Cigarette smoking and the onset and persistence of depression among adults in the United States: 1994-2005

Association of blood metals with anxiety among adults: A nationally representative cross-sectional study

BACKGROUND

Previous evidence demonstrated the inconsistent associations between metals and anxiety. The purpose of this study was to evaluate the individual and joint effects of blood lead (Pb), cadmium (Cd), mercury (Hg), selenium (Se) and manganese (Mn) on anxiety in the general population.

METHODS

Data of 4000 participants (aged≥20 years) in the study were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Multiple logistic regression, restricted cubic splines (RCS) logistic analysis, and weighted quantile sum (WQS) regression were fitted to explore the possible effects of single and mixed metal exposures on anxiety. Moreover, this association was assessed by smoking group.

RESULTS

In the study, 24.60 % of participants were in an anxiety state. In logistic regression, blood Pb, Cd, Hg, Se and Mn were not significantly associated with anxiety in all participants. After stratified by smoking group, blood Cd was positively associated with anxiety in the current smoking group [P = 0.029, OR (95 %): 1.708(1.063, 3.040)], whereas not in other groups. In RCS regression, we observed a linear dose-response effect of blood Cd on anxiety stratified by smoking group. In WQS analysis, mixed metal exposures were positively associated with anxiety [P = 0.033, OR (95 %): 1.437(1.031, 2.003)], with Cd (33.69 %) contributing the largest weight to the index.

CONCLUSIONS

Our study showed that excessive exposure to Cd is a significant risk factor for anxiety, and the co-exposures to Pb, Cd, Hg, Se and Mn were positively related with the risk of anxiety in current smokers.

Prospective bidirectional relations between depression and metabolic health: 30-year follow-up from the National Heart, Lung, and Blood Institute (NHLBI) Coronary Artery Disease in Young Adults (CARDIA) study

OBJECTIVE

This study investigated prospective bidirectional relationships between depressive symptoms and metabolic syndrome (MetS) and the moderating effects of race, sex, and health behaviors in a diverse cohort followed for 30 years.

METHOD

Data were analyzed from the National Heart, Lung, and Blood Institute (NHLBI) Coronary Artery Disease in Young Adults (CARDIA) study, a 30-year prospective study of young adults (N = 5,113; Mage = 24.76 [SD = 3.63] at baseline; 45% male) who were tested every 5 years between 1985 and 2015. Measures included biological assessments of MetS components and self-reported depressive symptoms based on the Center for Epidemiologic Studies Depression (CESD) scale. Data analyses included bidirectional general estimating equations analyses of time-lagged associations between depressive symptoms and MetS.

RESULTS

There was a consistent, bidirectional relationship between depressive symptoms and MetS over time. Individuals with more CESD depressive symptoms were more likely to develop MetS over time compared to those reporting fewer symptoms, Wald χ²(1) = 7.09, p < .008, and MetS was similarly predictive of CESD. MetS more consistently predicted CESD scores at each 5-year exam than CESD predicted MetS. Race and sex moderated these relationships, with White females, White individuals overall, and females overall demonstrating significant relationships between CESD depressive symptoms and MetS. Health behaviors were not related to associations between CESD and MetS.

CONCLUSION

In a diverse young adult population prospectively followed into late middle age, MetS more consistently predicted depressive symptoms over time than depressive symptoms predicted MetS. The relation between MetS and depressive symptoms was moderated by race and sex, but not health behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association between healthy eating and depression symptoms among Chinese older adults: A cross-sectional study based on the Chinese Longitudinal Healthy Longevity survey

Introduction

This study aimed to assess the relationship between the healthy eating index (HEI) and depression symptoms in an older adult population using the Chinese Longevity Health Survey.

Methods

The HEI was constructed based on the frequency of intake of 13 dietary variables, with higher scores indicating better diet quality. Depression symptoms was assessed by the Center for Epidemiologic Studies Depression-10 scale. We used multivariate binary logistic regression to explore the association between the HEI and depression symptoms and reported as odds ratio (OR) and 95 % confidence interval (95 % CI).

Results

A total of 12,078 older adults were included. The average HEI for this group of older adults was 26.4 ± 7.1. After adjusting for covariates, compared with participants in the lowest quartile of a healthy eating index, those in the second to the fourth quartile group had a 0.93- (95 % CI: 0.83 to 1.03), 0.84- (95 % CI: 0.75 to 0.95) and 0.69- (95 % CI: 0.62 to 0.77) fold risk of depression symptoms, respectively. Restricted cubic spline curves showed that the risk of depression symptoms decreased with increasing HEI, especially above 26, and for each unit increase in the HEI, the risk of depression symptoms in older adults decreased by 3 % (OR = 0.97; 95 % CI: 0.96 to 0.99).

Conclusions

This study found an association between higher levels of the HEI and reduced risk of depression symptoms in older Chinese adults. This result emphasizes the need to focus on dietary diversity in older adults to promote healthy aging.

Understanding the longitudinal associations between e-cigarette use and general mental health, social dysfunction and anhedonia, depression and anxiety, and loss of confidence in a sample from the UK: A linear mixed effect examination

OBJECTIVE

Our objective was to the longitudinal associations between e-cigarette use and general mental health, social dysfunction & anhedonia, depression & anxiety, and loss of confidence in a sample from the UK.

METHODS

We analyzed data of 19,706 participants from Wave 9 (collected from 2017 to 2018) and Wave 10 (collected from 2018 to 2019) of the Understanding Society: the UK Household Longitudinal Study using a confirmatory factor analysis, linear mixed effect model, and one-sample t-tests.

RESULTS

We found that there is a significant time by e-cigarette use status interaction on mental health issues (b = 0.32, p < 0.001, 95 % C.I. [0.15, 0.49]), social dysfunction & anhedonia (b = 0.36, p < 0.001, 95 % C.I. [0.18, 0.54]), and loss of confidence (b = 0.24, p < 0.01, 95 % C.I. [0.06, 0.41]). Indeed, participants who became e-cigarette smokers at Wave 10 had worse mental health (t(107) = 2.64, p < 0.01, 95 % C.I. [0.07, 0.48], Cohen's d = 0.28), social dysfunction & anhedonia (t(107) = 3.16, p < 0.01, 95 % C.I. [0.12, 0.52], Cohen's d = 0.32), and loss of confidence (t(107) = 2.08, p < 0.05, 95 % C.I. [0.01, 0.37], Cohen's d = 0.19) comparing to one year ago.

LIMITATION

Limitations of this study included its self-report measures, unclassified e-cigarette type, limited generalizability to other populations, and lack of experimental manipulations.

CONCLUSION

We revealed longitudinal associations between e-cigarette initiation and adverse general and dimensions of mental health except for depression and anxiety, which have significant implications for public health, specifically in terms of e-cigarette product regulation and advertising.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Associations of adolescent substance use and depressive symptoms with adult major depressive disorder in the United States: NSDUH 2016-2019

BACKGROUND

Few studies have focused on the associations of adolescent substance use and depressive symptoms with adult major depressive disorder (MDD).

METHODS

Data from 168,859 adults, among which, 15,959 had experienced MDD in the past year, as indicated by a major depressive episode (MDE) marked by MDD symptoms, were from the 2016-2019 National Surveys on Drug Use and Health. Weighted multivariable logistic regression (MLR) analyses were used to determine the associations.

RESULTS

The overall MDD prevalence was 7.2 %, whereas the prevalence for adults without early onset depressive symptoms prior to age 18 was 4.6 %. Variable cluster analysis revealed that adolescent use of alcohol, cigarettes, marijuana, cocaine, hallucinogen use, and inhalants prior to age 18 were in one cluster. MLR analyses showed that the presence of depressive symptoms prior to age 18 was the major risk factor for MDD, while adolescent use of alcohol, marijuana, and inhalants prior to age 18 were associated with increased odds of MDD (p < 0.05) both in the whole data and the subset of adults without depressive symptoms prior to age 18. Adolescent use of cocaine prior to age 18 were associated with MDD only in the whole data, whereas adolescent smokeless tobacco use was associated with MDD only in those without depressive symptoms prior to age 18.

CONCLUSIONS

These findings highlight the comorbid early substance use and depressive symptoms during adolescence with adult MDD. Intervention strategies should simultaneously address early-onset substance use and depressive symptoms prior to age 18.

Association between blood cadmium and depression varies by age and smoking status in US adult women: a cross-sectional study from NHANES 2005-2016

BACKGROUND

Cadmium, a toxic metal, is widely encountered in diverse environmental contexts. Despite its pervasive exposure, there is limited research on the association between blood cadmium levels and depression, especially among females. This study aimed to investigate the relationship between blood cadmium levels and depression in adult women.

