Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-28T22:21:28.210Z Has data issue: false hasContentIssue false
  • English
  • Français

Changes in prevalence of depression and anxiety following smoking cessation: results from an international cohort study (ATTEMPT)

Published online by Cambridge University Press:  14 March 2013

L. Shahab ,
S. Andrew  and
R. West
L. Shahab*
Affiliation:
Department of Epidemiology and Public Health, University College London, London, UK
S. Andrew
Affiliation:
Department of Epidemiology and Public Health, University College London, London, UK
R. West
Affiliation:
Department of Epidemiology and Public Health, University College London, London, UK
*
* Address for correspondence: L. Shahab, Ph.D., Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK. (Email lion.shahab@ucl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Smoking cessation improves physical health but it has been suggested that in vulnerable individuals it may worsen mental health. This study aimed to identify the short- and longer-term effects of stopping smoking on depression and anxiety in the general population and in those with a history of these disorders.

Method

Sociodemographic and smoking characteristics, and mental and physical health were assessed using established measures in the ATTEMPT cohort, an international longitudinal study of smokers (n = 3645). Smokers who had stopped for at least 3 months or less than 3 months at the 12-month follow-up were compared with current smokers (n = 1640).

Results

At follow-up, 9.7% [95% confidence interval (CI) 8.3–11.2] of smokers had stopped for less than 3 months and 7.5% (95% CI 6.3–8.9) for at least 3 months. Compared with current smokers, prevalence of depression prescriptions obtained in the last 2 weeks was lower for those who had stopped for less than 3 months [odds ratio (OR) 0.37, 95% CI 0.14–0.96] or at least 3 months (OR 0.25, 95% CI 0.06–0.94) after adjusting for baseline prescription levels and confounding variables. Adjusted prevalence of recent depression symptoms was also lower for ex-smokers who had stopped for less than 3 months (OR 0.34, 95% CI 0.15–0.78) or at least 3 months (OR 0.24, 95% CI 0.09–0.67) than among continuing smokers. There was no change in anxiety measures in the general population or any increase in anxiety or depression symptoms in ex-smokers with a past history of these conditions.

Conclusions

Smoking cessation does not appear to be associated with an increase in anxiety or depression and may lead to a reduced incidence of depression.

