Oxford, United Kingdom—Many smokers have reported that although they want to quit smoking, tobacco use helps them manage stress and provides other mental health benefits.

To address this concern, a UK study team led by researchers from the University of Oxford sought to determine whether smoking cessation is associated with changes in anxiety and depression in adults with and without psychiatric disorders.

The results, based on data from 4,260 adults and published in Journal of the American Medical Association Network Open, were somewhat surprising. The study team reported that smoking cessation was associated with significant improvements in anxiety and depression among people with and without psychiatric disorders.

“Although many people report a desire to quit smoking, concerns about mental health worsening after quitting are often raised by clinicians and people who smoke,” the authors wrote. The cohort study was conducted using data from a large, randomized clinical trial, the Evaluating Adverse Events in a Global Smoking Cessation Study. That trial was conducted in 16 countries at 140 centers between 2011 and 2015.

Only data collected from participants who completed the trial in the United States were available for the secondary analysis, according to the authors. These participants included adults with or without a psychiatric disorder who smoked. The focus was on smoking abstinence in weeks 9 through 24.

The study team measured anxiety and depression scores using the Hospital Anxiety and Depression Scale at 24 weeks, wherein a lower score indicated better mental health (range, 0-21).

The 4,260 participants had a mean age of 46.5 years, and 58.3% were women. The majority (71.5%) were white. Approximately one-half (55.4%) of the participants had a history of mental illness.

With the mean (SD) baseline Hospital Anxiety and Depression Scale score at 4.25 (3.68; median [IQR], 3 [1-6]) for anxiety and 2.44 (2.91; IQR, 1 [0-4]) for depression, the researchers reported that, after adjustment for demographics and baseline variables, smoking cessation was associated with a decrease in scores for both anxiety (–0.40 point; 95% CI, –0.58 to –0.22 point) and depression (–0.47 point; 95% CI, –0.61 to –0.33 point) compared with continuing smoking. “Similarly, propensity score–adjusted models indicated that smoking cessation was associated with reduced scores for anxiety (β = –0.32; 95% CI, –0.53 to –0.11) and depression (β = –0.42; 95% CI, –0.60 to –0.24),” the researchers explained.

The study concluded that, for this cohort, “…of people with and without psychiatric disorders, smoking cessation, sustained for at least 15 weeks, was associated with improved mental health outcomes in observational analyses, but the instrumental variable analysis provided inconclusive evidence. Findings like these may reassure people who smoke and their clinicians that smoking cessation likely will not worsen and may improve mental health.”

The authors suggested that the mental health benefits presumed by many smokers appear to be “spurious,” adding, “Feelings of low mood, irritability, and anxiety can manifest shortly after finishing a cigarette when blood levels of nicotine drop, and these feelings are relieved by smoking another cigarette. Therefore, individuals may perceive that smoking relieves their psychological distress; however, this distress may have been caused by smoking withdrawal. The belief that cigarettes are calming is widespread, and some health professionals may deter people with mental health disorders from trying to stop smoking.”

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