title: Does deterioration in mental health after smoking cessation predict relapse to smoking?
abstract: BACKGROUND
  It is possible that some people who quit smoking experience improved mental health after cessation and therefore remain abstinent, whereas other people who quit may experience worse mental health after cessation and therefore be more likely to relapse to smoking. Thus, in this study we aimed to examine the association between an enduring change in mental health following the cessation period and future risk of relapse.
  
  
  METHODS
  A secondary analysis of prospective data pooled from five placebo-controlled randomised trials for smoking reduction conducted in Europe, USA and Australia. Change in mental health (SF-36, scored 0-100) was measured from baseline to four months for those who were biologically-validated as point-prevalence abstainers at four month follow-up. Thereafter we assessed whether relapse to smoking by 12 months was more likely in those whose mental health had worsened between baseline and four months compared with those who saw no change or an improvement.
  
  
  RESULTS
  After adjustment for baseline mental health and other major covariates, there was no greater tendency to relapse at 12 months for those whose mental health worsened after cessation compared with those who had no change or an improvement. The odds ratio and 95% confidence interval was 1.01 (0.97 to 1.05).
  
  
  CONCLUSIONS
  People whose mental health worsens after smoking cessation are at no greater risk of subsequent relapse to smoking than those whose mental health stays the same or improves.
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, School of Health and Population, Sciences, University of Birmingham, Birmingham, B15 2TT, UK. gemma.taylor@bristol.ac.uk.
authors.forename: Gemma
authors.initials: G
authors.lastname: Taylor
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, King's College London, London, SE5 8AF, UK. ann.mcneill@kcl.ac.uk.
authors.forename: Ann
authors.initials: A
authors.lastname: McNeill
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Nuffield Department of Primary Care Health Sciences, The University of Oxford, Oxford, OX1 2ET, UK. paul.aveyard@phc.ox.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
mesh_terms: D000328:Adult; D001315:Australia; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008603:Mental Health; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D014481:United States