title: Change in mental health after smoking cessation: systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate change in mental health after smoking cessation compared with continuing to smoke.
  
  
  METHODS
  Systematic review and meta-analysis of observational studies.
  
  
  METHODS
  Web of Science, Cochrane Central Register of Controlled Trials, Medline, Embase, and PsycINFO for relevant studies from inception to April 2012. Reference lists of included studies were hand searched, and authors were contacted when insufficient data were reported.
  
  
  METHODS
  Longitudinal studies of adults that assessed mental health before smoking cessation and at least six weeks after cessation or baseline in healthy and clinical populations.
  
  
  RESULTS
  26 studies that assessed mental health with questionnaires designed to measure anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect, and stress were included. Follow-up mental health scores were measured between seven weeks and nine years after baseline. Anxiety, depression, mixed anxiety and depression, and stress significantly decreased between baseline and follow-up in quitters compared with continuing smokers: the standardised mean differences (95% confidence intervals) were anxiety -0.37 (95% confidence interval -0.70 to -0.03); depression -0.25 (-0.37 to -0.12); mixed anxiety and depression -0.31 (-0.47 to -0.14); stress -0.27 (-0.40 to -0.13). Both psychological quality of life and positive affect significantly increased between baseline and follow-up in quitters compared with continuing smokers 0.22 (0.09 to 0.36) and 0.40 (0.09 to 0.71), respectively). There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders.
  
  
  CONCLUSIONS
  Smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. The effect size seems as large for those with psychiatric disorders as those without. The effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders.
authors: School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors: Gemma
authors: G
authors: Taylor
authors: Ann
authors: A
authors: McNeill
authors: Alan
authors: A
authors: Girling
authors: Amanda
authors: A
authors: Farley
authors: Nicola
authors: N
authors: Lindson-Hawley
authors: Paul
authors: P
authors: Aveyard
mesh_terms: D000339:Affect; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D006801:Humans; D008603:Mental Health; D011788:Quality of Life / Q000523:psychology; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology