Crabb Amy Bethan, Allen Jennifer, Taylor Gemma
Psychology, University of Bath, Bath, UK
Psychology, University of Bath, Bath, UK.
BMJ Open. 2025 May 2;15(5):e091419. doi: 10.1136/bmjopen-2024-091419.
Evidence that smoking cessation benefits physical and mental health has led to recommendations to support quitting. Unsuccessful quit attempts are common and associated with guilt and frustration; however, their impact on mental health is unclear. This review investigated the association between the success/failure of smoking cessation attempts and changes in symptoms of depression and anxiety.
Systematic review and meta-analysis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines.
Inclusion and exclusion lists of two previous reviews, plus update searches of Embase, Medline and PsycINFO (January 2020-January 2025).
Trials and longitudinal observational studies measuring symptoms of anxiety or depression before and after a smoking cessation attempt, beyond the withdrawal period (6 weeks), in adults who successfully quit and made an unsuccessful attempt.
Standardised methods were used for screening and data extraction. Two independent reviewers screened a minimum of 25% and extracted data for 100% of studies. Meta-analyses were conducted using random effects models, and narrative synthesis was used when necessary. Study quality, heterogeneity and publication bias were assessed using the adapted Newcastle-Ottawa Scale, and funnel plots, respectively.
62 studies were included, representing 36 150 participants. Most featured behavioural smoking cessation interventions and defined successful cessation attempts by self-reported or biologically verified abstinence. Follow-up ranged from 6 weeks to 4 years. Overall, successfully quitting smoking was associated with reduced symptoms of depression (standardised mean difference (SMD)=-0.21, 95% CI -0.27 to -0.16) and anxiety (SMD=-0.22, 95% CI -0.33 to -0.12) compared with unsuccessful quit attempts. Heterogeneity was substantial =50-69%).
Most studies indicated a positive trend in alleviating symptoms of anxiety and depression during a quit attempt. Successful quitters experienced more substantial reductions in these symptoms compared with those who were unsuccessful. Importantly, those who made an unsuccessful quit attempt did not experience worse mental health.
CRD42022314728.
The majority of studies in our review indicated a positive trend in alleviating symptoms of anxiety and depression when individuals attempt to quit smoking. Successful quitters experienced more substantial reductions in these symptoms compared with those who were unsuccessful. Importantly, those who attempted to quit but failed did not experience worse mental health. These findings are relevant to people who smoke tobacco and the health professionals who support them as they may hold some apprehensions about quitting smoking or the anticipated emotional consequences of failing to quit. The current review contributes to clinical practice by adding to the information on which risk-benefit decisions are made regarding smoking cessation.
有证据表明戒烟有益于身心健康，因此有建议支持戒烟。戒烟尝试失败很常见，且会带来内疚和挫败感；然而，其对心理健康的影响尚不清楚。本综述调查了戒烟尝试的成功与否与抑郁和焦虑症状变化之间的关联。
遵循系统评价和Meta分析的首选报告项目（PRISMA）以及流行病学观察性研究的Meta分析（MOOSE）指南进行系统评价和Meta分析。
之前两项综述的纳入和排除清单，以及Embase、Medline和PsycINFO（2020年1月至2025年1月）的更新检索。
测量成功戒烟者和戒烟尝试失败的成年人在戒烟尝试前后（戒断期6周后）焦虑或抑郁症状的试验和纵向观察性研究。
采用标准化方法进行筛选和数据提取。两名独立评审员至少筛选25%的研究，并提取100%研究的数据。使用随机效应模型进行Meta分析，必要时进行叙述性综合。分别使用改良的纽卡斯尔-渥太华量表和漏斗图评估研究质量、异质性和发表偏倚。
纳入62项研究，共36150名参与者。大多数研究采用行为戒烟干预措施，并通过自我报告或生物学验证的戒烟来定义成功的戒烟尝试。随访时间从6周到4年不等。总体而言，与戒烟尝试失败相比，成功戒烟与抑郁症状减轻（标准化均数差（SMD）=-0.21，95%CI -0.27至-0.16）和焦虑症状减轻（SMD=-0.22，95%CI -0.33至-0.12）相关。异质性较大（I²=50-69%）。
大多数研究表明，在戒烟尝试期间，焦虑和抑郁症状有减轻的积极趋势。与未成功戒烟者相比，成功戒烟者这些症状的减轻更为显著。重要的是，戒烟尝试失败的人心理健康状况并未变差。
PROSPERO注册号：CRD42022314728。
我们综述中的大多数研究表明，当个体尝试戒烟时，焦虑和抑郁症状有减轻的积极趋势。与未成功戒烟者相比，成功戒烟者这些症状的减轻更为显著。重要的是，尝试戒烟但失败的人心理健康状况并未变差。这些发现与吸烟人群以及支持他们的健康专业人员相关，因为他们可能对戒烟或戒烟失败预期的情绪后果有所担忧。本综述通过补充有关戒烟风险效益决策的信息，为临床实践做出了贡献。
