Key result
Low depressive symptoms during CVD hospitalization linked to ~277% higher odds of one-year smoking abstinence.
Why the study?
Do moderate to severe depressive symptoms predict return to smoking in smokers hospitalized for acute cardiovascular disease?
RCT (n=245)
Double-blind
Randomized
Do moderate to severe depressive symptoms predict return to smoking in smokers hospitalized for acute cardiovascular disease?
Odds Ratio: 3.77 (95% CI 1.31–10.82)
Absolute Event Rate: 10% vs 27%
Moderate to severe depressive symptoms during hospitalization for acute CVD are independently associated with lower rates of long-term smoking cessation, mediated partly by stronger nicotine withdrawal symptoms.
Moderate/severe depressive symptoms during CVD hospitalization were associated with lower 1-year abstinence; hypothesis-generating for targeted interventions.
BACKGROUND: Although smoking cessation is essential for prevention of secondary cardiovascular disease (CVD), many smokers do not stop smoking after hospitalization. Mild depressive symptoms are common during hospitalization for CVD. We hypothesized that depressive symptoms measured during hospitalization for acute CVD would predict return to smoking after discharge from the hospital. METHODS: This was a planned secondary analysis of data from a placebo-controlled, double-blind, randomized trial of bupropion hydrochloride therapy in 245 smokers hospitalized for acute CVD. All subjects received smoking counseling in the hospital and for 12 weeks after discharge. Depressive symptoms were measured during hospitalization with the Beck Depression Inventory (BDI), and smoking cessation was biochemically validated at 2-week, 12-week, and 1-year follow-up. The effect of depressive symptoms on smoking cessation was assessed using multiple logistic regression and survival analyses. RESULTS: Twenty-two percent of smokers had moderate to severe depressive symptoms (BDI >or= 16) during hospitalization. These smokers were more likely to resume smoking by 4 weeks after discharge (P= .007; incidence rate ratio, 2.40; 95% confidence interval, 1.48-3.78) than were smokers with lower BDI scores. Smokers with low BDI scores were more likely to remain abstinent than were those with high BDI scores at 3-month follow-up (37% vs 15%; adjusted odds ratio, 3.02; 95% confidence interval, 1.28-7.09) and 1-year follow-up (27% vs 10%; adjusted odds ratio, 3.77; 95% confidence interval, 1.31-10.82). We estimate that 27% of the effect of the BDI score on smoking cessation was mediated by nicotine withdrawal symptoms. CONCLUSIONS: Moderate to severe depressive symptoms during hospitalization for acute CVD are independently associated with rapid relapse to smoking after discharge and lower rates of smoking cessation at long-term follow-up. The relationship was mediated in part by the stronger nicotine withdrawal symptoms experienced by smokers with higher depressive symptoms.
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Anne N. Thorndike (2008) conducted an RCT in Smokers hospitalized for acute cardiovascular disease (n=245). Moderate to severe depressive symptoms (BDI ≥ 16) vs. Low depressive symptoms (low BDI scores) was evaluated on Smoking abstinence at 1-year follow-up (adjusted OR 3.77, 95% CI 1.31-10.82). Smokers with low depressive symptoms during CVD hospitalization were more likely to remain abstinent at 1 year than those with moderate/severe symptoms (27% vs 10%; OR 3.77, 95% CI 1.31-10.82).
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