METHODS

Data spanning 2005-2016 from the National Health and Nutrition Examination Survey (NHANES) were selected. Depression was diagnosed with the Patient Health Questionnaire (PHQ-9, score ≥10). Multiple logistic regression, multiple linear regression, and smoothed curve fitting were used to investigate the relationship between blood cadmium and depression. Subgroup analyses and interaction tests were performed to evaluate the stability of this association across populations.

RESULTS

A total of 1,173 individuals were diagnosed with depression. The heightened prevalence of depression was linked to increased blood cadmium levels, a trend that persisted even after quartering blood cadmium. In the fully adjusted model, each incremental unit of blood cadmium was associated with a 33% rise in the prevalence of depression (OR = 1.33, 95% CI: 1.21-1.45). Participants in the highest quartile were 63% more likely to experience depression compared to those in the lowest quartile of blood cadmium (OR = 1.63, 95% CI: 1.15-2.30), and PHQ-9 score increased by 0.73 (β = 0.73, 95% CI: 0.30-1.17). This positive association may be relevant to the general population.

CONCLUSIONS

Blood cadmium levels are associated with depression in adult women, and this association varies by age and smoking status.

Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study

BACKGROUND

Little is known about whether people who use both tobacco and cannabis (co-use) are more or less likely to have mental health disorders than single substance users or non-users. We aimed to examine associations between use of tobacco and/or cannabis with anxiety and depression.

METHODS

We analyzed data from the COVID-19 Citizen Science Study, a digital cohort study, collected via online surveys during 2020-2022 from a convenience sample of 53,843 US adults (≥ 18 years old) nationwide. Past 30-day use of tobacco and cannabis was self-reported at baseline and categorized into four exclusive patterns: tobacco-only use, cannabis-only use, co-use of both substances, and non-use. Anxiety and depression were repeatedly measured in monthly surveys. To account for multiple assessments of mental health outcomes within a participant, we used Generalized Estimating Equations to examine associations between the patterns of tobacco and cannabis use with each outcome.

RESULTS

In the total sample (mean age 51.0 years old, 67.9% female), 4.9% reported tobacco-only use, 6.9% cannabis-only use, 1.6% co-use, and 86.6% non-use. Proportions of reporting anxiety and depression were highest for the co-use group (26.5% and 28.3%, respectively) and lowest for the non-use group (10.6% and 11.2%, respectively). Compared to non-use, the adjusted odds of mental health disorders were highest for co-use (Anxiety: OR = 1.89, 95%CI = 1.64-2.18; Depression: OR = 1.77, 95%CI = 1.46-2.16), followed by cannabis-only use, and tobacco-only use. Compared to tobacco-only use, co-use (OR = 1.35, 95%CI = 1.08-1.69) and cannabis-only use (OR = 1.17, 95%CI = 1.00-1.37) were associated with higher adjusted odds for anxiety, but not for depression. Daily use (vs. non-daily use) of cigarettes, e-cigarettes, and cannabis were associated with higher adjusted odds for anxiety and depression.

CONCLUSIONS

Use of tobacco and/or cannabis, particularly co-use of both substances, were associated with poor mental health. Integrating mental health support with tobacco and cannabis cessation may address this co-morbidity.

Adolescents' exposure to secondhand smoke and its association with susceptibility to smoking and mental health in Lagos, Nigeria

Introduction

this study assessed the relationship between exposure to secondhand smoking (SHS) and its association with self-reported anxiety, depression and susceptibility to smoking among adolescents in Lagos, Nigeria.

Methods

depression among study subjects was determined using the Patient Health Questionnaire-9 (PHQ-9) while the Generalized Anxiety Disorder - 7 (GAD-7) was used to determine anxiety levels. Susceptibility to smoking cigarettes was also determined while the Statistical Package for the Social Science (SPSS) 26.0 software was used for data analysis. Significant associations were determined at P-values <0.05.

Results

of the 300 adolescents surveyed (mean age 12.9±1.43), 7.6 % were regularly exposed to SHS, of which 3.0% were daily exposed to SHS indoors. In multivariable analyses, indoor SHS exposure for ≥ 1 hour daily was associated with increased odds for susceptibility to smoking (AOR=3.793; 95%-CI: 0.98-14.60; p= 0.052) and increased odds for depression (AOR=1.303; 95%-CI: 0.84-2.01; p= 0.228) and slightly reduced odds for anxiety (AOR=0.952; 95%-CI: 0.62-1.47; p=0.822).

Conclusion

secondhand smoking exposure was associated with higher odds of susceptibility to smoking cigarettes and depression among adolescents exposed to SHS, especially among females living in cramped accommodations. Further validation of these findings should however be determined by cohort study designs.

Prospective Bidirectional Relations Between Depression and Metabolic Health: 30 Year Follow-up from the NHLBI CARDIA Study

Objective

This study investigated prospective bidirectional relationships between depression and metabolic syndrome (MetS), and the moderating effects of race, sex, and health behaviors in a diverse cohort followed for 30 years.

Methods

Data were analyzed from the NHLBI CARDIA study, a 30 year-prospective study of young adults (N = 5113; M age = 24.76 (SD = 3.63) at baseline; 45% male) who were tested every 5 years between 1985-2015. Measures included biological assessments of MetS components, and self-reported depressive symptoms based on the Center for Epidemiologic Studies Depression (CESD) scale. Data analyses included bi-directional general estimating equations analyses of time-lagged associations between depressive symptoms and MetS.

Results

There was a consistent, bi-directional relationship between depressive symptoms and MetS over time. Individuals with more CESD depressive symptoms were more likely to develop MetS over time compared to those reporting fewer symptoms (Wald Chi-Square = 7.09 (1), p < 0.008), and MetS was similarly predictive of CESD. MetS more consistently predicted depressive symptoms at each 5-year exam than depressive symptoms predicted MetS. Race and sex moderated relationships between depression and MetS, with White females, White individuals overall, and females overall demonstrating significant relationships. Health behaviors were not related to depression-MetS associations.

Conclusion

In a diverse young adult population prospectively followed into late middle age, MetS more consistently predicted depression over time than depression predicted MetS. The relation between MetS and depressive symptoms was moderated by race and sex, but not health behaviors.

Cardiac Vagal Control Among Community Cigarette Smokers with Low to Moderate Depressive Symptoms

Impairments in cardiac vagal control (CVC) have been independently linked to smoking status and depression and are implicated in self-regulatory processes that may exacerbate depressive symptoms and maintain smoking behavior. Yet, few studies have examined how depressive symptoms, even at low levels, influence CVC reactivity among individuals who smoke. Investigating these relationships may provide novel insights into how depressive symptoms exacerbate existing regulatory vulnerabilities among smokers. This study investigated how depression symptoms affect CVC reactivity as a function of changing situational demands among a community sample of 60 daily adult cigarette smokers. Participants completed a mildly demanding cognitive task while physiological data was recorded. Growth curve modeling was used to examine the main and interactive effects of self-reported depressive symptoms on CVC reactivity over the course of the task. We hypothesized that greater depressive symptoms would be associated with less CVC reactivity, characterized by smaller initial reductions in CVC values and a flatter slope over time. Participants were daily smokers with mild to moderate levels of depression. Final model results, where time was specified as linear and the slope was fixed, showed no significant main or interactive effects of time and depression symptoms on CVC reactivity. Findings suggest that at low to moderate levels, depressive symptom severity is not related to patterns of CVC reactivity among adults who smoke. This is the first study to examine this relationship in this population. Future investigations that examine patterns of CVC reactivity among smokers and non-smokers with more severe depression are needed.

Maternal smoking during pregnancy, offspring smoking, adverse childhood events, and risk of major depression: a sibling design study

BACKGROUND

Evidence of a biologically plausible association between maternal smoking during pregnancy (MSP) and the risk of depression is discounted by null findings from two sibling studies. However, valid causal inference from sibling studies is subject to challenges inherent to human studies of MSP and biases particular to this design. We addressed these challenges in the first sibling study of MSP and depression conducted among adults past the peak age for the onset of depression, utilizing a prospectively collected and biologically validated measure of MSP and accounting for non-shared as well as mediating factors.

METHODS

We fit GEE binomial regression models to correct for dependence in the risk of depression across pregnancies of the same mother. We also fit marginal structural models (MSM) to estimate the controlled direct effect of MSP on depression that is not mediated by the offspring's smoking status. Both models allow the estimation of within- and between-sibling risk ratios.

RESULTS

The adjusted within-sibling risk ratios (RR_W) from both models (GEE: RR_W = 1.97, CI 1.16-3.32; MSM: RR_W = 2.08, CI 1.04-4.17) evinced an independent association between MSP and risk of depression. The overall effects from a standard model evinced lower associations (GEE: RR_T = 1.12, CI 0.98-1.28; MSM: RR_T = 1.18, CI 1.01-1.37).

