A rapid review of the effectiveness of smoking cessation interventions for people with anxiety and/or depression living within the community

This rapid review was conducted as part of the Evidence Service’s collaboration with Heath and Care Research Wales

Next update: Update not planned

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Introduction

Welsh Government aim to reduce the smoking rate from 13% to just 5% by 2030, so it is important to consider groups that have higher smoking rates, and who are less likely to access services to help them stop smoking. This review explores the effectiveness of interventions aiming to promote the quitting of smoking (smoking cessation) in people with anxiety and/or depression living in the community, as mental health is a known factor influencing smoking within this group. 

Main points

How up to date is this evidence?

A search of the international academic literature was performed in March 2024, and found 11 studies published between 2008 and 2023. 

What we found

The studies investigated a range of interventions delivered in various formats (mostly in person, with two delivered remotely) including:

• Pharmacological | Medication based therapy
• Psychological | Talking therapies (such as counselling) and CBT
• Exercise | Physical activity programmes to aid mental and physical health 

We  looked at the benefits of these interventions on quitting-smoking success rates, cost-effectiveness, mental health symptoms and ‘adverse events’ (such as sleep problems, heightened anxiety or depression, mood changes, dry mouth, reduced levels of physical activity, and self-harm). 

Key findings

Overall, evidence is inconsistent in how effective smoking cessation interventions are for those with anxiety and depression. 

Important differences between the studies (in their methodology and outcome measures) made it hard to compare them directly with one another, meaning our confidence in the results is low. 

Some evidence suggests that psychological interventions can help to reduce smoking in people with depression, however quitting smoking did not always improve people’s mental health. 

Some evidence suggests that pharmacological interventions can help to support quitting smoking, however they did not appear to impact mental health outcomes in people with anxiety and depression and did not consistently reduce the negative side-effects of people in this group. 

Exercise had mixed results on reduced smoking rates and did not appear to impact mental health outcomes for those with depression. 

Some evidence suggests combining pharmacological and psychological interventions can improve quitting smoking in those with depression and reduce negative side-effects, but they had mixed effects on mental health. 

What this means

There is limited evidence of the effectiveness of combining exercise and psychological interventions which had no apparent impact on quitting smoking or mental health outcomes in people with depression. There is very limited evidence to support the cost-effectiveness of psychological interventions for people with depression.

Technical information

Our rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. This rapid review aimed to identify and synthesise the evidence for the effectiveness of smoking cessation interventions in people with anxiety and/or depression living in the community.

Glossary

Systematic review: A review that summarises the evidence on a clearly formulated review question according to a predefined protocol, using systematic and explicit methods to identify, select and appraise relevant studies, and to extract, analyse, collate and report their findings. It may or may not use statistical techniques, such as meta-analysis