可能的烟草戒断新症状 III：正性情绪降低——综述和荟萃分析。
Possible New Symptoms of Tobacco Withdrawal III: Reduced Positive Affect-A Review and Meta-analysis.
机构信息
Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT.
Department of Psychological Science, University of Vermont, Burlington, VT.
出版信息
Nicotine Tob Res. 2021 Jan 22;23(2):259-266. doi: 10.1093/ntr/ntaa044.
INTRODUCTION
Most descriptions of tobacco withdrawal have not changed in >30 years despite new research. This meta-analysis tested whether abstinence leads to decreased positive affect (PA) because abstinence-induced symptom changes are a core feature of the tobacco withdrawal syndrome. In addition, we examined whether reduced PA was due to withdrawal (ie, temporary decrease in a "U-shaped" curve) or offset (ie, return to baseline) effect.
METHODS
Our main inclusion criterion was a prospective within-participant test of change in PA during abstinence conditions among people who smoke cigarettes daily who were not using a cessation medication. Our search of PubMed, PsycINFO, and personal libraries yielded a total of 32 tests with 2054 participants.
RESULTS
There was a medium effect size indicating an overall decrease in PA following abstinence from cigarettes (Cohen's d = -0.40, 95% CI = -0.30 to -0.49). There was large heterogeneity (I2 = 70.7%). Most (79%) of the 24 trials that conducted significance tests reported that reduction in PA was significant. Seven tests were adequately designed to detect a withdrawal versus offset effect. Over half (57%) displayed a U-shaped curve for abstinence-induced change in PA indicative of a withdrawal symptom rather than offset effect.
CONCLUSIONS
Abstinence from cigarettes is associated with a decrease in PA. Whether low PA should be added to withdrawal measures and diagnostic criteria requires replication of the time-course of change in PA and tests of whether abstinence-induced changes in PA and negative affect occur independently.
IMPLICATIONS
Though there was substantial heterogeneity among trials, our findings suggest that (1) abstinence from cigarettes decreases positive affect and (2) this decrease may represent a withdrawal effect (vs. an offset effect). However, it is unclear whether abstinence-induced losses in positive affect are independent from increased negative affect.
简介
尽管有新的研究，但 >30 年来，大多数关于烟草戒断的描述都没有改变。本荟萃分析检验了戒断是否会导致积极情绪（PA）下降，因为戒断引起的症状变化是烟草戒断综合征的核心特征。此外，我们还研究了 PA 的减少是由于戒断（即“U 形”曲线的暂时下降）还是由于抵消（即回到基线）效应。
方法
我们的主要纳入标准是在没有使用戒烟药物的情况下，每天吸烟的参与者在戒断期间 PA 变化的前瞻性个体内测试。我们对 PubMed、PsycINFO 和个人文库的搜索共产生了 32 项测试，涉及 2054 名参与者。
结果
结果表明，总体上 PA 在戒烟后呈中等效应大小下降（Cohen's d = -0.40，95%CI = -0.30 至 -0.49）。存在很大的异质性（I2 = 70.7%）。进行显著性检验的 24 项试验中有 79%报告 PA 减少显著。7 项测试设计合理，可以检测出戒断与抵消效应。超过一半（57%）的测试显示 PA 随戒断而变化的 U 形曲线，表明这是戒断症状而不是抵消效应。
结论
戒烟与 PA 下降有关。低 PA 是否应该添加到戒断措施和诊断标准中，需要对 PA 变化的时间进程进行复制，并检验 PA 和负性情绪的戒断诱导变化是否独立发生。
意义
尽管试验之间存在很大的异质性，但我们的研究结果表明：（1）戒烟会降低积极情绪，（2）这种降低可能代表戒断效应（而非抵消效应）。然而，尚不清楚戒断引起的积极情绪损失是否独立于负性情绪增加。
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