Cigarette smoking and incidence of first depressive episode: an 11-year, population-based follow-up study

[Role of tobacco use on the incidence of depression in the SUN cohort study]

BACKGROUND AND OBJECTIVE

Several investigations, most of them cross-sectional, have analyzed the association between smoking and depression, but there are not enough evidences to establish the direction of the association. Our objective was to prospectively assess the association between smoking habit and depression incidence in the SUN (Seguimiento Universidad de Navarra) cohort.

SUBJECTS AND METHOD

Dynamic cohort study (recruitment permanently open) based on 8,556 graduate participants where depression incidence was ascertained during 6 years of follow-up. Depression was defined as the presence of a self-reported physician diagnosis and/or use of antidepressant medication in at least one of the 2-year, 4-year or 6-year follow-up questionnaires. The association between smoking and depression incidence was estimated through the calculation of hazard ratios (HR) and their 95% confidence intervals (CI) using Cox regression models (proportional hazards).

RESULTS

The mean follow-up period was 47.4 months. One hundred and ninety participants initially free of depression reported a physician diagnosis of depression during follow-up. A significantly higher risk was found for smokers (HR = 1.39; 95% CI, 1.00-1.93) when they were compared to non smokers, whereas an inverse association was found for ex-smokers who had quit smoking more than 10 years ago (HR = 0.42; 95% CI, 0.19-0.94).

CONCLUSIONS

This study supports, with a prospective design, an increased risk of depression associated to smoking.

Tobacco smoking as a risk factor for major depressive disorder: population-based study

BACKGROUND

Smoking is disproportionately prevalent among people with psychiatric illness.

AIMS

To investigate smoking as a risk factor for major depressive disorder.

METHOD

A population-based sample of women was studied using case-control and retrospective cohort study designs. Exposure to smoking was self-reported, and major depressive disorder diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP).

RESULTS

Among 165 people with major depressive disorder and 806 controls, smoking was associated with increased odds for major depressive disorder (age-adjusted odds ratio (OR)=1.46, 95% CI 1.03-2.07). Compared with non-smokers, odds for major depressive disorder more than doubled for heavy smokers (>20 cigarettes/day). Among 671 women with no history of major depressive disorder at baseline, 13 of 87 smokers and 38 of 584 non-smokers developed de novo major depressive disorder during a decade of follow-up. Smoking increased major depressive disorder risk by 93% (hazard ratio (HR)=1.93, 95% CI 1.02-3.69); this was not explained by physical activity or alcohol consumption.

CONCLUSIONS

Evidence from cross-sectional and longitudinal data suggests that smoking increases the risk of major depressive disorder in women.

Tobacco smoking and depression--results from the WHO/ISBRA study

AIMS

To elucidate the relationship between tobacco smoking and depression, and to estimate the impact of other substance dependencies.

DESIGN

Cross-sectional.

PARTICIPANTS

A total of 1,849 men and women were interviewed face-to-face using a validated structured questionnaire. According to their tobacco smoking behavior, participants were grouped into never smokers, ex-smokers and current smokers.

MEASUREMENTS

Data were generated through the WHO/ISBRA study, an international multicenter study with a cross-sectional design. A standardized questionnaire was administered face-to-face by trained interviewers. Logistic regression analysis was used to predict depression.

RESULTS

There was a significant difference across the 3 smoking groups in the number of subjects who had major depression (DSM-IV) during their lifetime. The highest rate of depressives was found in current smokers (23.7%), the lowest rate in never smokers (6.2%), while the rate of those who had quit smoking (14.6%) was between both. In a logistic regression analysis, alcohol dependence (both current and during lifetime) as well as cocaine dependence were significant predictors of depression. However, the association between smoking and depression still remained statistically significant.

CONCLUSIONS

This study adds support to the evidence that smoking is linked to depression. It also elucidates the importance of taking into account alcohol and cocaine dependence since they have a significant impact on the relationship between smoking and depression.

Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania

BACKGROUND

This study aimed to compare the treatment responses between smokers and non-smokers in bipolar mania clinical trials.

