Cited by 266Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesCardiac Health and Mental Health

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Smoking cessation for improving mental health

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Taylor, Gemma MJ, Lindson, Nicola, Farley, Amanda, Leinberger-Jabari, Andrea, Sawyer, Katherine, te Water Naudé, Rebecca, Theodoulou, Annika, King, Naomi, Burke, Chloe, Aveyard, Paul·2021·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd013522.pub2PMC PMC8121093

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Abstract

BACKGROUND: There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self-medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health. OBJECTIVES: To examine the association between tobacco smoking cessation and change in mental health. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the trial registries clinicaltrials.gov and the International Clinical Trials Registry Platform, from 14 April 2012 to 07 January 2020. These were updated searches of a previously-conducted non-Cochrane review where searches were conducted from database inception to 13 April 2012. SELECTION CRITERIA: We included controlled before-after studies, including randomised controlled trials (RCTs) analysed by smoking status at follow-up, and longitudinal cohort studies. In order to be eligible for inclusion studies had to recruit adults who smoked tobacco, and assess whether they quit or continued smoking during the study. They also had to measure a mental health outcome at baseline and at least six weeks later. DATA COLLECTION AND ANALYSIS: . We conducted subgroup analyses to investigate any differences in associations between sub-populations, i.e. unselected people with mental illness, people with physical chronic diseases. We assessed the certainty of evidence for our primary outcomes (depression, anxiety, and mixed depression and anxiety) and our secondary social impact outcome using the eight GRADE considerations relevant to non-randomised studies (risk of bias, inconsistency, imprecision, indirectness, publication bias, magnitude of the effect, the influence of all plausible residual confounding, the presence of a dose-response gradient). MAIN RESULTS: = 87%). AUTHORS' CONCLUSIONS: Taken together, these data provide evidence that mental health does not worsen as a result of quitting smoking, and very low- to moderate-certainty evidence that smoking cessation is associated with small to moderate improvements in mental health. These improvements are seen in both unselected samples and in subpopulations, including people diagnosed with mental health conditions. Additional studies that use more advanced methods to overcome time-varying confounding would strengthen the evidence in this area.

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Authors: Taylor, G. M., Lindson, N., Farley, A., Leinberger-Jabari, A., Sawyer, K., te Water Naudé, R., Theodoulou, A., King, N., Burke, C., & Aveyard, P.
Affiliations: University of Bath (GB)
University of Oxford (GB)
University of Birmingham (GB)
New York University Abu Dhabi (AE)
Medical Sciences Division; University of Oxford; Oxford UK
ORCID: Lindson, Nicola
Farley, Amanda
Sawyer, Katherine
Theodoulou, Annika
Aveyard, Paul
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2021-03-09
Volume: 2021
Issue: 3
Pages: CD013522-CD013522
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd013522.pub2
PMC: PMC8121093
OpenAlex: W2999720558
Cited by: 266
References: 238
Citations by year: 2026: 22 · 2025: 78 · 2024: 62 · 2023: 50 · 2022: 41 · 2021: 12
FWCI: 5.51
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Pure (University of Bath) (publishedVersion, other-oa)
Bristol Research (University of Bristol) (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Explore Bristol Research (submittedVersion)
Funders: U.S. Department of Veterans Affairs (1IK2CX000718)
Robert Wood Johnson Foundation
John D. and Catherine T. MacArthur Foundation (P01‐AG020166)
Eli Lilly and Company
Pfizer
AstraZeneca
GlaxoSmithKline
Sanofi
Heart and Stroke Foundation of Canada
Office of Research and Development
University of Pennsylvania
Ministerio de Ciencia, Innovación y Universidades (FPU15)
Amsterdam University Medical Centers
Cancer Research UK (21330, C1417, C1417/A14135)
ZonMw (10-000-1001)
Universiteit Maastricht
Erasmus Medisch Centrum
GGZ inGeest
Rivierduinen
GGZ Friesland
GGZ Drenthe
Ministerio de Economía y Competitividad (PI14/, BES-2012-053988, BES-2016-076663)
Universidad de Navarra
Maastricht Universitair Medisch Centrum
Ministerio de Ciencia e Innovación (PSI-2011-23395, PI10/02293, G03/140, PSI2011-22804, PI13/00615, PSI2011-22804 and PSI2011-23395, PSI2012, PI14/01798, PSI2015, PI10/02658)
Shanghai Jiao Tong University
Universitair Medisch Centrum Groningen
Universiteit Antwerpen
H. Lundbeck A/S
Tasmanian Community Fund (D0013808)
National Institutes of Health (/ NCI R01, and K24, CA- 016672, P50 NS19632, P50-CA148596)
Agency for Healthcare Research and Quality
University of Texas MD Anderson Cancer Center (R25T CA057730, (CA016672), P30-CA-016672)
Center for AIDS Research, University of Washington
Heart And Stroke Foundation Of Quebec (NCT64989)
Canadian Institutes of Health Research (NCT64989)
Medical Research Council
National Health and Medical Research Council (544923, 1008299, 211316)
European Regional Development Fund (PSI2015-64371-P, BES-2016-076663, PI14/01798, (RD 06/0045, PI10/02658, G03/140, PI13/00615, PI10/02293, 45/2011)
National Institute on Aging (AG020166, P01AG020166)
National Heart, Lung, and Blood Institute (R01HL111821)
National Institute of Mental Health (MH097488, P01-AG020166, P30MH097488)
National Institute on Drug Abuse (R01 DA16708, DA045244, DA022549, R01DA023051, DA023051, DA16708, R01DA033681, K24DA030443, R01DA022549, K24DA045244)
National Cancer Institute (R01CA184211, CA057730, CA 016672, R25T-CA057730, P50CA148596, CA016672 to, R01CA152062, CA152062, R01CA165001, R25CA057730, P30CA016672)
National Institute of Allergy and Infectious Diseases (P30AI045008)
National Institute of Neurological Disorders and Stroke (P50NS19632, NS-19632)
Cilag
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords: smoking cessation, smoking, mental health, depression, anxiety, nicotine withdrawal symptoms, self-medication, mental illness, neural adaptation
MeSH terms: Social Interaction, Affect, Anxiety, Mental Disorders, Depression, Humans, Mental Health, Middle Aged, Quality of Life, Smoking, Stress, Psychological, Incidence, Confidence Intervals, Smoking Cessation, Tobacco Use Cessation, Controlled Before-After Studies

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