Change in anxiety following successful and unsuccessful attempts at smoking cessation: Cohort study

Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK. .
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 01/2013; 202(1):62-7. DOI: 10.1192/bjp.bp.112.114389
Source: PubMed


Despite a lack of empirical evidence, many smokers and health professionals believe that tobacco smoking reduces anxiety, which may deter smoking cessation.
The study aim was to assess whether successful smoking cessation or relapse to smoking after a quit attempt are associated with changes in anxiety.
A total of 491 smokers attending National Health Service smoking cessation clinics in England were followed up 6 months after enrolment in a trial of pharmacogenetic tailoring of nicotine replacement therapy (ISRCTN14352545).
There was a points difference of 11.8 (95% CI 7.7-16.0) in anxiety score 6 months after cessation between people who relapsed to smoking and people who attained abstinence. This reflected a three-point increase in anxiety from baseline for participants who relapsed and a nine-point decrease for participants who abstained. The increase in anxiety in those who relapsed was largest for those with a current diagnosis of psychiatric disorder and whose main reason for smoking was to cope with stress. The decrease in anxiety on abstinence was larger for these groups also.
People who achieve abstinence experience a marked reduction in anxiety whereas those who fail to quit experience a modest increase in the long term. These data contradict the assumption that smoking is a stress reliever, but suggest that failure of a quit attempt may generate anxiety.

Download full-text


Available from: Paul Aveyard, Nov 24, 2015
  • Source
    • "There is growing evidence that, on average, quitting tobacco does not negatively impact long-term psychological functioning for persons with MHCs—a concern often raised by providers [13]. In fact, treatment may reduce MHC symptoms and improve functioning [14] [15] [16] [17]. State tobacco quitlines in the United States provide evidence-based tobacco cessation treatment to more than 400,000 smokers annually, including free phone-based cessation counseling and often access to nicotine replacement therapy (NRT) [18] [19]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. To examine abstinence outcomes among tobacco users with and without a reported mental health condition (MHC) who enrolled in state tobacco quitline programs. Methods. Data were analyzed from a 7-month follow-up survey (response rate: 41% [3,132/7,459]) of three state-funded telephone quitline programs in the United States that assessed seven self-reported MHCs at quitline registration. We examined 30-day point prevalence tobacco quit rates for callers with any MHC versus none. Data were weighted to adjust for response bias and oversampling. Multivariable logistic regression was used to examine cessation outcomes. Results. Overall, 45.8% of respondents reported ≥1 MHC; 57.4% of those reporting a MHC reported ≥2 MHCs. The unadjusted quit rate for callers with any MHC was lower than for callers with no MHC (22.0% versus 31.0%, P < 0.001). After adjusting for demographics, nicotine dependence, and program engagement, callers reporting ≥1 MHC were less likely to be abstinent at follow-up (adjusted OR = 0.63, 95% CI = 0.51-0.78, P < 0.001). Conclusions. More intensive or tailored quitline programs may need to be developed among callers with MHCs as their quit rates appear to be lower than callers without MHCs.
    08/2015; 2015(5):817298. DOI:10.1155/2015/817298
  • Source
    • "For example, nicotine-dependent smokers have been shown to have greater severity of mood and anxiety symptoms, and also to have slower improvements in mood and anxiety symptoms, even after controlling for demographic covariates (Jamal et al., 2012). Furthermore, studies have demonstrated that smokers who attempt to quit but are unsuccessful are at greater risk for anxiety and depression than non-quitters or successful quitters (e.g., McClave et al., 2009; McDermott et al., 2013). Thus, individuals in the criminal justice system who smoke may be a particularly important group in which to explore the role of specific higher-order cognitive processes in anxiety pathology, as they appear to be at disproportionate risk for both deficits in cognitive abilities and anxiety pathology. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the present study was to identify subgroups of participants who may be at particularly high risk for anxiety pathology based on specific combinations of demographic characteristics and higher-order cognitive abilities in a population at disproportionate risk for deficits in cognitive abilities (i.e., smokers within the criminal justice system). Participants (N=495) provided demographic information, were administered a semi-structured diagnostic interview, and completed a number of measures assessing cognitive abilities. A receiver-operating characteristic (ROC) model using signal detection theory indicated that the strongest predictor of anxiety disorder diagnosis was race, with White participants having a 30.6% likelihood of diagnosis and participants in the non-White category (97% of which identified as Black/African American) having a 18.9% likelihood of diagnosis. Interestingly, the individual risk profile associated with the highest probability of having a current anxiety disorder was characterized by White participants with impaired response inhibition (58.6%), and the lowest probability of having a current anxiety disorder was among non-White males (13.9%). The findings, which indicated that White individuals with impaired response inhibition are at a disproportionately high risk for anxiety disorders, suggest a potential target for prevention and intervention. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 05/2015; 229(1-2). DOI:10.1016/j.psychres.2015.05.020 · 2.47 Impact Factor
  • Source
    • "Even among individuals with depression, research has shown that cessation does not increase the likelihood of exacerbating depression (Shahab et al., 2014; Shahab, Andrews, & West, 2013). There is some evidence that those who try to quit and are unsuccessful may experience an increase in anxiety, though research does not support the widely held belief that smoking is effective at reducing stress (McDermott et al., 2013). Instead successful smoking cessation has been shown to be associated with mental health benefits in this study and others (Cohen & Lichtenstein, 1990; Hajek et al., 2010; Shahab & West, 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Smoking cessation among adults is associated with increased happiness. This association has not been measured in parents, a subset of adults who face uniquely stressful and challenging circumstances that can affect happiness. Aims: The aim of this study was to determine if parental smoking cessation is associated with increased happiness and to identify characteristics of parental quitters who experience increased happiness. Methods: A total of 1,355 parents completed a 12-month follow-up interview from a U.S. national trial, Clinical Effort Against Secondhand Smoke Exposure (CEASE). Multivariable logistic regression examined if level of happiness was independently associated with quitting smoking and identified characteristics associated with feeling happier after quitting smoking. Results/Findings: Parents’ level of happiness was independently associated with quitting smoking (aOR = 1.60, 95% CI = 1.42–1.79). Factors associated with increased happiness among quitters include engaging in evidence-based cessation assistance (aOR = 2.69, 95% CI = 1.16–6.26), and adopting strictly enforced smoke-free home (aOR = 2.55, 95% CI = 1.19–5.48) and car (aOR = 3.85, 95% CI = 1.94–7.63) policies. Additionally, parents who believed that being a smoker got in the way of being a parent (aOR = 5.37, 95% CI = 2.61–11.07) and who believed that thirdhand smoke is harmful to children (aOR = 3.28, 95% CI = 1.16–9.28) were more likely to report feeling happier after quitting. Conclusions: Parents who quit smoking reported being happier than parents who did not quit. Though prospective studies can clarify what factors cause an increase in happiness, letting paediatricians know that most parents who smoke report being happier when quitting may facilitate communication with parents around cessation.
    The Journal of Smoking Cessation 03/2015; FirstView Article:1-9. DOI:10.1017/jsc.2015.6
Show more