The findings, published in the British Journal of Psychiatry, contradict a widely held belief that smoking relieves stress and giving up makes people feel more on edge.
Dr Máirtín McDermott lead author of the study from King’s Institute of Psychiatry Health Psychology Section and currently a researcher at the Florence Nightingale School of Nursing and Midwifery at King’s, says: “The commonly held belief that smoking helps relieve stress is almost certainly wrong. Smokers need to understand how their experience of smoking affects them, and that in many people, smoking actually increases levels of anxiety.”
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 quit smoking – 10 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 quit smoking showed a decrease in anxiety. People who had previously smoked to cope showed a more significant decrease in anxiety compared to those who had previously 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 in anxiety.
Interpreting their findings, the researchers state that those who smoked to cope were more likely to have a cigarette soon after waking up – behaviour intended to stave off withdrawal symptoms, including 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 said that there was no obvious causal mechanism other than those who relapsed may feel concerned about the continuing health risks of smoking.
The study was funded by grants from the Medical Research Council UK, Cancer Research UK, the National Institute of Health Research (NIHR) UK Centre for Tobacco Control Studies (UKCTCS), the British Heart Foundation, the Economic and Social Research Council and the Department of Health.
Paper reference: McDermott, M.S. et al. ‘Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study’ British Journal of Psychiatry. doi:10.1192/bjp.bp.112.114389
For further information, please contact Seil Collins, Press Officer, Institute of Psychiatry, King’s College London, email: [email protected] or tel: 0207 848 5377