METHODS

Post-hoc analysis was conducted on data collected from three double-blind, randomised controlled trials in bipolar mania that had similar inclusion criteria. Patients were randomised to olanzapine (N=70) or placebo (N=69) for 3 weeks in Trial 1, olanzapine (N=234) or haloperidol (N=216) for 12 weeks in Trial 2, and olanzapine (N=125) or divalproex (N=126) for 47 weeks in Trial 3. This study analysed the Young Mania Rating Scale (YMRS) total scores and Clinical Global Impressions scale for bipolar disorder (CGI-BP) mania severity scores between smokers and non-smokers for each trial and for the pooled data from all three trials, using a mixed-effects model repeated measures approach.

RESULTS

For the pooled data, non-smokers showed superior treatment outcomes on both the YMRS (P=0.002) and CGI-BP (P<0.001), as well as longer time to discontinuation for any cause utilising Kaplan-Meier survival curves. For the individual trials, non-smokers showed greater improvement than smokers on both CGI-BP and YMRS in both treatment arms of Trial 2 (CGI-BP: haloperidol P=0.011, olanzapine P=0.042; YMRS: haloperidol P=0.010, olanzapine P=0.019), and in the olanzapine arm of Trial 3 (CGI-BP: P=0.002; YMRS: P=0.006). No significant difference in outcomes was found between smokers and non-smokers in Trial 1.

LIMITATIONS

Post-hoc design, categorical definition of smoking status, unavailable antipsychotic drug levels, confounding effects of trial medications and substance abuse.

CONCLUSIONS

Smoking appears to be associated with worse treatment outcomes in mania.

Cerebrovascular risk factors and incident depression in community-dwelling elderly

OBJECTIVE

The 'vascular depression' hypothesis suggests that late-life depression results from vascular brain damage. We studied the longitudinal association between cerebrovascular risk factors and incident depression in a large population-based study.

METHOD

Two thousand nine hundred and thirty-one persons with the age of > or =61 years were followed up. Data on a comprehensive set of cerebrovascular risk factors were collected at baseline. Participants received a psychiatric assessment 5 years later to establish DSM-IV diagnoses.

RESULTS

Only current smoking and antihypertensive drug use were independently associated with incident depressive symptoms. Diabetes mellitus and the Framingham stroke risk score were related to incident depressive disorder. No relation with depression was observed for cholesterol, diastolic and systolic blood pressure, history of cardiovascular disease, atrial fibrillation, left ventricular hypertrophy or the use of statins and anticoagulants.

CONCLUSION

These results moderately support the 'vascular depression' hypothesis.

Active and passive smoking and depression among Japanese workers

OBJECTIVE

To assess the relation of passive and active smoking to depressive symptoms in 1839 men and 931 women working in a suburb of Tokyo in 2002.

METHOD

Self-reported smoking history and exposure to passive smoking (no, occasional, or regular) at work and at home. Depressive symptoms according to the Center for Epidemiologic Studies Depression Scale, with a cut-off point of 16.

RESULTS

Compared to never smokers unexposed to passive smoking, never smokers reporting regular and occasional exposure to passive smoking at work had increased depressive symptoms. The adjusted odds ratios (aORs) were 1.92 (95% confidence interval (CI) 1.14, 3.23) for regular exposure and 1.63 (95% CI 1.08, 2.47) for occasional exposure. Current smokers had significantly increased depressive symptoms (aOR ranging from 2.25 to 2.38) but former smokers had only marginal increases of depressive symptoms (aOR ranging from 1.43 to 1.55). Gender did not modify the effects of active/passive smoking on depressive symptoms.

CONCLUSION

Passive smoking at work and current smoking appear associated with higher levels of depressive symptoms.

Profiles of tamoxifen-related side effects by race and smoking status in women with breast cancer

BACKGROUND

Tamoxifen (TAM) is a selective estrogen receptor modulator (SERM) that is widely used as adjuvant therapy in breast cancer patients; however, it is also associated with undesirable side effects. The goal of this study was to investigate TAM-related side effects, and determine profiles of side effects by race and by smoking status.

