How robust is the association between smoking and depression in adults? A meta-analysis using linear mixed-effects models
Abstract
Introduction Our objective was to use meta-analytic techniques to assess the strength of the overall relationship and role of potential moderators in the association between smoking and depression in adults.Methods Two popular health and social science databases (PubMed and PsycINFO) were systematically searched to identify studies which examined the association between adult smoking behavior and major depressive disorder (MDD) or depressive symptoms. A total of 85 relevant studies were selected for inclusion. Studies were analyzed using a linear mixed effects modeling package ("lme4" for R) and the Comprehensive Meta-Analysis program version 2.Results Multiple nested linear mixed-effects models were compared. The best fitting models were those that included only random study effects and smoking status. In cross-sectional studies, current smokers were more likely to be depressed than never smokers (OR=1.50, CI=1.39-1.60), and current smokers were more likely to be depressed than former smokers (OR=1.76, CI=1.48-2.09). The few available prospective studies, that used the requisite statistical adjustments, also showed smokers at baseline had greater odds of incident depression at follow-up than never smokers (OR=1.62, CI=1.10-2.40).Conclusions In cross-sectional studies, smoking was associated with a nearly two-fold increased risk of depression relative to both never smokers and former smokers. In the smaller set of prospective studies, the odds of subsequent depression were also higher for current than never smokers. Attesting to its robustness, the relationship between smoking and depression was exhibited across several moderators. Findings could help health care providers to more effectively anticipate co-occurring health issues of their patients. Several methodological recommendations for future research are offered.
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In adults, smoking significantly increases the prospective risk of depression (OR=1.62, 95% CI 1.1-2.4).
“Among 52,568 adults, from seven studies with 1-6 year follow-ups, smoking significantly increased the prospective risk of depression, measured as either diagnosed depressive disorders or clinically-relevant depressive symptoms on validated scales (OR=1.62, 95% CI: 1.1-2.4, I 2 =N/R) 42 .”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [42]
Fewer studies have considered the effects of clinical depression on marital functioning, but those consistently document significant adverse effects.
“Fewer studies have considered the effects of clinical depression on marital functioning, 244,245 but those consistently document significant adverse effects.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [245]
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Firth, J., Solmi, M., Wootton, R. E., Vancampfort, D., Schuch, F. B., Hoare, E., Gilbody, S., Torous, J., Teasdale, S. B., Jackson, S. E., et al. (2020) · World Psychiatry · doi:10.1002/wps.20773 · Cited by 1,148 · see citing works
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Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes
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Health-Related Quality of Life, Depression and Anxiety in Hospitalized Patients with Tuberculosis
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- Authors
- Luger, T. M., Suls, J., & Vander Weg, M. W.
- Affiliations
- Center for Health Optimization and Implementation Research (US)
- National Institutes of Health (US)
- Venue
- Addictive Behaviors
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 39
- Issue
- 10
- Pages
- 1418-1429
- ISSN
- 0306-4603 (ISSN-L)
- OpenAlex
- W2010525475
- Cited by
- 231
- References
- 114
- Citations by year
- 2026: 13 · 2025: 22 · 2024: 17 · 2023: 20 · 2022: 16 · 2021: 21 · 2020: 26 · 2019: 20 · 2018: 21 · 2017: 19 · 2016: 19 · 2015: 13 · 2014: 3
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- smoking, depression, major depressive disorder, depressive symptoms, current smokers, former smokers, never smokers, incident depression, risk factors, moderator analysis
- MeSH terms
- Adult, Depression, Major Depressive Disorder, Humans, Smoking, Linear Models, Odds Ratio
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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