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Smoking cessation for improving mental health
Open accessAbstract
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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“Nicotine affects dopamine release, providing temporary pleasure and reinforcing the perception that smoking alleviates mental health symptoms, despite actually worsening these symptoms in the long-term [12, 13, 14, 15].”
From Can an Acceptance and Commitment Therapy-Based Smartphone App Help Individuals with Mental Health Disorders Quit Smoking? (2024) · cites this paper as [15]
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“Once withdrawal symptoms have abated, cessation is generally associated with improved mental health (Taylor 2014; Taylor 2021)”
From Mindfulness for smoking cessation (2022) · cites this paper as Taylor 2021
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Metadata
- 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
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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