CONCLUSIONS

Based on within-sibling information free of unmeasured shared confounders and accounting for a range of unshared factors, we found an effect of MSP on the offspring's risk of depression. Our findings, should they be replicated in future studies, highlight the importance of considering challenges inherent to human studies of MSP and affective disorders.

The dose-effect relationships of cigarette and alcohol consumption with depressive symptoms: a multiple-center, cross-sectional study in 5965 Chinese middle-aged and elderly men

BACKGROUND

Although association of depressive symptoms with cigarette or alcohol is well documented, the dose-response relationship between them is rarely studied. This study aims to evaluate dose-response relationships of cigarette and alcohol consumption with depressive symptoms in Chinese middle-aged and elderly men, providing evidence to guide cigarette and alcohol control.

METHODS

This multiple-center, cross-sectional study including 5965 Chinese men aged 40-79 years was conducted in 2013-2016 in China. Depressive symptoms were evaluated by Beck Depression Inventory-Short Form. History of cigarette smoking and alcohol drinking were collected with a structured questionnaire. Prevalence of depressive symptoms was compared depending on cigarette and alcohol consumption. Adjusted odds ratios (OR) and 95% confidence interval (CI) were estimated by binary logistic regression. Interpolation analysis was applied to test dose-effect relationships.

RESULTS

A parabolic-shaped relationship was observed between cigarette consumption and depressive symptoms. Compared to never smokers, 59.0% (OR = 1.59, 95% CI 1.30-1.94) and 29.0% (OR = 1.29, 95% CI 1.08-1.54) higher odds of depressive symptoms were observed in men smoking < 10 cigarettes/day and 10-20 cigarettes/day, whereas, similar odds of depressive symptoms among men smoking > 20 cigarettes/day (P = 0.092). An inverted J-shaped relationship was observed between alcohol consumption and depressive symptoms. Compared to never drinkers, a tendency of higher prevalence of depressive symptoms (OR = 1.16, 95% CI 0.99-1.36) was observed in men drinking < 140 g/week, and similar prevalence was observed in those drinking 140-280 g/week (P = 0.920), whereas, 29.4% (OR = 0.71, 95% CI 0.57-0.88) lower odds in men drinking > 280 g/week.

CONCLUSIONS

Associations of cigarette smoking and alcohol drinking with depressive symptoms differ with consumption in middle-aged and elderly men. Health-care providers should exercise great caution on depressive symptoms in conducting cigarette and alcohol control.

Smoking trajectories from adolescence to early adulthood as a longitudinal predictor of mental health in adulthood: evidence from 21 years of a nationally representative cohort

AIMS

To measure the prospective relationship between smoking trajectories from adolescence to young adulthood and mental health in later adulthood and test whether this relationship was mediated by concurrent co-use of alcohol and marijuana.

DESIGN

Longitudinal study using data drawn from rounds 1 to 18 of the National Longitudinal Survey of Youth 1997 (NLSY97), a nationally representative cohort study spanning 21 years.

SETTING

United States.

PARTICIPANTS

The analytical sample included those who completed survey items about smoking behaviors on at least half the data collection opportunities in adolescence and young adulthood (n = 8570, 48.9% female, 66.2% white).

MEASUREMENTS

Mental health in adulthood was measured using the five-item Mental Health Inventory (MHI-5; range = 0-100) at round 18. Seven trajectories of smoking from adolescence to young adulthood were identified by group-based multi-trajectory modeling, using data over 11 years from rounds 1 to 11.

FINDINGS

Late-onset moderate smokers [β = -1.95, 95% confidence interval (CI) = -3.61 to -0.29], late-onset accelerated smokers (β = -2.53, 95% CI = -4.28 to -0.78), early-onset heavy smokers (β = -3.72, 95% CI = -5.59 to -1.85) and early-onset moderate smokers (β = -2.66, 95% CI = -4.48 to -0.84) showed poorer regression-adjusted mean MHI-5 scores in later adulthood than stable abstainers, even after controlling for baseline mental health and covariates. Whether or not a difference in MHI-5 scores was present between quitters and stable abstainers was inconclusive. The concurrent co-use of alcohol and marijuana in young adulthood significantly mediated the relationship between smoking trajectory and mental health.

CONCLUSIONS

Continued smoking, especially early-onset and heavy smoking from adolescence to young adulthood, appears to increase the risk of poor mental health later in mid-adulthood, and quitting smoking in young adulthood may mitigate such risk even among early-onset smokers. Mediation analyses underscore the role of using multiple substances in this pathway.

Sexual Violence as a Key Predictor of Depressive Symptoms in Women: Korean Longitudinal Survey of Women and Families

The purpose of this study was to identify the influence of violence on depressive symptoms in women. We analyzed panel data from the Korean Longitudinal Survey of Women and Families (n  =  6,632). Exposure to sexual violence was a significant predictor of the onset of depressive symptoms. After adjusting for all covariates, other predictors included the perception of a poor or very poor health status than normal and participants in their 40s and 50s versus participants younger than 40 years. Assessing exposure to sexual violence might be beneficial for evaluating depressive symptoms in women who are newly diagnosed with depression.

Comparison of withdrawal symptom intensity between hypnosis and nicotine-replacement-therapies: A pilot study

Smoking cessation is a global public health issue. Nicotine dependence is a dynamic process that is not limited to physical dependence. Hypnosis can be helpful in the global management of smoking cessation. We explored this effect by comparing the effects of hypnosis and nicotine-replacement therapies (NRT) on tobacco withdrawal.Thirty participants were included in this comparative-randomized pilot study in parallel controlled groups after ethical validation. Participants were recruited by a general practitioner and had standardized consultations with addiction and hypnosis specialists and adapted treatment. The evolution of withdrawal symptoms was compared using the Cigarette Withdrawal Scale-21 for one month after smoking cessation in an adult tobacco-addict population wishing to stop smoking and receiving either NRT or hypnosis, both supported by motivational interviews. Craving intensity (French version of the Tobacco Craving Questionnaire), nicotine dependence (Fagerström), tobacco consumption, anxiety (Hamilton scale), and depression (Montgomery-Asberg scale) were also evaluated. Hypnosis appeared to have an influence on reducing the number of smoked cigarettes, whereas NRT appeared to influence markers of both physical and psychic dependence. A complementarity of hypnosis and NRT may be a viable therapeutic alternative to reduce the intensity of withdrawal symptoms after voluntary smoking cessation. A study on a larger population with a longer follow-up is needed to assess the advantages of each method to quit smoking.

Perinatal Mental Illness and Risk of Incident Autoimmune Disease: A Population-Based Propensity-Score Matched Cohort Study

Background

Studies have demonstrated elevated risk for autoimmune disease associated with perinatal mental illness, but the extent to which this risk is specific to mental illness arising perinatally, and not mental illness generally, is unknown. Our objective was to compare the risk of autoimmune disease in women with mental illness arising within the perinatal period to (1) women with mental illness arising outside the perinatal period and (2) women who did not develop mental illness.

Methods

We conducted a population-based matched cohort study of women aged 15–49 years with no history of mental illness or autoimmune disease in Ontario, Canada, 1998–2018. The exposed, 60,701 women with mental illness arising between conception and 365 days postpartum were propensity score-matched to (1) 264,864 women with mental illness arising non-perinatally and (2) 469,164 women who did not develop mental illness. Hazard ratios (HR) for autoimmune disease were generated using Cox proportional hazards models.

Results

The incidence of autoimmune disease was similar among women with mental illness arising perinatally compared to those with mental illness arising non-perinatally (138.4 vs 140.7 per 100,000 person-years; HR 0.98, 95% CI 0.92–1.05), and elevated among women with mental illness arising perinatally compared to those who did not develop mental illness (138.4 vs 88.9 per 100,000 person-years; HR 1.54, 95% CI 1.44–1.64). The HR for the latter comparison was more pronounced for autoimmune disease with brain-reactive antibodies than other autoimmune disease.

Conclusion

Perinatal mental illness is associated with increased risk of autoimmune disease that is no different than that of mental illness arising non-perinatally. Women with mental illness, regardless of the timing of onset, could benefit from early detection of autoimmune disease.

Religiosity and Depression at Midlife: A Prospective Study

Objectives:

Previously, authors found high personal importance of religion/spirituality (R/S) in early adulthood to predict a 75% decreased risk of recurrence of major depression in middle adulthood. Here, the authors follow up the original study sample to examine the association between R/S and major depression from middle adulthood into midlife.

Method:

Participants were 79 of 114 original adult offspring of depressed and non-depressed parents. Using logistic regression analysis, three measures of R/S from middle adulthood (personal importance, frequency of religious service attendance, and denomination) were used to predict Major Depressive Disorder (MDD) in midlife.