METHODS

A secondary data analysis was conducted using cross-sectional study data from 138 African American and Caucasian women with breast cancer taking TAM 20mg daily for at least 30 days prior to enrollment. Participants completed questionnaires that obtained information about demographic characteristics, reproductive history, health and lifestyle characteristics, TAM use and its related side effects. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals.

RESULTS

Compared to never smokers, a significantly greater percentage of current smokers reported ever experiencing TAM-related nausea (28.0% versus 5.0%, P=0.007), depression (40.0% versus 7.1%, P=0.001) and migraines (19.2% versus 1.7%, P=0.02). These differences remained statistically significant after controlling for race, age, obesity, tumor stage, and duration of TAM treatment. No significant differences by race were noted in women reporting TAM side effects.

CONCLUSION

The findings from this study suggest that current smokers with breast cancer should be informed of the increased probability of reporting TAM-related side effects such as nausea, depression and migraines, and counseled about smoking cessation which may reduce the incidence of these side effects.

Cancer in people with depression or anxiety: record-linkage study

BACKGROUND

It has been suggested that the risk of cancer may be higher in people with psychological disorders, like depression and anxiety, than in the general population.

AIMS

To determine cancer risk in cohorts of people with depression or anxiety, compared with that in a control cohort.

METHOD

Analysis of linked statistical records of hospital admission and mortality.

RESULTS

Lung cancer was more common in those with depression (risk ratio 1.36, 95% confidence intervals 1.19-1.54) or anxiety (1.29, 1.12-1.48) than in others. Excluding lung cancer, the risk ratio for all other cancers combined was 0.98 (0.92-1.04) in the depression cohort and 1.01 (0.95-1.07) in the anxiety cohort. There was a significant association, in the short-term only, between depression, anxiety and the subsequent diagnosis of brain tumours.

CONCLUSIONS

With the exception of lung and brain tumours, cancer risk was not increased in people with depression or anxiety.

Use of antidepressants and risk of lung cancer

OBJECTIVE

To evaluate the effect of antidepressant use on lung cancer risk.

METHODS

We conducted a case-control study nested in a cohort of patients 40-84 year-old in 1995-2004, without a prior diagnosis of cancer using The Health Improvement Network (THIN) database in the UK. Cases comprised 4,336 patients with a first diagnosis of primary lung cancer. A sample of 10,000 controls was frequency-matched to the cases for age, sex, and the calendar year of diagnosis. The index date for exposure definition was one year before the diagnosis for cases and one year before a random date for controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression models adjusted for potential confounders.

RESULTS

Selective serotonin reuptake inhibitor (SSRI) use during the year preceding the index date with treatment duration of at least one year had an OR of 0.59 (95% CI 0.41, 0.86). The corresponding OR was 1.23 (95% CI 0.96, 1.58) for tricyclic antidepressants (TCAs).

CONCLUSIONS

SSRI use did not increase the lung cancer risk and might be associated with a reduced risk. However, residual confounding might explain the apparent protective effect found for SSRI use, as well as the marginally elevated risk observed among TCA users.

Does cannabis use predict the first incidence of mood and anxiety disorders in the adult population?

AIMS

To investigate whether cannabis use predicted the first incidence of mood and anxiety disorders in adults during a 3-year follow-up period.

DESIGN AND PARTICIPANTS

Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective study in the adult population of 18-64 years. The analysis was carried out on 3881 people who had no life-time mood disorders and on 3854 people who had no life-time anxiety disorders at baseline.

MEASUREMENTS

Life-time cannabis use and DSM-III-R mood and anxiety disorders, assessed with the Composite International Diagnostic Interview (CIDI).

FINDINGS

After adjustment for strong confounders, any use of cannabis at baseline predicted a modest increase in the risk of a first major depression (odds ratio 1.62; 95% confidence interval 1.06-2.48) and a stronger increase in the risk of a first bipolar disorder (odds ratio 4.98; 95% confidence interval 1.80-13.81). The risk of 'any mood disorder' was elevated for weekly and almost daily users but not for less frequent use patterns. However, dose-response relationships were less clear for major depression and bipolar disorder separately. None of the associations between cannabis use and anxiety disorders remained significant after adjustment for confounders.

