Stopping smoking
Stopping smoking
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New study shows quitting smoking can improve mental health

A new cohort study has provided compelling evidence that quitting smoking can lead to improved mental health outcomes among people with and without mental health disorders, alleviating concerns raised by both clinicians and smokers.

Published in JAMA Network Open, the findings revealed that smoking abstinence between weeks nine and 24 was associated with significant improvements in anxiety and depression scores.

Led by a team of researchers at Oxford University’s Nuffield Department of Primary Care Health Sciences, the study employed rigorous analytical approaches to assess changes in mental health following smoking cessation.

The study used data from a large, randomized clinical trial, the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) which occurred in 16 countries at 140 centers between 2011 and 2015. However, only data from US-based participants were used for this secondary analysis. The study involved adults with or without a psychiatric disorder who smoked. A total of 4,260 participants were included in the analysis, with 55.4% having a history of mental illness.

Angela Wu, lead author and Researcher in the Nuffield Department of Primary Care Health Sciences, University of Oxford, said: ‘While we are seeing a large decrease of smoking rates over the years in the UK for the general population this is not the case for people living with mental health conditions. The number of people smoking who also have a mental health condition has remained the same since 1993 (approximately 40%). We hope our results can help motivate policymakers and stakeholders to better support smoking cessation in people with mental health conditions.’

Min Gao, co-author and Researcher in Nuffield Department of Primary Care Health Sciences says: ‘We used three statistical approaches to reduce confounding, so that we provided more robust evidence about the effects of quitting smoking on mental health. Quitting smoking will not worsen and may improve mental health outcomes.’

The findings are published on World No Tobacco Day, an annual event on 31 May, led by the World Health Organization (WHO). The primary objective of World No Tobacco Day is to raise awareness about the health risks associated with tobacco use and advocate for effective policies to reduce tobacco consumption worldwide.

Smoking is the global leading cause of preventable illnesses and deaths, with nearly half of all smokers dying from a smoking-related disease. Despite expressing a desire to quit, many smokers continue because they perceive smoking as a means of alleviating stress and providing other psychological benefits. This notion that cigarettes have a calming effect is pervasive, and some healthcare professionals may dissuade individuals with mental health disorders from attempting to quit due to concerns about potential worsening of their mental well-being.

Paul Aveyard, co-author, Professor of Behavioral Medicine at the Nuffield Department of Primary Care Health Sciences commented: 'Many people who smoke cannot contemplate stopping smoking. They know it affects their health, but they feel they need cigarettes to cope with stress. This is what people experience every day when they smoke — they feel better afterwards. However what people perceive are the benefits of smoking are the symptoms of withdrawal from cigarettes. While smoking gives a short-term benefit, smoking itself is the cause of the problems. Without smoking, mental health improves on average. Our study joins with others that show that when people stop smoking their mental health improves, whereas those who do not stop smoking have no improvement.’

‘Stopping smoking is not easy,’ added Angela Wu, ‘What we do know though is that you are more likely to successfully stop smoking when you are supported, whether that is pharmacologically or behaviourally. There are many alternatives and options to help you quit, such as counselling, nicotine replacement therapy (for example patches, gum and sprays), and even trying out electronic cigarettes. Electronic cigarettes do not burn tobacco, which is the most harmful element of smoking cigarettes, but will still give you nicotine.’

The paper, 'Smoking Cessation and Changes in Anxiety and Depression in Adults With and Without Psychiatric Disorders', can be read in JAMA Network Open.