Results:

High R/S importance in middle adulthood was prospectively associated with risk for an initial onset of depression during the period of midlife. Frequency of attendance in middle adulthood was associated with recurrence of depression at midlife in the high-risk group for depression, as compared to the low-risk group.

Conclusion:

Findings suggest that the relation between R/S and depression may vary across adult development, with risk for depression associated with R/S at midlife potentially revealing a developmental process.

Association of Environmental tobacco smoke exposure with depression among non-smoking adults

Background

Depression is a psychological dysfunction that impairs health and quality of life. However, whether environmental tobacco smoke exposure (ETSE) is associated with depression is poorly understood. This study was designed to evaluate the association of ETSE with depression among non-smoking adults in the United States.

Method

Using the 2015–2016 United States National Health and Nutrition Examination Survey (NHANES), we identified 2623 adults (females – 64.2%, males – 35.8%) who had never smoked and applied multivariable adjusted-logistic regression to determine the adjusted odds ratio (aOR) and 95% confidence interval (CI) at P < 0.05 for the association of ETSE with depression adjusting for relevant confounders.

Results

Mean age of respondents was 46.5 ± 17.9 years, 23.5% reported ETSE, and 4.7% reported depression. Also, aORs for the association of ETSE with depression were 1.992 (1.987, 1.997) among females and 0.674 (0.670, 0.677) among males. When we examined the association by age groups, the aORs were 1.792 (1.787, 1.796) among young adults (< 60 years) and 1.146 (1.140, 1.152) among older adults (≥60 years).

Conclusions

We found that ETSE was associated with higher odds of depression among females but not among males.

Cigarette Smoking in an Acute Partial Hospital Program

ABSTRACT

This study explored demographic and clinical features, plus clinical outcomes, in a smoke-free acute partial hospital (PH) among current smokers, former smokers, and those who had never smoked (nonsmokers). Compared with nonsmokers, current smokers were younger and more likely to be unmarried and unpartnered, unemployed, or receiving disability benefits. They had more prior inpatient (IP) and PH episodes. They also had more problems with interpersonal relationships, mood lability, psychosis, and substance use. Compared with nonsmokers, current smokers were more likely to miss PH treatment days and drop out. They also had longer time to readmission to PH or IP. Former smokers resembled nonsmokers, except that former smokers also had a high rate of dropout. Changes in symptoms and functioning for patients who completed PH were the same among all groups. In an acute PH setting, smoking is a marker for psychiatric and psychosocial impairment plus treatment interruption.

Prevalence of depression disorder in industrial workers: a meta-analysis

Objectives. Depression is known to be associated with a variety of occupational factors. The aim of this study was to meta-analyze the prevalence of depressive disorder in industrial workers. Methods. Three databases indexing abstracts of articles were selected and searched until August 2020: PubMed, Web of Science and Scopus. For each study, the sample size and number of depression events were extracted, and after extracting these data, the random effects method was used to assess the prevalence. I² and χ² values were used to investigate the heterogeneity. Results. The prevalence of depressive disorder in industrial workers is 21%. The prevalence of depressive disorder in men and women industrial workers is 23 and 28%, respectively. The prevalence of depressive disorder in Asia, Europe and America is equal to 22, 18 and 20%, respectively. The result of the heterogeneity test showed that the heterogeneity is high. Conclusion. The prevalence of depression in industrial workers is higher than in the general population. These differences can be due to the working conditions of industrial workers. Therefore, the work environment and the promotion of occupational health can play an important role in preventing depression.

Smoking cessation for improving mental health

BACKGROUND

There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self-medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health.

OBJECTIVES

To examine the association between tobacco smoking cessation and change in mental health.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the trial registries clinicaltrials.gov and the International Clinical Trials Registry Platform, from 14 April 2012 to 07 January 2020. These were updated searches of a previously-conducted non-Cochrane review where searches were conducted from database inception to 13 April 2012.  SELECTION CRITERIA: We included controlled before-after studies, including randomised controlled trials (RCTs) analysed by smoking status at follow-up, and longitudinal cohort studies. In order to be eligible for inclusion studies had to recruit adults who smoked tobacco, and assess whether they quit or continued smoking during the study. They also had to measure a mental health outcome at baseline and at least six weeks later.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methods for screening and data extraction. Our primary outcomes were change in depression symptoms, anxiety symptoms or mixed anxiety and depression symptoms between baseline and follow-up. Secondary outcomes  included change in symptoms of stress, psychological quality of life, positive affect, and social impact or social quality of life, as well as new incidence of depression, anxiety, or mixed anxiety and depression disorders. We assessed the risk of bias for the primary outcomes using a modified ROBINS-I tool.  For change in mental health outcomes, we calculated the pooled standardised mean difference (SMD) and 95% confidence interval (95% CI) for the difference in change in mental health from baseline to follow-up between those who had quit smoking and those who had continued to smoke. For the incidence of psychological disorders, we calculated odds ratios (ORs) and 95% CIs. For all meta-analyses we used a generic inverse variance random-effects model and quantified statistical heterogeneity using I2. We conducted subgroup analyses to investigate any differences in associations between sub-populations, i.e. unselected people with mental illness, people with physical chronic diseases. We assessed the certainty of evidence for our primary outcomes (depression, anxiety, and mixed depression and anxiety) and our secondary social impact outcome using the eight GRADE considerations relevant to non-randomised studies (risk of bias, inconsistency, imprecision, indirectness, publication bias, magnitude of the effect, the influence of all plausible residual confounding, the presence of a dose-response gradient).

MAIN RESULTS

We included 102 studies representing over 169,500 participants. Sixty-two of these were identified in the updated search for this review and 40 were included in the original version of the review.  Sixty-three studies provided data on change in mental health, 10 were included in meta-analyses of incidence of mental health disorders, and 31 were synthesised narratively.  For all primary outcomes, smoking cessation was associated with an improvement in mental health symptoms compared with continuing to smoke: anxiety symptoms (SMD -0.28, 95% CI -0.43 to -0.13; 15 studies, 3141 participants; I2 = 69%; low-certainty evidence); depression symptoms: (SMD -0.30, 95% CI -0.39 to -0.21; 34 studies, 7156 participants; I2 = 69%' very low-certainty evidence);  mixed anxiety and depression symptoms (SMD -0.31, 95% CI -0.40 to -0.22; 8 studies, 2829 participants; I2 = 0%; moderate certainty evidence).  These findings were robust to preplanned sensitivity analyses, and subgroup analysis generally did not produce evidence of differences in the effect size among subpopulations or based on methodological characteristics. All studies were deemed to be at serious risk of bias due to possible time-varying confounding, and three studies measuring depression symptoms were judged to be at critical risk of bias overall. There was also some evidence of funnel plot asymmetry. For these reasons, we rated our certainty in the estimates for anxiety as low, for depression as very low, and for mixed anxiety and depression as moderate. For the secondary outcomes, smoking cessation was associated with an improvement in symptoms of stress (SMD -0.19, 95% CI -0.34 to -0.04; 4 studies, 1792 participants; I2 = 50%), positive affect (SMD 0.22, 95% CI 0.11 to 0.33; 13 studies, 4880 participants; I2 = 75%), and psychological quality of life (SMD 0.11, 95% CI 0.06 to 0.16; 19 studies, 18,034 participants; I2 = 42%). There was also evidence that smoking cessation was not associated with a reduction in social quality of life, with the confidence interval incorporating the possibility of a small improvement (SMD 0.03, 95% CI 0.00 to 0.06; 9 studies, 14,673 participants; I2 = 0%). The incidence of new mixed anxiety and depression was lower in people who stopped smoking compared with those who continued (OR 0.76, 95% CI 0.66 to 0.86; 3 studies, 8685 participants; I2 = 57%), as was the incidence of anxiety disorder (OR 0.61, 95% CI 0.34 to 1.12; 2 studies, 2293 participants; I2 = 46%). We deemed it inappropriate to present a pooled estimate for the incidence of new cases of clinical depression, as there was high statistical heterogeneity (I2 = 87%).

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.

Cross-sectional survey of depressive symptoms and suicide-related ideation at a Japanese national university during the COVID-19 stay-home order

Background

We aimed to estimate the prevalence of depressive symptoms as well as suicide-related ideation among Japanese university students during the stay-home order necessitated by the coronavirus disease 2019 pandemic in Japan, and offer evidence in support of future intervention to depression and suicide prevention strategies among college and university students.

Methods

The data for this cross-sectional study were derived from the Student Mental Health Survey conducted from May 20 to June 16, 2020 at a national university in Akita prefecture. Among the 5111 students recruited, 2712 participated in this study (response rate, 53%; mean age ± standard deviation, 20.5 ±3.5 years; men, 53.8%). Depressive symptoms were identified by using the Patient Health Questionnaire-9 (PHQ-9).