Keywords

Anxietydepressionlongitudinal studiesmental healthsmokingsmoking cessation
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 1 , January 2014 , pp. 127 - 141
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aubin, HJ (2009). Management of emergent psychiatric symptoms during smoking cessation. Current Medical Research and Opinion 25, 519–525.CrossRefGoogle ScholarPubMed
Banham, L, Gilbody, S (2010). Smoking cessation in severe mental illness: what works? Addiction 105, 1176–1189.CrossRefGoogle ScholarPubMed
Beard, JR, Heathcote, K, Brooks, R, Earnest, A, Kelly, B (2007). Predictors of mental disorders and their outcome in a community based cohort. Social Psychiatry and Psychiatric Epidemiology 42, 623–630.Google Scholar
Benjet, C, Wagner, FA, Borges, GG, Medina-Mora, ME (2004). The relationship of tobacco smoking with depressive symptomatology in the Third Mexican National Addictions Survey. Psychological Medicine 34, 881–888.Google Scholar
Bienvenu, OJ, Nestadt, G, Samuels, JF, Costa, PT, Howard, WT, Eaton, WW (2001). Phobic, panic, and major depressive disorders and the five-factor model of personality. Journal of Nervous and Mental Disease 189, 154–161.Google Scholar
Boden, JM, Fergusson, DM, Horwood, LJ (2010). Cigarette smoking and depression: tests of causal linkages using a longitudinal birth cohort. British Journal of Psychiatry 196, 440–446.Google Scholar
Bolam, B, West, R, Gunnell, D (2011). Does smoking cessation cause depression and anxiety? Findings from the ATTEMPT cohort. Nicotine and Tobacco Research 13, 209–214.CrossRefGoogle ScholarPubMed
Breslau, N (1995). Psychiatric comorbidity of smoking and nicotine dependence. Behavior Genetics 25, 95–101.Google Scholar
Breslau, N, Kilbey, M, Andreski, P (1991). Nicotine dependence, major depression, and anxiety in young adults. Archives of General Psychiatry 48, 1069–1074.CrossRefGoogle ScholarPubMed
Breslau, N, Kilbey, MM, Andreski, P (1994). DSM-III-R nicotine dependence in young adults: prevalence, correlates and associated psychiatric disorders. Addiction 89, 743–754.CrossRefGoogle ScholarPubMed
Breslau, N, Klein, DF (1999). Smoking and panic attacks: an epidemiologic investigation. Archives of General Psychiatry 56, 1141–1147.Google Scholar
Breslau, N, Novak, SP, Kessler, RC (2004). Psychiatric disorders and stages of smoking. Biological Psychiatry 55, 69–76.Google Scholar
Breslau, N, Peterson, EL, Schultz, LR, Chilcoat, HD, Andreski, P (1998). Major depression and stages of smoking. A longitudinal investigation. Archives of General Psychiatry 55, 161–166.Google Scholar
Brown, RA, Lewinsohn, PM, Seeley, JR, Wagner, EF (1996). Cigarette smoking, major depression, and other psychiatric disorders among adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 35, 1602–1610.Google Scholar
Campion, J, Checinski, K, Nurse, J, McNeill, A (2008). Smoking by people with mental illness and benefits of smoke-free mental health services. Advances in Psychiatric Treatment 14, 217–228.Google Scholar
Carek, PJ, Laibstain, SE, Carek, SM (2011). Exercise for the treatment of depression and anxiety. International Journal of Psychiatry in Medicine 41, 15–28.Google Scholar
Covey, LS, Bomback, A, Yan, GW (2006). History of depression and smoking cessation: a rejoinder. Nicotine and Tobacco Research 8, 315–319.CrossRefGoogle ScholarPubMed
Covey, LS, Glassman, AH, Stetner, F (1997). Major depression following smoking cessation. American Journal of Psychiatry 154, 263–265.Google ScholarPubMed
Degenhardt, L, Hall, W, Lynskey, M (2001). Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis. Addiction 96, 1603–1614.Google Scholar
Doll, R, Peto, R, Boreham, J, Sutherland, I (2004). Mortality in relation to smoking: 50 years’ observations on male British doctors. British Medical Journal 328, 1519–1528.CrossRefGoogle ScholarPubMed
