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Gender differences in the comorbidity of smoking behavior and major depression

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Abstract

Objective

The present investigation sought to determine whether smoking behavior was associated with current or lifetime major depression and whether this association was greater in women.

Methods

Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 1, 2001–2002, n = 42,565). Relationships between smoking status (daily, occasional, prior) and DSM-IV major depression (current or lifetime) by gender were assessed in terms of odds ratios using logistic regressions.

Results

Current (daily, occasional) and prior smoking significantly increased odds of having current or prior major depression. These associations varied as a function of gender. Women with prior smoking were at significantly higher risk of current and past depression than men (OR: 1.53 vs 1.36; 1.72 vs 1.36), as was true for current occasional (OR: 1.92 vs 1.39; 1.90 vs 1.30) and daily smoking (OR: 2.52 vs 1.95; 1.84 vs 1.48).

Conclusions

The association between smoking and current or past depression is not necessarily limited to smoking that meets criteria for nicotine dependence, and is more potent in women. Smoking cessation interventions for this population should consider the role that depression may play in failure to quit and smoking relapse, particularly in women.

Introduction

Smoking is associated with substantial health risks and is the leading preventable cause of death in the United States (U.S. Department of Health and Human Services, 1994). Epidemiological data have demonstrated the existence of a strong relationship between psychiatric disorders and smoking (Glassman et al., 1990, Lasser et al., 2000, Grant et al., 2004). In particular, the association of major depression and smoking has been extensively documented (Breslau et al., 1993, Fergusson et al., 1996).

We know that smoking is less common in women than it is in men (Grant et al., 2004), while women have higher rates of major depression as compared to men (Kessler et al., 2005). Yet, we do not know whether smoking is differentially associated with lifetime major depression in women compared to men. There are several noteworthy gender differences in the association of negative affect and smoking behavior. While negative affect is associated with smoking in both women and men, it is more strongly related to smoking in women (McKee et al., 2003). Furthermore, women have greater expectations that smoking will reduce negative affect (Brandon and Baker, 1991), and report that they are more likely to smoke in response to negative affect or stress (Livson and Leino, 1988). Identifying possible gender differences in the relationship between depression and smoking could refine our understanding of the comorbidity of smoking and depression, and therefore contribute to more targeted smoking cessation interventions.

In order to identify potential gender differences in the patterns of comorbidity between smoking and depression, it is important to explore both current and prior major depression, and to use a wide range of smoking behaviors. Unlike a continuous measure of depressive symptomatology, the examination of clinical depression allows the identification of those who have experienced a previous depressive episode and those who have not, thereby making a distinction between prior depression and current depression. This distinction could inform the relationship between smoking and depression even after a depressive episode has remitted. With regard to the assessment of smoking, the Department of Health and Human Services’ Clinical Practice Guidelines have urged health professionals to screen for all tobacco use, as opposed to nicotine dependence only (Fiore et al., 2000, U.S. Preventive Services Task Force, 2003). Furthermore, current smokers are likely to present with significant tobacco-related health problems, and represent a much larger portion of the population than do smokers who meet criteria for DSM-IV nicotine dependence (Grant et al., 2004). Understanding gender differences in the co-occurrence of smoking and depression can be enhanced by examining a wide range of smoking behaviors rather than nicotine dependence alone. In an effort to identify gender differences in the patterns of comorbidity between major depression and smoking, the present investigation uses a wide range of smoking behaviors (not limited to nicotine dependence), and considers both current and lifetime major depression in a nationally representative sample.

Section snippets

Data source

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study (Wave 1, 2001–2002) was carried out by the National Institute on Alcohol Abuse and Alcoholism. Personal interviews were conducted with 43,093 civilian, noninstitutionalized adults, residing in the United States. The response rate was 81%. African–Americans, Hispanics, and young adults (ages 18–24) were oversampled. In our analyses, the data were weighted to account for oversampling and to adjust for nonresponse.

Results

The prevalence of smoking behaviors and major depression by gender is presented in Table 1. All Chi squares analyses that were performed to examine gender differences were significant at p < 0.0005. Gender was significantly associated both with major depression status and smoking status. Current or lifetime major depressions were each more prevalent in women. It was more likely that men never suffered from a mood disorder. Smoking was more prevalent in men than in women. This was true for prior

Discussion

The present investigation sought to determine whether there are gender-specific associations between daily, occasional and prior smoking with current and lifetime major depression in a nationally representative sample. Our findings confirm the well-established association between smoking and major depression found in nicotine dependent smokers (Grant et al., 2004) in current daily, occasional, and prior smokers. In addition, our results in the overall sample are consistent with prior findings

Acknowledgements

R03AA016267, P50AA015632, Women's Health Research at Yale.

References (20)

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