Results

The prevalence of moderate depressive symptoms based on a PHQ-9 score ≥10 and suicide-related ideation based on question 9 of PHQ-9 ≥1, which encompasses thoughts of both suicide and self-harm, was 11.7% and 6.7%, respectively. Multivariable logistic regression analyses showed that risk factors for depression included being a woman, smoking, alcohol consumption, and social network communication using either video or voice. For suicide-related ideation, alcohol consumption was the only risk factor. Exercise and having someone to consult about worries were associated with decreased risk of both depressive symptoms and suicide-related ideation.

Conclusions

Negative lifestyles of smoking and drinking, and being a woman, may be important risk factors for depressive symptoms, whereas exercise and having someone to consult about worries may be protective factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-021-00953-1.

Activation level as a mediator between behavioral activation, sex, and depression among treatment-seeking smokers

INTRODUCTION

Behavioral activation (BA) has gained interest when combined with tobacco interventions as it relates to improved depression and cessation rates. However, no prior efforts have examined mediators of BA effectiveness and sex-dependent effects. This secondary analysis assesses the main and interactive effects of sex and type of smoking cessation intervention [a cognitive behavioral treatment (CBT) only, or CBT + BA] on depressive symptoms among treatment-seeking patients with depression. It also examines the activation level as a mediator between BA, BA by sex, and depression.

METHOD

120 smokers were assigned to an 8-week CBT or to CBT + BA. They completed the Beck Depression Inventory-II (BDI-II) and the Behavioral Activation for Depression scale-short-form (BADS-SF). A two-way ANOVA assessed the effects of sex and treatment condition on participants' BDI-II scores. A moderated mediational analysis tested whether the indirect effect of treatment condition on BDI-II through BADS-SF differed by sex.

RESULTS

After controlling for end-of-treatment smoking status and baseline BDI-II, there were no significant effects of treatment condition, sex, and their interaction on end-of-treatment BDI-II. Being a male was indirectly associated with higher BDI-II scores through lower BADS-SF score (point estimate = -3.440; SE = 1.637; BC 95% CI [-7.105, -0.749]). This effect was not found for women.

CONCLUSIONS

There is a need to tailor interventions by sex when treating smokers with depression. It is recommended to assess symptoms such as mental rumination or self-consciousness, which tend to be more pronounced in women.

Early predictors of mental health in mid-adulthood

AIM

Substantial research has focused on the examination of factors that contribute to the development of psychiatric problems. However, much less is known about factors early in life that may protect from poor mental health outcomes in midlife. This study aimed to identify the extent to which a set of key perinatal demographic variables and adolescent academic performance were associated with good mental health in mid-adulthood.

METHODS

In a sample of 525 individuals (aged 34-44, 55.4% male) born and raised in Jerusalem, Israel (STREAM study) we attempted to differentiate those who did and did not report psychiatric symptoms in mid-adulthood. Using χ² and regression analysis, we explored birth factors (year of birth, sex, birth weight, and number of older siblings, data on parental immigration and socioeconomic status), academic achievement in eighth grade and contemporaneous measures of lifestyle factors, personality traits, and perceived resilience.

RESULTS

Participants with good mental health were more often male (P = .005) and had better academic performance already at adolescence than participants who reported psychiatric symptoms in midlife (P < .001). They reported fewer physical complaints (P = .008), were less likely to smoke (P = .001) and considered themselves to be more "resilient" (P < .001).

CONCLUSIONS

The results showed that better academic performance in adolescence may be associated with better stress-coping strategies, resulting in fewer psychiatric complaints, more perceived resilience, and less stress-related behaviours in mid-adulthood. Future studies confirming this hypothesis could inform public mental health interventions.

Lower self-efficacy and greater depressive symptoms predict greater failure to recover from a single lapse cigarette

OBJECTIVE

Smoking reexposure after a quit attempt (i.e., lapse) increases relapse risk, but lapse recovery is possible. Using a 6-day analogue model of smoking cessation and lapse, this study tested the effect of a single lapse cigarette on the risk of subsequent smoking. Abstinence self-efficacy (ASE) and depressive symptoms (using the Center for Epidemiological Studies Depression Scale, CES-D) were also examined as hypothesized moderators of lapse recovery.

METHOD

After receiving cessation counseling and achieving 2 days of incentivized abstinence, 54 daily smokers (mean age: 41 years, 61% African American, 63% male) were randomly assigned to smoke 1 cigarette or to a no-lapse control condition. Participants were then offered monetary incentives to abstain for 3 more days and smoking was monitored.

RESULTS

Compared to the control condition, participants who experienced a lapse had a 2.5 times greater risk of smoking in the first 24 hours Furthermore, a lapse resulted in much greater risk of subsequent smoking compared to the control condition among individuals with lower postquit ASE scores (p = .044) and greater CES-D scores (p = .040).

CONCLUSIONS

These findings provide preliminary evidence that a single lapse cigarette after quitting plays a causal role in subsequent smoking and suggest that individuals with lower postquit ASE and greater depressive symptoms are less likely to recover from a lapse. Future research should investigate factors associated with lapse recovery and failure so that effective lapse-responsive strategies can be developed. Laboratory models provide an efficient and controlled method to examine such processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prevalence of Anxiety and Depression Symptoms in People with Carpal Tunnel Syndrome

Objectives  To demonstrate the prevalence of depression and anxiety symptoms in patients with carpal tunnel syndrome treated at a hand surgery outpatient clinic and to describe the clinical and epidemiological characteristics of this population. Methods  People diagnosed with carpal tunnel syndrome at the initial visit were evaluated over a 6-month period for data collection. Clinical and epidemiological characteristics were noted, and patients diagnosed with anxiety and/or depression were evaluated. Results  In total, 101 people had carpal tunnel syndrome, including 38 diagnosed with depression and 29 with anxiety. Most patients were low-income women, with elementary school-level education. More than half of the patients had at least one associated systemic comorbidity. Conclusion  Independent characteristics that statistically influenced anxiety and depression symptoms in patients with carpal tunnel syndrome were gender, smoking, and family income ( p  < 0.05).

Contribution of Alcohol and Nicotine Dependence to the Prevalence of Depressed Mood in Different Ethnic Groups in The Netherlands: The HELIUS Study

Objective: Ethnic minorities report different levels of drinking and smoking and higher rates of depression compared to native populations. In this study we aimed to investigate in six ethnic groups whether tobacco and alcohol use were associated with depressive symptoms, which are more prevalent in ethnic minorities.Methods: Cross-sectional data from the multi-ethnic Healthy Life in an Urban Setting (HELIUS) study sample (N = 22,471) was used, comprising 4,580 native Dutch participants which were compared with participants from five ethnic minority groups (3,259 South Asian Surinamese, 4,292 African Surinamese, 2,262 Ghanaian, 3,891 Turkish, and 4,187 Moroccan).Results: Alcohol misuse was positively associated with depressed mood in all ethnic groups except for the Dutch and the Ghanaians. Nicotine dependence was positively associated with depressed mood in all ethnic groups except for the Ghanaian group.Conclusions: Alcohol misuse and nicotine dependence were significantly associated with depressed mood in most but not all ethnic groups and especially in men. However, across all groups the contribution of alcohol misuse and nicotine dependence to depressed mood was small. Prospective multi-ethnic studies should confirm whether the relations are causal and elucidate their direction.

A key indicator of nicotine dependence is associated with greater depression symptoms, after accounting for smoking behavior

INTRODUCTION

Depression is a global burden that is exacerbated by smoking. The association between depression and chronic smoking is well-known; however, existing findings contain possible confounding between nicotine dependence (ND), a latent construct measuring addiction, and objective smoking behavior. The current study examines the possible unique role of ND in explaining depression, independently of smoking behavior.

METHODS

A nationally-representative sample of current adult daily smokers was drawn by pooling three independent, cross-sectional, biennial waves (spanning 2011-16) of the National Health and Nutrition Examination Survey (NHANES). The association between ND (operationally defined as time to first cigarette (TTFC) after waking) and the amount of depression symptoms was examined after adjusting for both current and lifetime smoking behaviors (cigarettes per day and years of smoking duration) and sociodemographic factors (gender, age, race, education and income to poverty ratio).

RESULTS

Earlier TTFC was associated with more depression symptoms, such that those smoking within 5 minutes of waking had an approximately 1.6-fold higher depression score (PRR = 1.576, 95% CI = 1.324-1.687) relative to those who smoke more than 1 hour after waking. This relationship remained significant after adjusting for current and lifetime smoking behavior as well as sociodemographic factors (PRR = 1.370, 95% CI = 1.113, 1.687).

CONCLUSIONS

The latent construct of ND, as assessed by TTFC, may be associated with an additional risk for depression symptoms, beyond that conveyed by smoking behavior alone. This finding can be used for more refined risk prediction for depression among smokers.

