Smoking Cessation Interventions for Patients with Depression: A Systematic Review and Meta-analysis
Open accessAbstract
Objectives We conducted a systematic literature review of smoking cessation interventions for patients with histories of depressive disorders or current significant depressive symptoms. We examined the comparative effectiveness of smoking cessation strategies on abstinence rates, differential effects of cessation strategies by depression status (i.e., history positive vs. current depression), and differential effects by gender.Data sources Peer-reviewed literature in MEDLINE, Embase, PsycINFO, and Cochrane Library.Study eligibility criteria, participants, and interventions Randomized controlled trials or secondary analysis of RCT data comparing two or more smoking cessation interventions or intervention to control, and reporting cessation outcomes in adults with depression.Study appraisal and synthesis methods Two trained researchers screened articles for inclusion. When possible, we estimated pooled risk ratios with 95% confidence intervals by using a random effects model with the Mantel-Haenszel method. We synthesized other studies qualitatively. We classified each intervention as antidepressants, nicotine replacement therapy (NRT), brief smoking cessation counseling, smoking cessation behavioral counseling, or behavioral mood management.Results We identified 16 unique RCTs, of which, only three trials recruited participants with current depression. Meta-analysis demonstrated a small, positive effect of adding behavioral mood management (RR = 1.41, 95% CI 1.01-1.96). All included antidepressant trials showed small, positive effects, but risk ratio summary was not significant (RR = 1.31, 95% CI 0.73-2.34). Three NRT trials demonstrated small, positive effects on smoking cessation rates. We found insufficient evidence to examine gender and depression status moderator effects.Limitations Few RCTs exist that test smoking cessation interventions among adults with depression. To make meaningful comparisons, we created broad intervention categories that contained heterogeneity.Conclusions and implications of key findings Few trials enrolled smokers with current depression. Most of data identified were from subgroup analyses of patients history-positive for depression. However, several promising interventions exist. Healthcare providers should consider encouraging their patients with significant depressive symptoms or depression histories to seek smoking cessation services that include NRT and behavioral mood management.
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The study required a sample size of 157 at baseline, assuming 36% of participants would be lost to follow-up.
“We assumed that 36% of participants would be lost to follow‐up [28], and therefore the study required a sample size of 157 at baseline.”
From intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, acceptability and feasibility trial with nested qualitative methods (2025) · cites this paper as [28]
The citation is attached to the assumed 36% loss to follow-up; the baseline sample-size calculation is the citing authors’ own. The Data Extraction and Quality Assessment section says the review recorded follow-up duration, but neither it nor the trial tables provide a 36% loss-to-follow-up estimate (searched: 36% loss to follow-up, attrition, 157 baseline). (LLM, conf=0.76)
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- Authors
- Gierisch, J. M., Bastian, L. A., Calhoun, P. S., McDuffie, J. R., & Williams, J. W.
- Affiliations
- Duke University (US)
- Corresponding author
- Gierisch, Jennifer M.
- Venue
- Journal of General Internal Medicine
- Published
- 2011-10-26
- Volume
- 27
- Issue
- 3
- Pages
- 351-360
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC3286553
- OpenAlex
- W2076527606
- Cited by
- 120
- References
- 67
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 6 · 2022: 9 · 2021: 12 · 2020: 2 · 2019: 9 · 2018: 9 · 2017: 6 · 2016: 11 · 2015: 16 · 2014: 8 · 2013: 12 · 2012: 7
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (ESP-09-010)
- Office of Research and Development
- Agency for Healthcare Research and Quality (T32HS000079)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- smoking cessation, depression, nicotine replacement therapy, antidepressants, smoking cessation counseling, abstinence rates, depressive symptoms, gender differences, comparative effectiveness
- MeSH terms
- Counseling, Depression, Health Promotion, Humans, Smoking, United States, Incidence, Smoking Cessation
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