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Cigarette Smoking and Incidence of First Depressive Episode: An 11-Year, Population-based Follow-up Study

Klungsøyr, Ole, Nygård, Jan F., Sørensen, Tom, Sandanger, Inger·2006·American Journal of Epidemiology

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Abstract

Smoking has been found to be associated with depression. Biologic hypotheses support causation in both directions. This study examined the association between cigarette smoking and a subsequent first depression. In 1990, 2,014 adults in Norway were interviewed about their lifestyle and mental health. A 2001 reinterview by trained interviewers defined the study cohort of 1,190 participants. The cases were those who experienced a first depression whose onset was estimated to occur during the follow-up period, based on retrospective assessment by the Composite International Diagnostic Interview (International Classification of Diseases, Tenth Revision). Cox regression was used to estimate the hazard rate of depression during follow-up. Alternative explanations for a direct causal influence from smoking on subsequent depression were assessed, and a sensitivity analysis was performed. The risk of depression was four times as high for heavy smokers compared with never smokers. A dose-response relation with an increasing hazard for past smokers and for an increasing number of cigarettes smoked per day for current smokers was found. Similarly, increasing smoking time was associated with increasing risk. Failure of other plausible alternatives to explain the observed association between smoking and depression might reflect a direct causal influence of smoking on depression.