Evans, DL, Charney, DS, Lewis, L, Golden, RN, Gorman, JM, Krishnan, KR, Nemeroff, CB, Bremner, JD, Carney, RM, Coyne, JC, Delong, MR, Frasure-Smith, N, Glassman, AH, Gold, PW, Grant, I, Gwyther, L, Ironson, G, Johnson, RL, Kanner, AM, Katon, WJ, Kaufmann, PG, Keefe, FJ, Ketter, T, Laughren, TP, Leserman, J, Lyketsos, CG, McDonald, WM, Mcewen, BS, Miller, AH, Musselman, D, O'Connor, C, Petitto, JM, Pollock, BG, Robinson, RG, Roose, SP, Rowland, J, Sheline, Y, Sheps, DS, Simon, G, Spiegel, D, Stunkard, A, Sunderland, T, Tibbits, P Jr, Valvo, WJ (2005). Mood disorders in the medically ill: scientific review and recommendations. Biological Psychiatry 58, 175–189.Google Scholar
Farrell, M, Howes, S, Bebbington, P, Brugha, T, Jenkins, R, Lewis, G, Marsden, J, Taylor, C, Meltzer, H (2001). Nicotine, alcohol and drug dependence and psychiatric comorbidity. Results of a national household survey. British Journal of Psychiatry 179, 432–437.Google Scholar
Flanagan, J, Maany, I (1982). Smoking and depression. American Journal of Psychiatry 139, 541.Google Scholar
Fowler, JS, Volkow, ND, Wang, GJ, Pappas, N, Logan, J, MacGregor, R, Alexoff, D, Shea, C, Schlyer, D, Wolf, AP, Warner, D, Zezulkova, I, Cilento, R (1996). Inhibition of monoamine oxidase B in the brains of smokers. Nature 379, 733–736.CrossRefGoogle ScholarPubMed
Frech, A, Williams, K (2007). Depression and the psychological benefits of entering marriage. Journal of Health and Social Behavior 48, 149–163.Google Scholar
Gilbert, DG, McClernon, FJ, Rabinovich, NE, Dibb, WD, Plath, LC, Hiyane, S, Jensen, RA, Meliska, CJ, Estes, SL, Gehlbach, BA (1999). EEG, physiology, and task-related mood fail to resolve across 31 days of smoking abstinence: relations to depressive traits, nicotine exposure, and dependence. Experimental and Clinical Psychopharmacology 7, 427–443.Google Scholar
Gilbert, DG, McClernon, FJ, Rabinovich, NE, Plath, LC, Masson, CL, Anderson, AE, Sly, KF (2002). Mood disturbance fails to resolve across 31 days of cigarette abstinence in women. Journal of Consulting and Clinical Psychology 70, 142–152.Google Scholar
Glassman, AH, Covey, LS, Stetner, F, Rivelli, S (2001). Smoking cessation and the course of major depression: a follow-up study. Lancet 357, 1929–1932.Google Scholar
Glassman, AH, Helzer, JE, Covey, LS, Cottler, LB, Stetner, F, Tipp, JE, Johnson, J (1990). Smoking, smoking cessation, and major depression. Journal of the American Medical Association 264, 1546–1549.Google Scholar
Goodwin, R, Hamilton, SP (2002). Cigarette smoking and panic: the role of neuroticism. American Journal of Psychiatry 159, 1208–1213.Google Scholar
Goodwin, RD, Fergusson, DM, Horwood, LJ (2004). Association between anxiety disorders and substance use disorders among young persons: results of a 21-year longitudinal study. Journal of Psychiatric Research 38, 295–304.CrossRefGoogle ScholarPubMed
Goodwin, RD, Pagura, J, Spiwak, R, Lemeshow, AR, Sareen, J (2011). Predictors of persistent nicotine dependence among adults in the United States. Drug and Alcohol Dependence 118, 127–133.Google Scholar
Grant, BF, Hasin, DS, Chou, SP, Stinson, FS, Dawson, DA (2004). Nicotine dependence and psychiatric disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 1107–1115.Google Scholar
Hajek, P, Taylor, T, McRobbie, H (2010). The effect of stopping smoking on perceived stress levels. Addiction 105, 1466–1471.Google Scholar
Haustein, KO, Haffner, S, Woodcock, BG (2002). A review of the pharmacological and psychopharmacological aspects of smoking and smoking cessation in psychiatric patients. International Journal of Clinical Pharmacology and Therapeutics 40, 404–418.Google Scholar
Heatherton, TF, Kozlowski, LT, Frecker, RC, Fagerstrom, KO (1991). The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction 86, 1119–1127.Google Scholar
Hitsman, B, Borrelli, B, McChargue, DE, Spring, B, Niaura, R (2003). History of depression and smoking cessation outcome: a meta-analysis. Journal of Consulting and Clinical Psychology 71, 657–663.CrossRefGoogle ScholarPubMed
