戒烟、焦虑、心情与生活质量的关系：可靠的证据
2015/01/22
摘要
目前，有研究表明吸烟与心理健康问题之间存在很多密切和复杂的联系，其可能的原因有以下几种假说：1.吸烟与不佳的心理健康可能是由共同的原因导致的（遗传因素或环境因素）。2.对于心理健康较差的人群，吸烟是作为调节其精神症状的一种手段。3.吸烟可进一步恶化其心理健康。此外，同时患有精神相关疾病的吸烟者其成功戒烟的难度更大，而对于那些在之前接受过精神疗法的心理疾病患者，其戒烟的成功率比未接受过精神疗法的患者更大。Taylor等猜测戒烟可能改善患者的心理健康状态而不是恶化，因为戒烟可以避免撤烟引起的负面情绪。为了证实以上猜测，他们采用系统性回顾及meta-analysis的方法进行了纵向研究（包括随机对照临床试验和队列研究），以评估成功戒烟心理疾病患者和没有戒烟心理疾病患者之间心理健康状态的不同。我们总共纳入了26项关于焦虑、抑郁、合并焦虑和抑郁、正面效应、心理状态以及紧张等的纵向研究。研究结果显示，与继续吸烟者相比，成功戒烟的患者其抑制症、焦虑以及紧张的状态明显改善，对患者的心理素质有很大的提高，并产生了正面的效应。无论对于正常人群体还是临床试验研究群体，如精神疾病患者，戒烟对于心理健康的改善程度是相似的。本项meta分析结果有直接的临床应用价值：戒烟对正常人及患者心理健康状态的改善可激发临床医生和患者戒烟的积极性。
（刘国梁 审校）
Minerva Med. 2014 Nov 14. [Epub ahead of print]
Smoking cessation, anxiety, mood and quality of life: reassuring evidences.
Baiardini I1, Sorino C, Di Marco F, Facchini F.
ABSTRACT
A close and complex relationship between smoking and mental health problems was found. Different hypotheses have been proposed to explain these associations: 1) smoking and poor mental health may share common causes (genetic factors or environmental mechanisms); 2) for people with poor mental health smoking is a coping strategy to regulate psychiatric symptoms; 3) smokings worsen mental health. Moreover, smokers with psychiatric disorders may have more difficulty quitting and patients with mental diseases who received mental health treatment within the previous year were more likely to stop smoking than those not receiving treatment. Taylor et al. hypothesized that quitting smoking might improve rather than exacerbate mental health, because it allows to avoid multiple episodes of negative affect induced by withdrawal. With the aim to verify this hypothesis, they conducted a systematic review and meta-analysis on longitudinal studies (randomized controlled trials and cohort studies) in which the difference in change in mental health between subjects who stop smoking and subjects who continue to smoke has been explored. A total of 26 longitudinal studies evaluating anxiety, depression, mixed anxiety and depression, positive effect, psychological quality of life, and stress have been included. The study results provided enough evidence to assure that quitting smoking is associated with a reduction of depression, anxiety, and stress, with an improvement of psychological quality of life and positive affect compared with continuing to smoke. The strength of association was similar for both the general population and study enrolled populations, including those with mental health disorders. The results of this meta-analysis have direct clinical implications: the benefits for mental health could motivate physicians and patients to take into account the possibility of smoking cessation.
Minerva Med. 2014 Nov 14. [Epub ahead of print]
