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Evidence published in the Cochrane Library will reassure people who want to stop smoking that quitting for at least six weeks is associated with improved mental wellbeing - by reducing anxiety, depression, and stress. People’s social relationships are also unlikely to suffer if they stop smoking. 

The review was produced by a team of researchers from the Universities of Bath, Birmingham, Oxford, and New York University.

Smoking is the world's leading cause of preventable illness and death. One in every two people who smoke will die of a smoking-related disease unless they quit. Some people believe that smoking helps reduce stress and other mental health symptoms, and that quitting smoking might make their mental health problems worse. People who smoke may also worry that stopping smoking will have a negative impact on their social lives and friendships.

The review found that people who stopped smoking for at least 6 weeks experienced less depression, anxiety, and stress than people who continued to smoke. People who quit also experienced more positive feelings and better psychological wellbeing.  Giving up smoking did not have an impact on the quality of people’s social relationships and it is possible that stopping smoking may be associated with a small improvement in social wellbeing.

The review summarises evidence from 102 observational studies involving over 169,500 people. The review authors combined the results from 63 of these studies that measured changes in mental health symptoms in people who stopped smoking with changes occurring in people who continued to smoke. They also combined results from 10 studies that measured how many people developed a mental health disorder during the study. The studies involved a wide range of people, including people with mental health conditions and people with long-term physical illnesses. The length of time the studies followed people varied, with the shortest being 6 weeks, but some studies followed people for up to 6 years. The certainty of the evidence ranged from very low to moderate.

The lead author of this Cochrane Review, Dr Gemma Taylor from the Addiction & Mental Health Group at the University of Bath, said, “We found stopping smoking was associated with small to moderate improvements in mood. The benefits of smoking cessation on mood seem to be similar in a range of people, and most crucially, there is no reason to fear that people with mental health conditions will experience a worsening of their health if they stop smoking. Our confidence in the precise size of the benefit is limited due to the way the studies were designed and future studies that can overcome those challenges will greatly strengthen the evidence about the impacts of smoking cessation on mental health.”

Co-author Professor Paul Aveyard in the Nuffield Department of Primary Care Health Sciences, Co-ordinating editor for Cochrane Tobacco Addiction Group, said: “These results should particularly reassure people suffering from mental health problems and clinicians who are treating them. Stopping smoking is very unlikely to worsen and likely to improve mental health and the benefit on mental health is the same for people with as those without these disorders.“

Read more: 

Smoking cessation for improving mental health
Gemma MJ Taylor, Nicola Lindson, Amanda Farley et al
Cochrane Database of Systematic Reviews 2021 https://doi.org/10.1002/14651858.CD013522.pub2

Research co-authors:

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Opinions expressed are those of the authors and not of Oxford University. Readers' comments will be moderated - see our guidelines for further information.