Trends in the Prevalence of Current, Daily, and Nondaily Cigarette Smoking and Quit Ratios by Depression Status in the U.S.: 2005-2017

INTRODUCTION

Cigarette smoking remains more common among individuals with depression. This study investigates whether cigarette quit ratios and cigarette use prevalence have changed differentially by depression status during the past decade.

METHODS

National Survey on Drug Use and Health data (2005-2017) were analyzed in 2019. Respondents aged ≥12 years were included in analyses of smoking prevalence (n=728,691) and respondents aged ≥26 years were included in analyses of quit ratio (n=131,412). Time trends in smoking prevalence (current, daily, and nondaily) and quit ratio (former/lifetime smokers) were estimated, stratified by past-year depression. Adjusted analyses controlled for demographics.

RESULTS

Smoking prevalence was consistently higher among those with depression than those without depression. From 2005 to 2017, nondaily smoking did not significantly change among individuals with depression (9.25% to 9.40%; AOR=0.995, 95% CI=0.986, 1.005), whereas it decreased from 7.02% to 5.85% among those without depression (AOR=0.986, 95% CI=0.981, 0.990). By contrast, daily smoking declined among individuals with (25.21% to 15.11%; AOR=0.953, 95% CI=0.945, 0.962) and without depression (14.94% to 9.76%; AOR=0.970, 95% CI=0.967, 0.973). The quit ratio increased among individuals with (28.61% to 39.75%; AOR=1.036, 95% CI=1.021, 1.052) and without depression (47.65% to 53.09%; AOR=1.013, 95% CI=1.009, 1.017), yet quit ratios were consistently lower for those with depression than those without depression.

CONCLUSIONS

Quit ratios are increasing and smoking prevalence is decreasing overall, yet disparities by depression status remain significant. Disparities in quit ratio may be one contributing factor to the elevated prevalence of smoking among those with depression. Innovative tobacco control approaches for people with depression appear long overdue.

Gender Differences in Negative Mood, Emotional Intelligence and Tobacco Use among Young Adults

Background: Tobacco use is recognized as a form of addiction and remains a significant health concern. Despite this well accepted problem, the various components associated with tobacco use across gender remain relatively unknown. Objectives: The purpose of this study was to investigate the relationship between tobacco use and negative moods (anxiety, depression, stress) between men and women. The relationship between emotional intelligence (EI) and attitudes about smoking was also investigated. Methods: A questionnaire was used to determine sociodemographic characteristics, negative moods, EI, smoking behavior, and tobacco-related attitudes (N = 350). Results: Amongst individuals who used tobacco products, women reported greater disturbances in stress and anxiety compared to men. In addition, both men and women who used tobacco products reported higher depression scores compared to nonsmokers, however, no gender differences were observed. Hierarchical regression analyses revealed that higher EI scores explained negative attitudes about smoking in relation to health concerns. Lastly, women reported stronger attitudes for the restriction of cigarette sales and marketing of tobacco products. Conclusion: These findings support the literature by showing that mood dysregulation is an important factor associated with tobacco use among women. Additionally, we report that specific aspects of EI are psychological constructs closely linked with attitudes about smoking. Future studies elucidating the various components of tobacco use across gender might lead to more effective treatments for smoking.

Electronic cigarette use and mental health: A Canadian population-based study

BACKGROUND

To examine the association between electronic cigarette (e-cigarette) use and adverse mental health status.

METHODS

A cross-sectional analysis was conducted using data from the 2015 and 2016 Canadian Community Health Survey (n = 53,050). Sampling weights and associated bootstrap procedures were used to account for survey design effects. Multivariable logistic regression was employed to examine the association between e-cigarette use and the following mental health outcomes: depressive symptom ratings (using the Patient Health Questionnaire 9), self-reported professionally diagnosed mood and anxiety disorders, perceived mental health, suicidal thoughts/attempts, and binge drinking.

RESULTS

The overall prevalence of past 30-day e-cigarette use was 2.9% (95% CI: 2.6-3.1). 11.5% (95% CI: 10.4-12.7) of smokers reported also using e-cigarettes. Dual users had the highest prevalence of adverse mental health status. The association between e-cigarette use and mental health was found to be modified by smoking status and sex in most of the logistic models. E-cigarettes had less than multiplicative effects among smokers. Female e-cigarette users tended to have higher odds of adverse mental health than male users. Overall, in the multivariable modeling, e-cigarette use was consistently associated with poor mental health among non-smokers and women, a finding that persisted after adjustment for additional covariates.

CONCLUSIONS

These results indicate that e-cigarette use is associated with adverse mental health status, particularly among the non-smoking general population and women.

LIMITATIONS

The study relied on respondent self-report, and the cross-sectional nature of the study does not allow us to clarify the direction of this association.

Unhealthy behavior clustering and mental health status in United States college students

Objective: Examine the association of health risk behavior clusters with mental health status among US college students. Participants: 105,781 US college students who completed the Spring 2011 National College Health Assessment. Methods: We utilized the latent class analysis to determine clustering of health risk behaviors (alcohol binge drinking, cigarette/marijuana use, insufficient physical activity, and fruit/vegetable consumption), and chi-square and ANOVA analyses to examine associations between the class membership and mental health (mental health diagnoses, psychological symptoms, and self-injurious thoughts/behaviors). Results: Three classes were identified with differing rates of binge drinking, substance use, and insufficient physical activity but similar rates of insufficient fruit/vegetable consumption. Students classified with the highest rates of binge drinking and cigarette/marijuana use had the highest rates across all mental health variables compared to other classes. Conclusions: Students who reported engaging in multiple health risk behaviors, especially high alcohol and cigarette/marijuana use, were also more likely to report poorer mental health.

Parental Depression is Prospectively Associated With Lower Smoking Cessation Rates and Poor Child Asthma Outcomes

Background

Depressive symptoms are elevated in parents of asthmatic children compared with parents of healthy children. The role of depression in smoking cessation and pediatric asthma outcomes in this population is unclear.

Purpose

To prospectively examine the effect of parent depression on smoking cessation and child asthma outcomes.

Methods

Secondary analysis from a cessation induction trial involving Motivational Interviewing (MI) and biomarker feedback on secondhand smoke exposure (SHSe). Parents (n=341) had an asthmatic child (mean age=5.2 years) and did not have to want to quit smoking to enroll. Intervention included asthma education, MI, and SHSe feedback plus randomization to six counseling (MI; repeated feedback) or control calls (brief check on asthma) for 4 months. Depressive symptoms were defined as scoring ≥22 on the Center for Epidemiologic Study-Depression scale. Smoking outcomes were bioverified 7- and 30-day point-prevalence abstinence (ppa). Child asthma outcomes were past month functional limitation, health care utilization, and number of days with asthma symptoms. Data were obtained at baseline, 2, 4, and 6 months.

Results

Parental depression was associated with lower odds of abstinence (7-day ppa odds ratio [OR]=0.38, 95% confidence interval [CI]=0.23, 0.64; 30-day ppa OR=0.27, 95% CI=0.15, 0.47), greater odds of child health care utilization for asthma (OR=1.71, 95% CI=1.01, 2.92), and greater child asthma functional limitation (B=0.16, SE=0.06, p=.03) even after controlling for smoking status. Depression predicted a greater number of child asthma symptom days (B=1.08, SE=0.44, p=.01), but this became nonsignificant after controlling for smoking status.

Conclusions

Among parents who smoke, both depressive symptoms and smoking should be targeted for treatment aimed at improving pediatric asthma.

Prospective Study on the Association Between Adherence to Healthy Lifestyles and Depressive Symptoms Among Japanese Employees: The Furukawa Nutrition and Health Study

Background

While a growing body of research suggests a protective role of healthy lifestyle against depression, evidence from prospective studies is scarce. We constructed a healthy lifestyle index (HLI) and examined its prospective association with depressive symptoms in a Japanese working population.

Methods

Participants were 917 employees (19–68 years old) who were free from depressive symptoms at baseline in 2012–2013 and attended the 3-year follow-up survey. The HLI (range: 0–7 points) was constructed by assigning 1 point to each healthy lifestyle factor, namely, (1) normal body mass index (18.5–24.9 kg/m²), (2) non-smoking, (3) no or moderate alcohol intake (≤23 g ethanol/day), (4) adequate physical activity (≥7.5 metabolic equivalent-hours/week), (5) high vegetable intake (≥350 g/day), (6) high fruit intake (≥200 g/day), and (7) adequate sleep duration (6–8.9 hours/day), which was categorized into three groups (low: 0–2 points; middle: 3–4 points; and high: 5–7 points). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale.

