In a paper published in today’s (2 January 2013) British Journal of Psychiatry, the researchers, drawn from several universities including the Universities of Southampton, Cambridge, Oxford and Kings’s College in London, state: “The belief that smoking is stress relieving is pervasive, but almost certainly wrong. The reverse is true: smoking is probably anxiogenic [causes anxiety] and smokers deserve to know this and understand how their own experience may be misleading.”
The study followed 491 smokers attending NHS smoking cessation clinics in England. All participants were given a nicotine patch and attended eight weekly appointments.
Of the sample, 21.6% (106 people) had a diagnosed mental health problem, primarily mood and anxiety disorders.
All participants were assessed for their anxiety levels at the start of the research, and were also asked whether their motives for smoking were ‘mainly for pleasure’, ‘mainly to cope’ or ‘about equal’.
Six months after the start of the trial, 68 of the smokers (14%) had managed to abstain from smoking, and ten of these had a current psychiatric disorder. The researchers found a significant difference in anxiety between those who had successfully quit and those who had relapsed.
All of those who had abstained showed a decrease in anxiety, with those who had smoked to cope showing a “significant” decrease compared with those who had smoked for pleasure.
Among the smokers who relapsed, those smoking for enjoyment showed no change in anxiety, but those who smoked to cope and those with a diagnosed mental health problem showed an increase.
Interpreting their findings, the researchers state that those who smoked to cope were more likely to have a cigarette soon after waking up, which was behaviour “to stave off withdrawal symptoms, which include anxiety.” By quitting, they removed these repeated episodes of anxiety and felt less anxious as a result.
Among those who relapsed and showed an increase in anxiety, the researchers say: “There is no obvious causal mechanism other than those who relapse feeling concern arising from the continuing health risks of their smoking.”
Dr Matthew Hankins, Senior Lecturer in Public Health at the University of Southampton, adds: “Stopping smoking probably reduces anxiety and the effect is probably larger in those who have a psychiatric disorder and who smoke to cope with stress.
“A failed quit attempt may well increase anxiety to a modest degree, but perhaps to a clinically relevant degree in people with a psychiatric disorder and those who report smoking to cope.
“Clinicians should reassure patients that stopping smoking is beneficial for their mental health, but they may need to monitor for clinically relevant increases in anxiety among people who fail to attain abstinence.”
Notes for editors
Read the paper: Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study, here.