Association between depression and smoking: a global perspective from 48 low- and middle-income countries
Open accessAbstract
Background Smoking is a leading modifiable cause of global morbidity and mortality. Research from high-income countries has found a high prevalence of smoking among people with depression and suggested that this may partially contribute to the increased premature mortality in this population. Limited research has investigated smoking behaviors across the depression spectrum and in low- and middle-income countries (LMICs). This study explored the relationship between depression and smoking across 48 LMICs. Methods We conducted a cross-sectional, community-based study comprising 242,952 people [mean age 38.4 (SD = 16.1) years, 50.8% females] from the World Health Survey. Multivariable binary logistic regression analyses were performed to investigate the relationship between depression (including subsyndromal, brief depressive episode and depressive episodes) and smoking behaviours. Results Overall, the prevalence of current smoking was lowest in Africa (13.5%) and highest in Asia (32.2%). A depressive episode was present in 6.7% of the sample. Compared to people without depression, subsyndromal depression, brief depressive episode, and depressive episodes were all significantly associated with smoking with similar effect sizes (ORs: 1.36-1.49). Countrywide meta-analysis found that the pooled overall OR for smoking in depression was 1.42 (95%CI = 1.32-1.52, I 2 = 39.7%). Furthermore, alcohol consumption and male gender were consistently associated with smoking across all regions and smoking was consistently less common in those who were wealthier and had a higher education. Conclusion These data suggest that the depression spectrum is consistently associated with high levels of smoking behaivours in LMICs. Given that most of the world's smokers reside in LMICs, future smoking cessation interventions are required to target people with depression.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Statins reduce the risk of coronary heart disease events by 20-30%.
“Statins reduce the risk of coronary heart disease events by 20-30%.[193][194][195]”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [194]
Cites
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Kessler, R. C., & Üstün, T. B. (2004) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.168 · Cited by 4,771 · see citing works
Depression, chronic diseases, and decrements in health: results from the World Health Surveys
Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61415-9 · Cited by 4,070 · see citing works
Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., & Meader, N. (2011) · The Lancet Oncology · doi:10.1016/s1470-2045(11)70002-x · Cited by 2,449 · see citing works
Risks of all-cause and suicide mortality in mental disorders: a meta-review
Chesney, E., Goodwin, G. M., & Fazel, S. (2014) · World Psychiatry · doi:10.1002/wps.20128 · Cited by 2,115 · see citing works
Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., Thapa‐Chhetri, N., Fornaro, M., Gallicchio, D., Collantoni, E., et al. (2017) · World Psychiatry · doi:10.1002/wps.20420 · Cited by 1,729 · see citing works
Self-citationSmoking prevalence and cigarette consumption in 187 countries, 1980-2012
Ng, M., Freeman, M. K., Fleming, T. D., Robinson, M., Dwyer-Lindgren, L., Thomson, B., Wollum, A., Sanman, E., Wulf, S., Lopez, A. D., et al. (2014) · JAMA · doi:10.1001/jama.2013.284692 · Cited by 1,576 · see citing works
The association of cigarette smoking with depression and anxiety: a systematic review
Fluharty, M., Taylor, A. E., Grabski, M., & Munafò, M. R. (2017) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntw140 · Cited by 1,299 · see citing works
Gelaye, B., Rondon, M. B., Araya, R., & Williams, M. A. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30284-x · Cited by 1,155 · see citing works
Change in mental health after smoking cessation: systematic review and meta-analysis
Taylor, G., McNeill, A., Girling, A., Farley, A., Lindson-Hawley, N., & Aveyard, P. (2014) · BMJ · doi:10.1136/bmj.g1151 · Cited by 1,039 · see citing works
INTERNATIONAL GUIDE FOR MONITORING ALCOHOL CONSUMPTION AND RELATED HARM
Desapriya, E., Stockwell, T. R., Doll, R., & Room, R. (2000) · doi:10.13140/rg.2.2.29007.48808 · Cited by 740 · see citing works
Cook, B. L., Wayne, G. F., Kafali, E. N., Liu, Z., Shu, C., & Flores, M. (2014) · JAMA · doi:10.1001/jama.2013.284985 · Cited by 519 · see citing works
Hosseinpoor, A. R., Parker, L. A., d’Espaignet, E. T., & Chatterji, S. (2012) · PLoS ONE · doi:10.1371/journal.pone.0042843 · Cited by 445 · see citing works
From depressive symptoms to depressive disorders: the relevance of thresholds
