Analysis of patient health questionnaire-9 (PHQ-9) based depression prevalence according to a discordance between quantitative urinary cotinine levels and self-report of second-hand smoke exposure among adults: A cross-sectional study

BackgroundSecond-hand smoke (SHS) exposure appears to be more common among individuals with depression. However, self-report of SHS exposure is an inaccurate classification compared to confirming SHS exposure using urinary cotinine (UC). Additionally, the dose-response relationship between depression and UC is controversial.MethodsThe severe stress rate and depression prevalence was estimated among 14530 Korean participants aged ≥19 years using data patient health questionnaire-9 (PHQ-9) and on UC from the Korean National Health and Nutrition Examination Survey. Measured UCs were divided into four categories: UC– (≤0.3 μg/L), UC± (0.4 μg/L–0.9 μg/L), UC+ (1.0 μg/L–11.9 μg/L), and UC++ (≥12.0 μg/L).ResultsAbout 55.0% participants were female and participants' mean age was 51.1 years. Non-smokers were 80.3%. Among non-smokers, non-SHS exposure participants (SR–) and SHS exposure participants (SR+) were 83.0% and 17.0%, respectively. When UC– was used as the reference subgroup, the UC++ subgroup showed a higher depression prevalence, whereas the UC± subgroup showed a lower prevalence. In the same UC categories, the depression prevalence and severe stress rate were higher among females than among males. Furthermore, the SR+ subgroup had a higher severe stress rate than the SR– subgroup.ConclusionsOur study showed a paradoxical reduction in the depression prevalence and severe stress rate in the UC± subgroup compared to the UC– subgroup. Additionally, the dose-response relationship between the SHS exposure biomarker and the depression prevalence was not linear. Our study indicates that an emotional stress-based model may be more appropriate for explaining the relationship between depression and SHS exposure.