Thursday, June 1, 2023

Smoking Cessation Does Not Worsen Mental Health Outcomes, Study Finds

Smoking cessation may be associated with improved mental health outcomes among people with and without psychiatric disorders, according to a study published yesterday in JAMA Network Open.

“Many people who smoke state that they want to quit, but many continue because they report that smoking helps relieve stress and offers other mental health benefits,” wrote Angela Difeng Wu, M.Sc., and Min Gao, Ph.D., of the University of Oxford, and colleagues. “The belief that cigarettes are calming is widespread, and some health professionals may deter people with mental health disorders from trying to stop smoking.”

Wu, Gao, and colleagues used data from the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES), which compared outcomes in people with and without psychiatric disorders who had received either varenicline with nicotine replacement therapy, bupropion, or placebo for smoking cessation. People aged 18 to 75 who smoked 10 or more cigarettes per day during the previous year and were motivated to quit were included. Participants in the EAGLES study received 12 weeks of treatment followed by 12 weeks of follow-up visits that did not include treatment. Smoking cessation was defined as continuous abstinence between weeks nine and 24. Anxiety and depression outcomes were measured with the Hospital Anxiety and Depression Scale (HADS), which was administered at baseline and 11 times during visits between weeks six and 24. HADS includes seven items to assess anxiety and seven to assess depression, with a lower score representing less severe symptoms.

Of 4,260 participants, 2,359 (55%) had a history of mental illness, and 923 (21.7%) were taking psychotropic medication. At the end of the study period, 3,781 participants continued smoking and 479 had stopped. Those who were taking psychotropic medications were significantly more likely to continue smoking at the end of the study period compared with those who were not. Those who stopped smoking had a lower HADS score at week 24 compared with those who continued smoking (for example, anxiety was lower by 0.40 points, while depression was lower by 0.47 points). Those with a history of psychiatric illness who stopped smoking had greater decreases in HADS scores compared with those who did not have a history of psychiatric illness.

“The disparity between smoking cessation rates in people with and without psychiatric disorders is concerning, given that smoking may account for up to two-thirds of the difference in life expectancy between people with a history of psychiatric disorders who smoke vs people who have never smoked,” the authors wrote. “These findings might motivate policy makers and stakeholders to support smoking cessation in people with mental health disorders.”

For related information, see the Psychiatric Services article “Smoking Cessation Medication Prescribing for Smokers With and Without Mental Illness.”

(Image: iStock/bymuratdeniz)


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