Elsevier

Journal of Affective Disorders

Volume 218, 15 August 2017, Pages 182-187
Journal of Affective Disorders

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

https://doi.org/10.1016/j.jad.2017.04.056Get rights and content

Highlights

  • Major depressive episode prevalence and non-specific distress improve after successful smoking cessation.

  • The improvement is gradual, over about one year.

  • People who smoke can be reassured that smoking, cessation will likely improve their mental health in the longer term.

Abstract

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.

Section snippets

Background

Smoking is a well-established risk factor for cardiovascular disease, lung disease and cancer, and for these reasons smoking cessation has been a target of primary prevention for decades (Office on Smoking and Health National Centre for Chronic Disease Prevention and Health Promotion, 2015). People with mental disorders often smoke (Lawrence et al., 2009), yet it is suspected that the problem is “largely ignored” in mental health treatment settings (Williams and Ziedonis, 2004). It is suspected

Methods

The study was based on a series of national surveys conducted by the Canadian national statistical agency, Statistics Canada under its Canadian Community Health Survey (CCHS) program (Statistics Canada, 2011). This program began in 2001 with a survey called the CCHS 1.1, followed by the CCHS 2.1 (conducted in 2003), CCHS 3.1 (conducted in 2005), CCHS 4.1 (conducted in 2007/08), the CCHS 2009/10 (based on data collected in those two years), the CCHS 2011/12, CCHS-MH (conducted in 2012) and the

Results

Table 1 shows the sample size of each of the surveys, and the number of observations for past-year MDE and K-6 ratings. There were n=391,362 respondents administered the CIDI and n=239,408 administered the K-6 scale. The frequency of daily smoking in 2001 was 22.4%, declining to 14.9% in 2013 (meta-regression-derived slope term: beta=−0.005, t=−6.61, d.f.=6, p=0.001). The frequency of never smoking increased from 34.9% to 41.2% (meta-regression-derived slope term: beta =0.005, t=9.49, d.f. =6,

Discussion

Among members of the general population, smoking was associated both with MDE and distress. Former smokers were only slightly more likely to have MDE or have high distress ratings than never smokers, whereas substantially increase prevalence of both of these outcomes was observed in current daily and current occasional smokers. This replicates previous reports of an association between smoking and negative mental health. Among prior studies, the most comparable one is the MIDUS study (Bakhshaie

Limitations

The most important limitation of this study is its cross-sectional nature and the resulting inability to fully clarify temporality of the underlying causal effects. This is particularly true for estimates of MDE prevalence in respondents who had quit smoking in the year preceding their interview. Here, the temporal sequencing between past year MDE, past month distress and past year smoking cessation could not be clarified. It is possible that respondents succeeded at long-term cessation because

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