Depression and cigarette smoking behavior: A critical review of population-based studies

BACKGROUND: Smoking and depression are both leading causes of disability, mortality and morbidity around the world. Using epidemiologic data to study the association between depression and the severity, course, and persistence of smoking in the general population is important for understanding the scope of the problem of smoking among people with depression. OBJECTIVES: The current paper aims to critically review existing epidemiologic research on the smoking behaviors of persons with depressive symptoms and disorders and to identify gaps in the literature that warrant further study. METHODS: Literature searches of Medline and EMBASE were used to identify articles that analyzed epidemiologic data and examined an aspect of smoking behavior in persons with depressive symptoms or disorders. Six hundred ninety-three abstracts were reviewed and 45 studies met all of the inclusion criteria to be included in the review. RESULTS: Persons with depression, compared to those without depression, are more likely to smoke, and meet criteria for nicotine dependence, are less likely to quit smoking, and are more likely to relapse. Little is known about the association between depression and smoking behavior by age, socioeconomic status, or race/ethnicity or with regard to the use of tobacco products other than cigarettes. CONCLUSION: Persons with depression are more likely to smoke cigarettes and have greater difficulty quitting smoking. Community-based and public health approaches may need to begin considering the links between depression and smoking in order to best target the current smokers in the population and develop more effective tobacco control campaigns.