Ayuso‐Mateos, J. L., Nuevo, R., Verdes, E., Naidoo, N., & Chatterji, S. (2010) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.109.071191 · Cited by 348 · see citing works
Comorbidity between major depression and alcohol use disorder from adolescence to adulthood
Brière, F. N., Rohde, P., Seeley, J. R., Klein, D., & Lewinsohn, P. M. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.10.007 · Cited by 328 · see citing works
Cigarette smoking and depression comorbidity: systematic review and proposed theoretical model
Mathew, A. R., Hogarth, L., Leventhal, A. M., Cook, J. W., & Hitsman, B. L. (2016) · Addiction · doi:10.1111/add.13604 · Cited by 277 · see citing works
Depression and cigarette smoking behavior: a critical review of population-based studies
Weinberger, A. H., Kashan, R. S., Shpigel, D. M., Esan, H., Taha, F., Lee, C. J., Funk, A. P., & Goodwin, R. D. (2017) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2016.1171327 · Cited by 263 · see citing works
Luger, T. M., Suls, J., & Vander Weg, M. W. (2014) · Addictive Behaviors · doi:10.1016/j.addbeh.2014.05.011 · Cited by 231 · see citing works
Tobacco use in sub-Sahara Africa: Estimates from the demographic health surveys
Pampel, F. C. (2008) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.12.003 · Cited by 218 · see citing works
Ramasubbu, R., Taylor, V. H., Samaan, Z., Sockalingham, S., Li, M., Patten, S., Rodin, G., Schaffer, A., Beaulieu, S., & McIntyre, R. S. (2012) · Annals of Clinical Psychiatry · doi:10.1177/104012371202400110 · Cited by 206 · see citing works
Taylor, A. E., Fluharty, M. E., Bjørngaard, J. H., Gabrielsen, M. E., Skorpen, F., Marioni, R. E., Campbell, A., Engmann, J., Mirza, S. S., Loukola, A., et al. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-006141 · Cited by 187 · see citing works
Overview of systematic reviews on the health-related effects of government tobacco control policies
Hoffman, S. J., & Tan, C. (2015) · BMC Public Health · doi:10.1186/s12889-015-2041-6 · Cited by 168 · see citing works
Stubbs, B., Vancampfort, D., Veronese, N., Kahl, K. G., Mitchell, A. J., Lin, P.-Y., Tseng, P.-T., Mugisha, J., Solmi, M., Carvalho, A. F., et al. (2017) · Psychological Medicine · doi:10.1017/s0033291717000551 · Cited by 167 · see citing works
Self-citationStubbs, B., Veronese, N., Vancampfort, D., Prina, M. A., Lin, P., Tseng, P., Εvangelou, Ε., Solmi, M., Köhler, C. A., Carvalho, A. F., et al. (2017) · Scientific Reports · doi:10.1038/s41598-017-07579-w · Cited by 154 · see citing works
Self-citationStubbs, B., Koyanagi, A., Veronese, N., Vancampfort, D., Solmi, M., Gaughran, F., Carvalho, A. F., Lally, J., Mitchell, A. J., Mugisha, J., et al. (2016) · BMC Medicine · doi:10.1186/s12916-016-0734-z · Cited by 151 · see citing works
Self-citationHosseinpoor, A. R., Parker, L. A., d’Espaignet, E. T., & Chatterji, S. (2011) · PLoS ONE · doi:10.1371/journal.pone.0020331 · Cited by 137 · see citing works
Cigarette Smoking and the Risk for Alcohol Use Disorders Among Adolescent Drinkers
Grucza, R. A., & Bierut, L. J. (2006) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2006.00255.x · Cited by 130 · see citing works
Peters, S. A. E., Huxley, R., & Woodward, M. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005663 · Cited by 123 · see citing works
Roberts, E., Eden Evins, A., McNeill, A., & Robson, D. (2016) · Addiction · doi:10.1111/add.13236 · Cited by 119 · see citing works
Smoking cessation is associated with lower rates of mood/anxiety and alcohol use disorders
Cavazos‐Rehg, P. A., Breslau, N., Hatsukami, D. K., Krauss, M. J., Spitznagel, E. L., Grucza, R. A., Salyer, P., Hartz, S. M., & Bierut, L. J. (2014) · Psychological Medicine · doi:10.1017/s0033291713003206 · Cited by 102 · see citing works
Does cigarette smoking relieve stress? Evidence from the event-related potential (ERP)
Choi, D., Ota, S., & Watanuki, S. (2015) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2015.10.005 · Cited by 96 · see citing works
A twin study of smoking, nicotine dependence, and major depression in men
Lyons, M. J., Hitsman, B. L., Xian, H., Panizzon, M. S., Jerskey, B. A., Santangelo, S. L., Grant, M., Rende, R., Eisen, S. A., Eaves, L. J., et al. (2008) · Nicotine & Tobacco Research · doi:10.1080/14622200701705332 · Cited by 94 · see citing works
Tobacco control progress in low and middle income countries in comparison to high income countries
Anderson, C., Becher, H., & Winkler, V. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13101039 · Cited by 85 · see citing works
Chow, C. K., Corsi, D. J., Gilmore, A., Kruger, A., Igumbor, E. U., Chifamba, J., Wang, Y., Li, W., Iqbal, R., Mony, P. K., et al. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-013817 · Cited by 79 · see citing works