Hooten, WM, Ames, SC, Vickers, KS, Hays, JT, Wolter, TD, Hurt, RD, Offord, KP (2005). Personality correlates related to tobacco abstinence following treatment. International Journal of Psychiatry in Medicine 35, 59–74.CrossRefGoogle ScholarPubMed
Jamal, M, Van der Does, AJW, Cuijpers, P, Penninx, BW (2012). Association of smoking and nicotine dependence with severity and course of symptoms in patients with depressive or anxiety disorder. Drug and Alcohol Dependence 126, 138–146.Google Scholar
Janney, CA, Richardson, CR, Holleman, RG, Glasheen, C, Strath, SJ, Conroy, MB, Kriska, AM (2008). Gender, mental health service use and objectively measured physical activity: data from the National Health and Nutrition Examination Survey (NHANES 2003–2004). Mental Health and Physical Activity 1, 9–16.Google Scholar
Johnson, JG, Cohen, P, Pine, DS, Klein, DF, Kasen, S, Brook, JS (2000). Association between cigarette smoking and anxiety disorders during adolescence and early adulthood. Journal of the American Medical Association 284, 2348–2351.Google Scholar
Kang, E, Lee, J (2010). A longitudinal study on the causal association between smoking and depression. Journal of Preventive Medicine and Public Health 43, 193–204.Google Scholar
Kassel, JD, Stroud, LR, Paronis, CA (2003). Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking. Psychological Bulletin 129, 270–304.CrossRefGoogle ScholarPubMed
Kendler, KS, Neale, MC, MacLean, CJ, Heath, AC, Eaves, LJ, Kessler, RC (1993). Smoking and major depression. A causal analysis. Archives of General Psychiatry 50, 36–43.Google Scholar
Kim, TS, Kim, DJ, Lee, H, Kim, YK (2007). Increased plasma brain-derived neurotrophic factor levels in chronic smokers following unaided smoking cessation. Neuroscience Letters 423, 53–57.Google Scholar
Klungsoyr, O, Nygard, JF, Sorensen, T, Sandanger, I (2006). Cigarette smoking and incidence of first depressive episode: an 11-year, population-based follow-up study. American Journal of Epidemiology 163, 421–432.Google Scholar
Lawrence, D, Mitrou, F, Zubrick, SR (2009). Smoking and mental illness: results from population surveys in Australia and the United States. BioMed Central Public Health 9, 285.Google Scholar
Lewinsohn, PM, Gotlib, IH, Lewinsohn, M, Seeley, JR, Allen, NB (1998). Gender differences in anxiety disorders and anxiety symptoms in adolescents. Journal of Abnormal Psychology 107, 109–117.CrossRefGoogle ScholarPubMed
McChargue, DE, Werth, CJ (2007). Depression vulnerability within smoking research: how accurate are one-item screening items? Addictive Behaviors 32, 404–409.CrossRefGoogle ScholarPubMed
McClave, AK, Dube, SR, Strine, TW, Kroenke, K, Caraballo, RS, Mokdad, AH (2009). Associations between smoking cessation and anxiety and depression among U.S. adults. Addictive Behaviors 34, 491–497.Google Scholar
Morissette, SB, Tull, MT, Gulliver, SB, Kamholz, BW, Zimering, RT (2007). Anxiety, anxiety disorders, tobacco use, and nicotine: a critical review of interrelationships. Psychological Bulletin 133, 245–272.Google Scholar
Morrell, HER, Cohen, LM (2006). Cigarette smoking, anxiety, and depression. Journal of Psychopathology and Behavioral Assessment 28, 283–297.Google Scholar
Murphy, GC, Athanasou, JA (1999). The effect of unemployment on mental health. Journal of Occupational and Organizational Psychology 72, 83–99.CrossRefGoogle Scholar
Mykletun, A, Overland, S, Aaro, LE, Liabo, HM, Stewart, R (2008). Smoking in relation to anxiety and depression: evidence from a large population survey: the HUNT study. European Psychiatry 23, 77–84.Google Scholar
Parrott, AC (2006). Nicotine psychobiology: how chronic-dose prospective studies can illuminate some of the theoretical issues from acute-dose research. Psychopharmacology (Berlin) 184, 567–576.Google Scholar
Patrick, DL, Cheadle, A, Thompson, DC, Diehr, P, Koepsell, T, Kinne, S (1994). The validity of self-reported smoking: a review and meta-analysis. American Journal of Public Health 84, 1086–1093.Google Scholar
Patten, SB (2001). Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2. Journal of Affective Disorders 63, 35–41.Google Scholar
