吸烟与心理健康
一些医疗服务提供者和吸烟者认为，吸烟有助于缓解压力以及其他心理健康症状，例如抑郁和焦虑。他们担心戒烟可能会加重心理健康症状。然而，多项研究表明吸烟可能会对人们的心理健康产生负面影响，而戒烟则可以缓解焦虑和抑郁。
（图片来自TripSavvy）
我们为什么开展本Cochrane系统综述
我们想了解戒烟如何影响人们的心理健康。如果戒烟可以改善心理健康症状，而不是使症状恶化，那么这可能会鼓励更多人尝试戒烟，同时更多的医务人员也会帮助他们的患者戒烟。这也可能从源头上阻止人们吸烟。
我们做了什么？
我们检索了至少持续六周的研究，纳入了在研究开始时就吸烟的受试者。被纳入的研究必须测量人们在研究期间是否停止吸烟以及心理健康是否发生了任何变化。
我们对戒烟如何影响心理健康感兴趣：
-焦虑症状；
-抑郁症状；
-焦虑和抑郁症状并存；
-压力症状；
-整体幸福感
-心理健康问题；
-社会幸福感，人际关系，孤立和孤独。
检索日期：我们纳入了截止至2020年1月7日发表的证据。
我们发现了什么
我们纳入了102项研究，包括了超过169,500名受试者：一些研究并未清晰报告有多少名受试者参加。这些研究使用了一系列不同的评价量表来测量人们的心理健康症状。
大多数研究（53项研究）纳入的受试者是普通人群；23项研究的受试者是存在心理健康问题的人；其他研究的受试者是存在生理或心理健康问题，或长期生理问题，最近接受过手术，或怀孕的人。
我们将63项测量心理健康症状变化的研究与10项测量有多少人在研究过程中发生心理健康疾病的研究结果进行了合并和比较。
本系统综述的研究结果是什么？
与继续吸烟者相比，戒烟者在以下方面表现出显著的缓解：
-焦虑（来自15项研究中3141人的证据）；
-抑郁（34项研究中的7156人）；以及
-混合型焦虑和抑郁（8项研究中的2829人）。
我们的结果可信度为极低（抑郁），低（焦虑）和中等（混合型焦虑和抑郁）。结果可信度降低的原因是我们发现这些研究在设计和执行方面存在局限性。
与继续吸烟者相比，戒烟者在以下方面表现出显著的改善：
-压力症状（来自4项研究中1792人的证据）；
-积极的感受（13项研究中的4880人）；以及
-心理幸福感（19项研究中的18,034人）。
也有证据表明，戒烟者的社会幸福感并没有降低，反而可能略有增加（9项研究中的14,673人）。
在戒烟者中，混合型焦虑和抑郁的新增病例少于继续吸烟者（来自3项研究中8685人的证据）。焦虑的新增病例也较少（2项研究中的2293人）。抑郁的新增病例数目无法做出判断，因为不同研究结果之间的异致性太大。
关键信息
无论是否有心理健康问题，戒烟者都不太可能会经历长期的情绪恶化。他们的心理健康状况还可能会得以改善，例如焦虑和抑郁症状的减轻。
作者结论:
综上所述，这些资料提供的证据表明戒烟并不会使心理健康恶化，并且极低至中等质量证据表明戒烟与心理健康的轻度至中度改善有关。在未经选择的样本和亚组人群（包括被诊断患有心理健康疾病的人群）中都可以看到这些改善。使用更前沿方法克服时依性混杂的其他研究将进一步强化这一领域的证据。
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；译者：刘辉，Cochrane中国协作网成员单位，兰州大学健康数据科学研究院；审校：吕萌，Cochrane中国协作网成员单位，兰州大学健康数据科学研究院；编辑排版：索于思，北京中医药大学循证医学中心
相关文章链接
【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 could reduce 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.
Authors' conclusions:
Taken together, these data provide evidence that mental health does not worsen as a result of quitting smoking, and very low- to moderate-certainty evidence that smoking cessation is associated with small to moderate improvements in mental health. These improvements are seen in both unselected samples and in subpopulations, including people diagnosed with mental health conditions. Additional studies that use more advanced methods to overcome time-varying confounding would strengthen the evidence in this area.
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