane Central Register of Controlled Trials, Medline, Embase, and PsycINFO for relevant studies from inception to April 2012.
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