Patton, GC, Carlin, JB, Coffey, C, Wolfe, R, Hibbert, M, Bowes, G (1998). Depression, anxiety, and smoking initiation: a prospective study over 3 years. American Journal of Public Health 88, 1518–1522.Google Scholar
Perez-Stable, EJ, Marin, G, Marin, BV, Katz, MH (1990). Depressive symptoms and cigarette smoking among Latinos in San Francisco. American Journal of Public Health 80, 1500–1502.Google Scholar
Piasecki, TM, Jorenby, DE, Smith, SS, Fiore, MC, Baker, TB (2003). Smoking withdrawal dynamics: II. Improved tests of withdrawal–relapse relations. Journal of Abnormal Psychology 112, 14–27.Google Scholar
Pigott, TA (1999). Gender differences in the epidemiology and treatment of anxiety disorders. Journal of Clinical Psychiatry 60 (Suppl. 18), 4–15.Google ScholarPubMed
Pintar, JE, Breakefield, XO (1982). Monoamine oxidase (MAO) activity as a determinant in human neurophysiology. Behavior Genetics 12, 53–68.Google Scholar
Rabin, R, de Charro, F (2001). EQ-5D: a measure of health status from the EuroQol Group. Annals of Medicine 33, 337–343.CrossRefGoogle ScholarPubMed
Rohde, P, Kahler, CW, Lewinsohn, PM, Brown, RA (2004). Psychiatric disorders, familial factors, and cigarette smoking: III. Associations with cessation by young adulthood among daily smokers. Nicotine and Tobacco Research 6, 509–522.Google Scholar
Ruo, B, Rumsfeld, JS, Hlatky, MA, Liu, H, Browner, WS, Whooley, MA (2003). Depressive symptoms and health-related quality of life: the Heart and Soul Study. Journal of the American Medical Association 290, 215–221.Google Scholar
Sen, S, Duman, R, Sanacora, G (2008). Serum brain-derived neurotrophic factor, depression, and antidepressant medications: meta-analyses and implications. Biological Psychiatry 64, 527–532.Google Scholar
Sherbourne, CD, Wells, KB, Meredith, LS, Jackson, CA, Camp, P (1996). Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Archives of General Psychiatry 53, 889–895.Google Scholar
Shiffman, S, Waters, AJ (2004). Negative affect and smoking lapses: a prospective analysis. Journal of Consulting and Clinical Psychology 72, 192–201.Google Scholar
Steuber, TL, Danner, F (2006). Adolescent smoking and depression: which comes first? Addictive Behaviors 31, 133–136.Google Scholar
Taylor, DH, Hasselblad, V, Henley, SJ, Thun, MJ, Sloan, FA (2002). Benefits of smoking cessation for longevity. American Journal of Public Health 92, 990–996.CrossRefGoogle ScholarPubMed
Weissman, MM, Bland, RC, Canino, GJ, Faravelli, C, Greenwald, S, Hwu, HG, Joyce, PR, Karam, EG, Lee, CK, Lellouch, J, Lepine, JP, Newman, SC, Rubio-Stipec, M, Wells, JE, Wickramaratne, PJ, Wittchen, H, Yeh, EK (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association 276, 293–299.Google Scholar
West, R, Gilsenan, A, Coste, F, Zhou, X, Brouard, R, Nonnemaker, J, Curry, SJ, Sullivan, SD (2006). The ATTEMPT cohort: a multi-national longitudinal study of predictors, patterns and consequences of smoking cessation; introduction and evaluation of internet recruitment and data collection methods. Addiction 101, 1352–1361.Google Scholar
West, R, Hajek, P (1997). What happens to anxiety levels on giving up smoking? American Journal of Psychiatry 154, 1589–1592.Google Scholar
West, R, Jarvis, MJ (2005). Tobacco smoking and mental disorder. Italian Journal of Psychiatry and Behavioural Sciences 15, 10–17.Google Scholar
Wiesbeck, GA, Kuhl, HC, Yaldizli, O, Wurst, FM (2008). Tobacco smoking and depression – results from the WHO/ISBRA study. Neuropsychobiology 57, 26–31.Google Scholar
Wise, MG, Taylor, SE (1990). Anxiety and mood disorders in medically ill patients. Journal of Clinical Psychiatry 51, 27–32.Google Scholar
Ziedonis, D, Hitsman, B, Beckham, JC, Zvolensky, M, Adler, LE, Audrain-McGovern, J, Breslau, N, Brown, RA, George, TP, Williams, J, Calhoun, PS, Riley, WT (2008). Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine and Tobacco Research 10, 1691–1715.Google Scholar