Taylor GMJ, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, te Water Naudé R, Theodoulou A, King N, Burke C, Aveyard P. Smoking cessation for improving mental health. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD013522. DOI: 10.1002/14651858.CD013522.pub2.
Picture this…
James is 60 and has been smoking since his early 20s. He began smoking socially when he went out with his friends, but as he entered his professional working life it became more associated with stress and avoidance. He believes that smoking acts as a “self-medication” in order to cope with life’s daily difficulties. James knows that smoking is bad for his physical health however believes that its positive impact on his mental health outweighs this which is why he has continued to smoke for so long. He has considered stopping smoking many times but is worried that it might have an impact on his mental health.
Summary Messages:
- The research in this systematic review suggests that stopping smoking will not worsen mood.
- Stopping smoking may improve mood, by reducing anxiety, depression, and stress, and boosting positive mood. It is also unlikely to worsen social relationships.
- However, because of limitations in the ways that the studies were designed and carried out, mean that the researcher’s confidence in the results was reduced for some of the results e.g., the impact of stopping smoking on depression.
What the Research Says-
This is a systematic review published in the Cochrane Library. The review team wanted to collect evidence on the effects of stopping smoking on mental health. If stopping smoking leads to improvements in mental health, it could lead to incentives for current smokers to quit. Armed with this information, it would be possible to not only improve the mental health of many adults but also the physical health of these adults as quitting tobacco and nicotine products has many positive effects.
Data was collected from 102 studies in more than 165,000 people in which wellbeing symptoms in individuals that smoked were monitored. Information on whether they continued to smoke or whether they stopped smoking during the study was also collected. The studies measured anxiety, depression and stress symptoms and overall wellbeing using a range of different tools. Some of the studies included the general population, some included people with mental health conditions, or people with physical and mental health conditions or long-term physical health conditions, others included people who had recently had surgery or who were pregnant.
The review team were able to combine the results from groups of similar studies and found that compared with people who carried on smoking, those who stopped smoking showed greater reductions in anxiety, depression and mixed anxiety and depression. There was also no evidence that people’s social wellbeing was reduced when they stopped smoking, in fact social wellbeing may have increased slightly. However, there were some methodological issues with some of the studies, which mean that there is some uncertainty in the results, especially for depression and anxiety. The review authors concluded that stopping smoking is unlikely to lead to a worsening of mood in the long term and may lead to reductions in anxiety and depression symptoms.
Where is James now…
James decided to quit smoking. He has noticed an improvement in some symptoms however others remain the same. James hopes that as time moves on, he will notice even bigger improvements in his mental health once his withdrawal symptoms have calmed. He is also optimistic that this change will have a positive impact on his physical health and is on the lookout for other community-based activities to help with his work-related stress.
Reference points –
Taylor GMJ, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, te Water Naudé R, Theodoulou A, King N, Burke C, Aveyard P. Smoking cessation for improving mental health. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD013522. DOI: 10.1002/14651858.CD013522.pub2.
A podcast that summarises the results from the study is also available from Cochrane.
Please note: this research was conducted in adult populations and is not specific to older people. Stories and pictures used do not represent specific individuals – they are utilised to contextualise the data into a more digestible format.
IMAGES – All images sourced from the free age positive image library of the Centre for Better Ageing. All images are published under the CC01.0 Universal licence, entered into the public domain.
BSc Medical Sciences student
University of Exeter
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