Supporting older people with mental ill health to give up smoking reduces depression, research finds

Helping older people who experience mental ill health to give up smoking has positive health benefits and does not, as previously thought, worsen depression, new research has found.

Research, published online in the British Journal of Psychiatry, suggests that more should be done to help older people with mental ill health who smoke to give up the habit. Currently, they are less likely to be offered smoking cessation support because professionals believe that it could exacerbate mental health problems.

Depressive disorders and smoking are leading contributors to the global disease burden among adults, and an association between smoking and poor mental health has been widely documented. Likewise, taking up smoking has been shown to predispose an individual to poor mental health, and conversely those suffering with poor mental health are more likely to take up smoking.

Many theories have been proposed to explain this bi-directional relationship. These include the possibility that smoking and mental ill health have common causes such as genetic vulnerability. It has also been proposed that those with poor mental health may smoke as a way of self-medicating.

The research, carried out by Lion Shahab and colleagues from University College London, refutes this belief. Their study suggests that the bi-directional relationship between smoking and mental ill health is not equal and that it is mental ill health that maintains smoking more than the other way around.

Taking this a step further, they also found that stopping smoking does not lead to an exacerbation of depression among older people.

But smokers with a history of mental ill health are less likely to attempt to give up smoking or to be successful if they try.

Taken together these findings strongly suggest that older smokers, including those with depression, should be encouraged and supported to give up, and that those with depression should be given the additional support needed to achieve success. Giving up will do no harm at all, and there is likely to be an overall consequent improvement in physical health.

“Stopping smoking is the single most important step anyone can take to improve their health, whatever their age,” Dr Shahab said. “Our findings show that quitting does not worsen and, if anything improves mental health, even after life-long smoking. However, smokers with depression may require more help so clinicians should support cessation to reduce health inequalities.”