CONCLUSIONS

The associations between cannabis use and the first incidence of depression and bipolar disorder, which remained significant after adjustment for strong confounders, warrant research into the underlying mechanisms.

Smoking is associated with first-ever incidence of mental disorders: a prospective population-based study

AIMS

It is well established that tobacco use is associated with mental disorders. However, the association between tobacco use and mental disorders has not yet been examined sufficiently in prospective, population-based studies. The current study is aimed at examining whether smoking is associated with first-ever incidence of mental disorders.

DESIGN, SETTING AND PARTICIPANTS

We conducted a prospective, population-based epidemiological study (the Netherlands Mental Health Survey and Incidence Study: NEMESIS) in which a representative sample of adults aged 18-64 years (n = 7076) were interviewed to establish the presence of a broad range of mental disorders. We re-interviewed them at 1 year (n = 5618; response 79.4%) and 3 years (n = 4796; 67.8%) after baseline.

MEASUREMENTS

The presence of mental disorders was assessed according to DSM-III-R criteria with the Composite International Diagnostic Interview (CIDI), which was administered by trained lay interviewers. Tobacco use was assessed by asking respondents whether they had smoked in the past year, and how many cigarettes they smoked.

FINDINGS

Subjects who smoked but never had a mental disorder in their life, had an increased risk of developing a mental disorder (P < 0.01), and this remained significant after correcting for major risk indicators of mental disorders.

CONCLUSIONS

Smoking is associated not only with the prevalence, but also with first-ever incidence of mental disorders. More research is needed to study the causal pathways.

Depression and smoking across 25 years of the Normative Aging Study

OBJECTIVE

The majority of past findings indicate that smokers are more likely than non-smokers to report depressive symptoms and that depression may act as an impediment to smoking cessation. The aim of the present study is to examine the stability of the relationship between depressive symptoms and smoking status and to determine whether the presence of depressive symptoms predicts continued smoking.

METHODS

Subjects were initially healthy men (n = 2208) from the Veterans Administration Normative Aging Study, an ongoing cohort of older men who have been re-assessed every 3-5 years for a period of 25 years. Depressive symptoms measures employed were the Cornell Medical Index, the MMPI-2 Content Depression Scale, and the Center for Epidemiological Studies Depression Scale.

RESULTS

Depression scores were higher among continuing smokers compared to never and former smokers and those who quit after entering the study. None of the three depressive symptoms measures were associated with decreased likelihood of smoking cessation. The change in MMPI-2 depression scores observed in a 4-year follow-up was the same among those who quit and those who remained smokers.

CONCLUSIONS

Higher prevalence of depressive symptoms among male smokers is stable across time and is likely to contribute to higher morbidity and mortality among these smokers. However, presence of depressive symptoms did not have a significant impact on smoking cessation.

Prevalence and risk factors for depression in a longitudinal, population-based study including individuals in the community and residential care

OBJECTIVE

The authors report the population prevalence of depression in older adults living in the community and in residential care. Demographic, medical, health behavior, functional and cognitive measures, and transition to residential care are evaluated as risk factors for depression over eight years.

METHODS

Depression prevalence estimates were obtained from the initial electoral role sample of the Australian Longitudinal Study of Ageing that included persons living in residential care. A subsample (N = 1,116) based on follow-up data were included in longitudinal multilevel analyses that evaluated between-person and within-person predictors associated with scores from the Center for Epidemiology-Depression Scale.

RESULTS

At wave 1, 14.4% of community-dwelling and 32.0% of residential care-dwelling participants were depressed (15.2% of total cases). Increase in depression was associated with antidepressant status, sex, education, and marital status, but not history of hypertension, stroke, diabetes, heart disease, or smoking. Time-varying predictors, including residential care, activities of daily living, instrumental activities of daily living, self-rated health, and Mini-Mental State Examination, predicted depressive symptoms both between and within persons.

CONCLUSIONS

Depression is strongly linked with factors indicating increased dependency. Risk assessment and targeting of intervention strategies to prevent depression in late life should incorporate changes in functional capacity, mental status, and need for residential care.