鑽石舞台

吸煙與心理健康

一些醫療服務提供者和吸煙者認為，吸煙有助於緩解壓力以及其他心理健康症狀，例如抑鬱和焦慮。他們擔心戒煙可能會加重心理健康症狀。然而，多項研究表明吸煙可能會對人們的心理健康產生負面影響，而戒煙則可以緩解焦慮和抑鬱。

（圖片來自TripSavvy）

我們為什麼開展本Cochrane系統綜述

我們想了解戒煙如何影響人們的心理健康。如果戒煙可以改善心理健康症狀，而不是使症狀惡化，那麼這可能會鼓勵更多人嘗試戒煙，同時更多的醫務人員也會幫助他們的患者戒煙。這也可能從源頭上阻止人們吸煙。

我們做了什麼？

我們檢索了至少持續六周的研究，納入了在研究開始時就吸煙的受試者。被納入的研究必須測量人們在研究期間是否停止吸煙以及心理健康是否發生了任何變化。

我們對戒煙如何影響心理健康感興趣：

-焦慮症狀；

-抑鬱症狀；

-焦慮和抑鬱症狀並存；

-壓力症狀；

-整體幸福感

-心理健康問題；

-社會幸福感，人際關係，孤立和孤獨。

檢索日期：我們納入了截止至2020年1月7日發表的證據。

我們發現了什麼

我們納入了102項研究，包括了超過169,500名受試者：一些研究並未清晰報告有多少名受試者參加。這些研究使用了一系列不同的評價量表來測量人們的心理健康症狀。

大多數研究（53項研究）納入的受試者是普通人群；23項研究的受試者是存在心理健康問題的人；其他研究的受試者是存在生理或心理健康問題，或長期生理問題，最近接受過手術，或懷孕的人。

我們將63項測量心理健康症狀變化的研究與10項測量有多少人在研究過程中發生心理健康疾病的研究結果進行了合併和比較。

本系統綜述的研究結果是什麼？

與繼續吸煙者相比，戒煙者在以下方面表現出顯著的緩解：

-焦慮（來自15項研究中3141人的證據）；

-抑鬱（34項研究中的7156人）；以及

-混合型焦慮和抑鬱（8項研究中的2829人）。

我們的結果可信度為極低（抑鬱），低（焦慮）和中等（混合型焦慮和抑鬱）。結果可信度降低的原因是我們發現這些研究在設計和執行方面存在局限性。

與繼續吸煙者相比，戒煙者在以下方面表現出顯著的改善：

-壓力症狀（來自4項研究中1792人的證據）；

-積極的感受（13項研究中的4880人）；以及

-心理幸福感（19項研究中的18,034人）。

也有證據表明，戒煙者的社會幸福感並沒有降低，反而可能略有增加（9項研究中的14,673人）。

在戒煙者中，混合型焦慮和抑鬱的新增病例少於繼續吸煙者（來自3項研究中8685人的證據）。焦慮的新增病例也較少（2項研究中的2293人）。抑鬱的新增病例數目無法做出判斷，因為不同研究結果之間的異致性太大。

關鍵信息

無論是否有心理健康問題，戒煙者都不太可能會經歷長期的情緒惡化。他們的心理健康狀況還可能會得以改善，例如焦慮和抑鬱症狀的減輕。

作者：Taylor GMJ, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, te Water Naudé R, Theodoulou A, King N, Burke C, Aveyard P；譯者：劉輝，Cochrane中國協作網成員單位，蘭州大學健康數據科學研究院；審校：呂萌，Cochrane中國協作網成員單位，蘭州大學健康數據科學研究院；編輯排版：索于思，北京中醫藥大學循證醫學中心

相關文章鏈接

【Cochrane簡語概要】人們可以通過減少吸煙量來戒煙嗎？

【Cochrane Plain Language Summary】Does stopping smoking improve mental health?

Smoking and mental health

Some health providers and people who smoke believe that smoking helps reduce stress and other mental health symptoms, like depression and anxiety. They worry that stopping smoking may make mental health symptoms worse. However, studies have shown that smoking may have a negative impact on people's mental health, and stopping smoking couldreduce anxiety and depression.

Why we did this Cochrane Review

We wanted to find out how stopping smoking affects people's mental health. If stopping smoking improves mental health symptoms, rather than worsening them, then this may encourage more people to try to quit smoking and more health professionals to help their patients to quit. It may also discourage people from beginning to smoke tobacco in the first place.

What did we do?

We searched for studies that lasted for at least six weeks that included people who were smoking at the start of the studies. To be included, studies also had to measure whether people did or did not stop smoking and any changes in mental health during the study.

We were interested in how stopping smoking affected:

- symptoms of anxiety;

- symptoms of depression;

- symptoms of anxiety and depression together;

- symptoms of stress;

- overall well-being;

- mental health problems;

- social well-being, personal relationships, isolation and loneliness.

Search date:we included evidence published up to 7 January 2020.

What we found

We found 102 studies in more than 169,500 people: some studies did not clearly report how many people took part.The studies used a range of different assessment scales to measure people's mental health symptoms.

Most studies included people from the general population (53 studies); 23 studies included people with mental health conditions; other studies included people with physical or mental health conditions, or long-lasting physical conditions, who had recently had surgery, or who were pregnant.

We combined and compared the results from 63 studies that measured changes in mental health symptoms, and from 10 studies that measured how many people developed a mental health disorder during the study.

What are the results of our review?

Compared with people who continued to smoke, people who stopped smoking showed greater reductions in:

- anxiety (evidence from 3141 people in 15 studies);

- depression (7156 people in 34 studies); and

- mixed anxiety and depression (2829 people in 8 studies).

Our confidence in our results was very low (for depression), low (for anxiety), and moderate (for mixed anxiety and depression). Our confidence was reduced because we found limitations in the ways the studies were designed and carried out.

Compared with people who continued to smoke, people who stopped smoking showed greater improvements in:

- symptoms of stress (evidence from 4 studies in 1792 people);

- positive feelings (13 studies in 4880 people); and

- mental well-being (19 studies in 18,034 people).

There was also evidence that people who stopped smoking did not have a reduction in their social well-being, and their social well-being may have increased slightly (9 studies in 14,673 people).

In people who stopped smoking, new cases of mixed anxiety and depression were fewer than in those who continued to smoke (evidence from 3 studies in 8685 people). New cases of anxiety were also fewer (2 studies in 2293 people). We were unable to come to a decision about the numbers of new cases of depression, as the results from different studies were too variable.

Key messages

People who stop smoking are not likely to experience a worsening in their mood long-term, whether they have a mental health condition or not. They may also experience improvements in their mental health, such as reductions in anxiety and depression symptoms.