Cross-National Sources of Health Inequality: Education and Tobacco Use in the World Health Survey
Pampel, F. C., & Denney, J. T. (2011) · Demography · doi:10.1007/s13524-011-0027-2 · Cited by 74 · see citing works
Is excess mortality higher in depressed men than in depressed women? A meta-analytic comparison
Cuijpers, P., Vogelzangs, N., Twisk, J., Kleiboer, A., Li, J., & Penninx, B. W. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.03.003 · Cited by 71 · see citing works
Smoking, standard of living, and poverty in China
Hu, T.-W., Mao, Z., Liu, Y., de Beyer, J., & Ong, M. K. (2005) · Tobacco Control · doi:10.1136/tc.2004.010777 · Cited by 67 · see citing works
Peretti‐Watel, P., Seror, V., Constance, J., & Beck, F. (2008) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2008.10.001 · Cited by 60 · see citing works
Patterns of Tobacco Use in the Early Epidemic Stages: Malawi and Zambia, 2000–2002
Pampel, F. C. (2005) · American Journal of Public Health · doi:10.2105/ajph.2004.056895 · Cited by 56 · see citing works
Genetics of smoking and depression
Tsuang, M. T., Francis, T., Minor, K. S., Thomas, A., & Stone, W. S. (2012) · Human Genetics · doi:10.1007/s00439-012-1170-6 · Cited by 51 · see citing works
Koyanagi, A., Oh, H. Y., Stubbs, B., Haro, J. M., & DeVylder, J. (2016) · Psychological Medicine · doi:10.1017/s0033291716002750 · Cited by 34 · see citing works
Self-citationByeon, H. (2015) · PeerJ · doi:10.7717/peerj.1288 · Cited by 31 · see citing works
Salte, K., Titlestad, I. L., & Halling, A. (2015) · PubMed · Cited by 20 · see citing works
Ho, S. Y., Alnashri, N., Rohde, D., Murphy, P., & Doyle, F. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2015.05.002 · Cited by 13 · see citing works
How to reduce adolescent smoking in low-income and middle-income countries
Thomas, D., & Hefler, M. (2016) · The Lancet Global Health · doi:10.1016/s2214-109x(16)30220-0 · Cited by 11 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
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
Self-citationOECD (2021) · OECD Health Policy Studies · doi:10.1787/4ed890f6-en · Cited by 407 · see citing works
Smith, L., Jacob, L., Yakkundi, A., McDermott, D., Armstrong, N. C., Barnett, Y., López-Sánchez, G. F., Martin, S., Butler, L., & Tully, M. A. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113138 · Cited by 385 · see citing works
Self-citationBurden of depression in China, 1990–2017: Findings from the global burden of disease study 2017
Ren, X., Yu, S., Dong, W., Yin, P., Xu, X., & Zhou, M. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.03.011 · Cited by 234 · see citing works
Fornaro, M., Carvalho, A. F., De Prisco, M., Mondin, A. M., Billeci, M., Selby, P., Iasevoli, F., Berk, M., Castle, D. J., & de Bartolomeis, A. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.11.039 · Cited by 82 · see citing works
Self-citation
- Authors
- Stubbs, B., Vancampfort, D., Firth, J., Solmi, M., Siddiqi, N., Smith, L., Carvalho, A. F., & Koyanagi, A.
- Affiliations
- King's College London (GB)
- KU Leuven (BE)
- Western Sydney University (AU)
- University of Padua (IT)
- Bradford District Care NHS Foundation Trust (GB)
- Anglia Ruskin University (GB)
- Centre for Addiction and Mental Health (CA)
- Instituto de Salud Carlos III (ES)
- Corresponding author
- Stubbs, Brendon
- ORCID
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 103
- Pages
- 142-149
- ISSN
- 0022-3956 (ISSN-L)
- OpenAlex
- W2803882773
- Cited by
- 82
- References
- 45
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 5 · 2023: 11 · 2022: 12 · 2021: 20 · 2020: 11 · 2019: 7
- FWCI
- 6.52
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Anglia Ruskin Research Online (Anglia Ruskin University) (submittedVersion)
- Figshare (submittedVersion, cc-by-nc-nd)
- Research Portal (King's College London) (submittedVersion)
- Lirias (KU Leuven) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion, cc-by-nc-nd)
- Funders
- Health Education England and the National Institute for Health Research HEE/NIHR ICA Programme Clinical Lectureship (ICA-CL-2017-03-001)
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust
- 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
- depression, smoking, low- and middle-income countries, subthreshold depression, depressive episodes, smoking prevalence, alcohol consumption, socioeconomic factors, smoking cessation, World Health Survey
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Depression, Developing Countries, Female, Health Surveys, Humans, Male, Middle Aged, Morbidity, Sex Factors, Smoking, Global Health, Prevalence, Logistic Models, Young Adult
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 ›
Are you an author, or do you see a problem with this page? Request a review