Results

A total of 155 incident cases (17.0%) of depressive symptoms were identified at the follow-up survey. Compared with the low HLI group, multivariable-adjusted odds ratios of depressive symptoms were 0.74 (95% confidence interval, 0.48–1.15) and 0.55 (95% confidence interval, 0.31–0.99) for the middle and high HLI groups, respectively (P-trend = 0.041).

Conclusion

The present study suggests the importance of adherence to multiple healthy lifestyle factors in prevention of depressive symptoms.

Single and dual diagnoses of major depressive disorder and posttraumatic stress disorder predicted by triple comorbid trajectories of tobacco, alcohol, and marijuana use among urban adults

Background: The adverse consequences of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) affect a significant portion of the US population every year (i.e., 15 million for MDD; 8 million for PTSD) and are of public health concern. The current study examines tobacco, alcohol, and marijuana use as possible longitudinal predictors of MDD and/or PTSD. Methods: A community sample of 674 participants (53% African Americans and 47% Puerto Ricans; 405 females and 269 males) were recruited from the Harlem Longitudinal Development Study. We used Mplus software to obtain the triple trajectories of tobacco, alcohol, and marijuana use from mean age 14 to 36. Logistic regression analyses were then conducted to examine the associations between those triple trajectory groups and a single diagnosis of MDD or PTSD as well as a dual diagnosis of MDD with PTSD at age 36. Results: The observed percentages of MDD, PTSD, and the comorbidity of MDD and PTSD were 17%, 8%, and 5%, respectively. The heavy use of all 3 substances group was associated with an increased likelihood of having MDD (adjusted odds ratio [AOR] = 3.14, P < .01), PTSD (AOR = 3.91, P < .05), and MDD with PTSD (AOR = 6.64, P < .01), as compared with the tobacco and alcohol use group. Conclusions: Treatment programs to quit or reduce the use of tobacco, alcohol, and marijuana may help decrease the prevalence of MDD and PTSD. This could lead to improvements in individualized treatments for patients who use tobacco, alcohol, and marijuana and who have both MDD and PTSD.

The association between exposure to second-hand smoke and major depressive disorder in perimenopausal women: results from apopulation-based study

PURPOSE

The aim of this study was to test the hypothesis that exposure to second-hand smoke (SHS) would be positively associated with major depressive disorder (MDD) in perimenopausal women from a population-based perspective, after adjustment for all potential confounders.

METHODS

This study used the National Health and Nutrition Examination Survey (NHANES) database, 2005-2012, to report on MDD in perimenopausal women.

RESULTS

The odds ratio (OR) for MDD increased when there was a smoker was in the home, as compared to not having a smoker in the home (aOR = 2.97, 95% confidence interval [CI] = 1.15-7.67); however, in the non-poor group, the OR for MDD showed no difference between those who had or did not have a smoker in their home. For participants who self-rated their health condition as excellent, very good or good, the OR for MDD increased; it also increased if there were smokers in the home, as compared to those without smokers in the home (aOR = 2.58, 95% CI = 1.08-6.14).

CONCLUSIONS

The present study results augment our understanding of the clinical and public health significance of SHS, as well as the role of various socioeconomic and self-rated health conditions, in perimenopausal women. Key messages An increasing OR for MDD was demonstrated with regard to health status such as CVD, chronic respiratory tract disease, arthritis, thyroid problems, lower eGFR, fair or poor self-rated health condition, and elevated CRP level. Participants who self-rated their health condition as excellent, very good or good had an increased OR for MDD. The OR also increased if the women had smokers in their home versus women who did not have smokers in the home.

Cigarette smoking among those with mental disorders in the US population: 2012-2013 update

BACKGROUND

Recent nationally representative estimates from the USA suggest the prevalence of cigarette smoking continues to be much higher among those with mental disorders compared with those without; however, prevalence estimates for current cigarette use by specific diagnoses are outdated.

METHODS

We analysed data from the National Epidemiologic Survey on Alcohol and Related Conditions III (2012-2013). We estimated the prevalence of lifetime and past-year smoking, lifetime and past-year daily smoking, and lifetime smoking cessation among ever smokers (ie, the quit ratio) among those with common mood, anxiety and substance use disorders in comparison to those without these disorders.

RESULTS

Across disorders, smoking prevalence was higher and the quit ratio was lower among those with common mental disorders compared with those without, with twofold to sixfold relativedifferences in the odds of the magnitude.

CONCLUSIONS

Despite tobacco control advances since 2000 and resulting declines in smoking prevalence, smoking remains extraordinarily more common among those with mood, anxiety and substance use disorders, with highest rates among those with bipolar and substance use disorders.

Genome-wide association study identifies glutamate ionotropic receptor GRIA4 as a risk gene for comorbid nicotine dependence and major depression

Smoking and major depression frequently co-occur, at least in part due to shared genetic risk. However, the nature of the shared genetic basis is poorly understood. To detect genetic risk variants for comorbid nicotine dependence (ND) and major depression (MD), we conducted genome-wide association study (GWAS) in two samples of African-American participants (Yale-Penn 1 and 2) using linear mixed model, followed by meta-analysis. 3724 nicotine-exposed subjects were analyzed: 2596 from Yale-Penn-1 and 1128 from Yale-Penn-2. Continuous measures (Fagerström Test for Nicotine Dependence (FTND) scores and DSM-IV MD criteria) rather than disorder status were used to maximize the power of the GWAS. Genotypes were ascertained using the Illumina HumanOmni1-Quad array (Yale-Penn-1 sample) or the Illumina HumanCore Exome array (Yale-Penn-2 sample), followed by imputation based on the 1000 Genomes reference panel. An intronic variant at the GRIA4 locus, rs68081839, was significantly associated with ND-MD comorbidity (β = 0.69 [95% CI, 0.43-0.89], P = 1.53 × 10-8). GRIA4 encodes an AMPA-sensitive glutamate receptor that mediates fast excitatory synaptic transmission and neuroplasticity. Conditional analyses revealed that the association was explained jointly by both traits. Enrichment analysis showed that the top risk genes and genes co-expressed with GRIA4 are enriched in cell adhesion, calcium ion binding, and synapses. They also have enriched expression in the brain and they have been implicated in the risk for other neuropsychiatric disorders. Further research is needed to determine the replicability of these findings and to identify the biological mechanisms through which genetic risk for each condition is conveyed.

Association between maternal adherence to healthy lifestyle practices and risk of obesity in offspring: results from two prospective cohort studies of mother-child pairs in the United States

OBJECTIVE

To examine the association between an overall maternal healthy lifestyle (characterized by a healthy body mass index, high quality diet, regular exercise, no smoking, and light to moderate alcohol intake) and the risk of developing obesity in offspring.

DESIGN

Prospective cohort studies of mother-child pairs.

SETTING

Nurses' Health Study II (NHSII) and Growing Up Today Study (GUTS) in the United States.

PARTICIPANTS

24 289 GUTS participants aged 9-14 years at baseline who were free of obesity and born to 16 945 NHSII women.

MAIN OUTCOME MEASURE

Obesity in childhood and adolescence, defined by age and sex specific cutoff points from the International Obesity Task Force. Risk of offspring obesity was evaluated by multivariable log-binomial regression models with generalized estimating equations and an exchangeable correlation structure.

RESULTS

1282 (5.3%) offspring became obese during a median of five years of follow-up. Risk of incident obesity was lower among offspring whose mothers maintained a healthy body mass index of 18.5-24.9 (relative risk 0.44, 95% confidence interval 0.39 to 0.50), engaged in at least 150 min/week of moderate/vigorous physical activities (0.79, 0.69 to 0.91), did not smoke (0.69, 0.56 to 0.86), and consumed alcohol in moderation (1.0-14.9 g/day; 0.88, 0.79 to 0.99), compared with the rest. Maternal high quality diet (top 40% of the Alternate Healthy Eating Index 2010 diet score) was not significantly associated with the risk of obesity in offspring (0.97, 0.83 to 1.12). When all healthy lifestyle factors were considered simultaneously, offspring of women who adhered to all five low risk lifestyle factors had a 75% lower risk of obesity than offspring of mothers who did not adhere to any low risk factor (0.25, 0.14 to 0.47). This association was similar across sex and age groups and persisted in subgroups of children with various risk profiles defined by factors such as pregnancy complications, birth weight, gestational age, and gestational weight gain. Children's lifestyle did not significantly account for the association between maternal lifestyle and offspring obesity risk, but when both mothers and offspring adhered to a healthy lifestyle, the risk of developing obesity fell further (0.18, 0.09 to 0.37).

CONCLUSION

Our study indicates that adherence to a healthy lifestyle in mothers during their offspring's childhood and adolescence is associated with a substantially reduced risk of obesity in the children. These findings highlight the potential benefits of implementing family or parental based multifactorial interventions to curb the risk of childhood obesity.

Moderators of smoking cessation outcomes in a randomized-controlled trial of varenicline versus placebo

RATIONALE AND OBJECTIVE

Varenicline has gained a reputation as the optimal intervention for treatment resistant smokers, yet more than half of those who try it do not succeed. To better understand individual differences in the effectiveness of varenicline, this study evaluates the effectiveness of varenicline for smoking cessation in a double-blind, placebo-controlled, randomized clinical trial and examines the influence of psychological factors on treatment outcome.

METHOD

Two hundred five cigarette smokers interested in quitting were randomly assigned to 12 weeks of varenicline or placebo. Outcomes examined were CO-confirmed continuous abstinence for the past month, average number of cigarettes smoked per day, and 7-day point prevalence.

RESULTS

Varenicline-treated participants were more likely than placebo to achieve continuous abstinence at the end of treatment (OR = 3.29; RR = 2.62), and 7-day point prevalence rates showed an effect of medication at each time point. Participants in both groups significantly reduced their smoking during the course of treatment and follow-up, and the medication by visit interaction was significant in the expected direction. Impulsivity and personality style emerged as moderators of the relationship between medication condition and treatment outcome.

CONCLUSIONS

In addition to replicating efficacy results for varenicline versus placebo, the present study shows that the efficacy of pharmacotherapy is influenced by psychological factors. In an era where pharmacotherapy is often perceived as the "silver bullet," we are reminded that smoking cessation is a dynamic process and intervention must be adaptable to address individual differences.

Association of serum BDNF levels with psychotic symptom in chronic patients with treatment-resistant depression in a Chinese Han population

The neurotrophic hypothesis of depression is supported by consistent findings of lower serum BDNF levels in depressed patients. Increasing evidence shows different clinical characteristics of patients with psychotic major depression versus nonpsychotic major depression. However, the possible association between BDNF and psychotic symptoms in depression has not been investigated. We recruited 90 treatment-resistant depression (TRD) patients and 90 gender- and age-matched healthy control subjects and examined serum BDNF in both groups. Patients' depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HDRS-17), and psychopathological symptoms by the 18-item Brief Psychiatric Rating Scale (BPRS-18). Our results showed that BDNF levels were significantly lower in patients than controls. Correlation analysis revealed a significantly positive correlation between BDNF and the thought disturbance subscale of BPRS-18 (p < 0.05), and a trend toward a significantly positive correlation between BDNF and the BPRS-18 total score (p = 0.06). Stepwise multiple regression analyses confirmed BDNF as the influencing factor for the thought disturbance subscales of the BPRS-18. Our findings suggest that BDNF may be involved in the pathophysiology of TRD, and its associated psychotic symptoms, especially thought disturbance.

Blood cadmium and depressive symptoms: Confounded by cigarette smoking

Our aim was to explore the association between blood cadmium (BCd) and depressive symptoms, adjusting for pack years and blood cotinine, and also stratifying by smoking status. Using data from the US National Health and Nutrition Examination Survey (NHANES) 2005-2012, we categorized depressive symptoms using the PHQ-9 (Patient Health Questionnaire-9) survey and modeled depressive symptoms in relation to BCd adjusted for blood cotinine, pack years of smoking, and other covariates. We also stratified by self-reported smoking status (current, former, never). There were 11,209 subjects from 2005 to 2012, age ≥ 18 with PHQ-9, smoking, and blood cadmium data available. 876 (7.8%) met criteria for depressive symptoms. Depressive symptoms were associated with BCd levels in a crude model and with adjustment for pack years and cotinine. The association disappeared when analyzed among current, former, or never smokers. Consistent with the literature, we found an association between BCd and depressive symptoms; however, that association disappears in analyses stratified by smoking status. This suggests residual confounding may be present. It is important to stratify by smoking status when investigating health outcomes associated with BCd.

Major depression and non-specific distress following smoking cessation in the Canadian general population

BACKGROUND

Outcome data from smoking cessation trials indicate that improvement in mental health occurs after smoking cessation. This suggests that smoking cessation should be a priority for mental health services. However, participants in such trials may not be representative of the general population. This study investigates changes in mental health following smoking cessation in a set of general population samples.

METHODS

Data from a library of cross-sectional surveys conducted by Statistics Canada between 2001 and 2013 were included in this analysis. Survey estimates were pooled in order to increase precision. Associations between smoking (and smoking cessation), major depressive episodes (MDE) and non-specific distress (assessed using the K-6 scale) were evaluated using meta-analysis and meta-regression techniques.

RESULTS

The annual prevalence of major depression was higher in daily (11.0%) than in never smokers (4.4%). The prevalence in former daily smokers was 5.1%. The prevalence of MDE and distress was elevated in those recently quitting but returned to baseline levels within one year.

CONCLUSIONS

After smoking cessation, indicators of mental health improve over time, especially in the first year. The findings support the idea that smoking cessation should be a part of the management of common mood and anxiety disorders. However, due to its observational nature this study in itself cannot confirm causality, sustained abstinence may be an effect of improved mental health rather than its cause.

LIMITATIONS

The cross-sectional nature of the constituent surveys does not allow causal inference. No biological measures (e.g. cotinine) were available.

Fatigue in psoriasis: a controlled study

BACKGROUND

Fatigue is associated with various chronic inflammatory diseases, but few studies have focused on its occurrence in psoriasis.

OBJECTIVES

To describe fatigue prevalence and degree among patients with chronic plaque psoriasis vs. age- and sex-matched healthy subjects, and to examine how fatigue is influenced by essential clinical and demographic factors.

METHODS

In 84 patients and 84 healthy subjects, fatigue severity was assessed using three different generic fatigue instruments: the fatigue Visual Analogue Scale (fVAS), the Fatigue Severity Scale (FSS) and the Short Form 36 (SF-36) Vitality scale. Cut-off scores for clinically important fatigue were defined as ≥ 4 for FSS, ≥ 50 for fVAS and ≤ 35 for the SF-36 Vitality scale. Disease activity was evaluated using the Psoriasis Area and Severity Index (PASI), and the impact on quality of life with the Dermatology Life Quality Index (DLQI).

RESULTS

Patients and healthy control subjects, respectively, showed median fVAS scores of 51 [interquartile range (IQR) 21-67] and 11 (IQR 3-20); FSS scores of 4 (IQR 2·5-5·3) and 1·6 (IQR 1·1-2·2); and SF-36 Vitality scores of 43 (IQR 25-85) and 73 (IQR 65-85). The rates of clinically important fatigue among patients vs. healthy controls, respectively, were 51% vs. 4% (fVAS); 52% vs. 4% (FSS); and 42% vs. 2% (SF-36 Vitality) (P < 0·001 for all differences). Fatigue was associated with DLQI scores, but not PASI scores, in univariate analysis but not in multivariate analysis.

CONCLUSIONS

Nearly 50% of patients with psoriasis suffered from substantial fatigue. Fatigue severity was associated with smoking, pain and depression, but not with psoriasis severity.

Serious Psychological Distress and Smoking During Pregnancy in the United States: 2008-2014

INTRODUCTION

The current study examined the relationship between acute (past 30 day) and recent (past year but not past 30 day) serious psychological distress (SPD) and smoking during pregnancy among women in the United States overall, stratified by demographic characteristics, and described the change in the prevalence of prenatal smoking among women with and without SPD, from 2008 to 2014.

METHODS

Data were drawn from the National Survey on Drug Use and Health (NSDUH), an annual cross-sectional study of US persons aged 12 and over. SPD and smoking in the past 30 days among pregnant women, aged 18 and older, were examined using logistic regression models. Heterogeneity in this association by demographic characteristics, trends over time, and level of cigarette consumption was also examined.

RESULTS

Prenatal smoking was common. Almost 40% of pregnant women with acute SPD reported smoking, 23% of pregnant women with recent SPD smoked, and 11.7% of pregnant women without recent SPD smoked. No significant change was found in the prevalence of prenatal smoking from 2008 to 2014 in any of these groups. Robust relationships were found between acute (OR = 5.05 [3.64-6.99]) and recent SPD (OR = 2.37 [1.74-3.24]) and smoking; these findings remained after adjusting for demographics.

CONCLUSIONS

SPD and smoking during pregnancy are strongly associated; this relationship is present across all sociodemographic groups and the prevalence of smoking in pregnancy has remained relatively unchanged over the past decade both in the presence and absence of SPD.

IMPLICATIONS

SPD and smoking in pregnancy are robustly linked; the prevalence of smoking in pregnancy is extremely high in women with SPD. Screening women with mental health problems for prenatal smoking, as well as screening pregnant smokers for mental health problems, seems warranted and may assist more women in seeking and utilizing treatment options. Efforts to reduce the prevalence of smoking during pregnancy might specifically target women with SPD, where the potential for impact is substantial.