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“With respect to internalizing problems, Pederson and von Soest (21), Klungsøyr, Nygård, Sørensen, and Sandanger (22), and Cuijpers, Smit, ten Have, and de Graaf (23) found empirical support for a longitudinal association of smoking and nicotine dependence with later internalizing mood and anxiety disorders.”
Background
A Longitudinal Study on the Causal Association Between Smoking and Depression
Kang, E., & Lee, J. (2010) · Journal of Preventive Medicine and Public Health · doi:10.3961/jpmph.2010.43.3.193 · Cited by 53
“The research result that smoking was the cause of depression has been found in teenagers [27,28], the aged [29], the population group [15,30], and the workers [31].”
Background
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 54
Sense of coherence and psychiatric morbidity: a 19-year register-based prospective study
Kouvonen, A. M., Väänänen, A., Vahtera, J., Heponiemi, T., Koskinen, A., Cox, S. J., & Mika Kivimaki, B. (2009) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2008.083352 · Cited by 51
“Health-risk behaviours have been found to be associated with psychiatric disorders”
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Cerebrovascular risk factors and incident depression in community‐dwelling elderly
Luijendijk, H. J., Stricker, B. H. C., Hofman, A., Witteman, J. C. M., & Tiemeier, H. W. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01189.x · Cited by 49
Cancer in people with depression or anxiety: record-linkage study
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“Numerous studies have found associations between cigarette smoking and depression, and the association has been reported in all age groups examined [1, 4, 5, 7, 9, 13, 14, 19, 21, 22, 25, 26, 28, 33].”
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A Longitudinal Study of the Relationship Between Lifestyle and Mental Health Among Midlife and Older Women in Australia: Findings From the Healthy Aging of Women Study
Xu, Q., Anderson, D. J., & Courtney, M. D. (2010) · Health Care For Women International · doi:10.1080/07399332.2010.486096 · Cited by 53
“Consistent with other longitudinal studies ( Kinnunen et al, 2006 ; Klungsoyr, Nygard, Sorensen, & Sandanger, 2006 ), we found current smokers were more likely to experience worse mental health relevant to never and past smokers.”
Result
Psychological distress is associated with tobacco smoking and quitting behaviour in the Australian population: evidence from National Cross-Sectional Surveys
Leung, J., Gartner, C., Dobson, A., Lucke, J., & Hall, W. (2011) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048674.2010.534070 · Cited by 46
Depression, Selective Serotonin Reuptake Inhibitors, and Osteoporosis
Bab, I., & Yirmiya, R. (2010) · Current Osteoporosis Reports · doi:10.1007/s11914-010-0026-z · Cited by 46
“It increases the risk for the onset of MDD [ 24 , 25] and has repeatedly been shown to negatively influence bone mass in cross-sectional studies of both men and women [26, 27].”
Background
Association of smoking status, cumulative smoking, duration of smoking cessation, age of starting smoking, and depression in Korean adults
Yun, W.-J., Shin, M., Kweon, S., Ryu, S. Y., & Rhee, J.-A. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-724 · Cited by 45
“; licensee BioMed Central Ltd Commons Attribution License (http://creativec reproduction in any medium, provided the or risk of depression [13-18].”
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Marijuana Use and Depressive Symptoms; Gender Differences in African American Adolescents
Assari, S., Mistry, R., Caldwell, C. H., & Zimmerman, M. A. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.02135 · Cited by 48
Co-morbid tobacco use disorder and depression: A re-evaluation of smoking cessation therapy in depressed smokers
Morozova, M., Rabin, R. A., & George, T. P. (2015) · American Journal on Addictions · doi:10.1111/ajad.12277 · Cited by 49
Secondhand smoke exposure and mental health in adults: a meta-analysis of cross-sectional studies
Zeng, Y., & Li, Y. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1164-5 · Cited by 43
“Numerous studies have reported the relationship between smoking and mental health including depressive disorder, anxiety disorder, social phobia, schizophrenia and psychotic spectrum disorders [7–10].”
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Socioeconomic related inequality in depression among young and middle-adult women in Indonesia׳s major cities
Christiani, Y., Byles, J., Tavener, M., & Dugdale, P. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.04.042 · Cited by 47
Use of antidepressants and risk of lung cancer
Toh, S., Rodríguez, L. A. G., & Hernández–Dı́az, S. (2007) · Cancer Causes & Control · doi:10.1007/s10552-007-9045-1 · Cited by 42
“Smoking is positively associated with depression [35, 36 ] and, consequently, certain unmeasured aspects of smoking might be associated with antidepressant use.”
Background
Association of mental distress with smoking status in the community: Results from the Gutenberg Health Study
Michal, M., Wiltink, J., Reiner, I., Kirschner, Y., Wild, P. S., Schulz, A., Zwiener, I., Blettner, M., & Beutel, M. E. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.09.019 · Cited by 44
Individual and family correlates for cigarette smoking among Taiwanese college students
Gau, S. S., Lai, M., Chiu, Y., Liu, C.-T., Lee, M., & Hwu, H. (2008) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2008.08.009 · Cited by 42
Depression and bone mass
Bab, I., & Yirmiya, R. (2010) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2009.05218.x · Cited by 43
Chronic medical conditions and metabolic syndrome as risk factors for incidence of major depressive disorder: A longitudinal study based on 4.7 million adults in South Korea
Han, K., Kim, M. S., Kim, A., Paik, J., Lee, J., & Ham, B. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.07.003 · Cited by 43
DEPRESSION AND SMOKING: A 5-YEAR PROSPECTIVE STUDY OF PATIENTS WITH MAJOR DEPRESSIVE DISORDER
Holma, I. A. K., Holma, K. M., Melartin, T. K., Ketokivi, M. A., & Isometsä, E. T. (2013) · Depression and Anxiety · doi:10.1002/da.22108 · Cited by 44
Contribution of Hypothalamic–Pituitary–Adrenal Activity and Environmental Stress to Vulnerability for Smoking in Adolescents
Rao, U., Hammen, C. L., London, E. D., & Poland, R. E. (2009) · Neuropsychopharmacology · doi:10.1038/npp.2009.112 · Cited by 41
“Prospective studies in adolescents and adults have shown that depression increases the risk for smoking, and vice versa (Breslau et al., 1998; Brown et al., 1996; Choi et al., 1997; Fergusson et al., 2003; Klungsøyr et al., 2006; Munafò et al., 2008; Patton et al., 1998; Steuber and Danner, 2006; Windle and Windle, 20…”
Background
The Meaning of Bereavement Following Spousal Loss: A Qualitative Study of the Experiences of Older Adults
Holm, A. L., Severinsson, E., & Berland, A. K. (2019) · SAGE Open · doi:10.1177/2158244019894273 · Cited by 36
“Stress can increase health problems due to negative behaviors such as smoking (Klungsøyr et al., 2006), alcohol use (Davis et al., 2008), poor sleep and physical inactivity (Berger et al., 2009).”
Background
Smoking as a Risk Factor for Mental Health Disturbances After a Disaster
van der Velden, P. G., Grievink, L., Olff, M., Gersons, B. P. R., & Kleber, R. J. (2007) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v68n0112 · Cited by 36
Depressive symptoms and self-reported adherence to medical recommendations to prevent cardiovascular disease: NHANES 2005–2010
Berntson, J., Stewart, K. R., Vrany, E. A., Khambaty, T., & Stewart, J. C. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.05.041 · Cited by 38
The mediating role of depressive symptoms in the relationship between adverse childhood experiences and smoking
Walsh, E. G., & Cawthon, S. W. (2014) · Addictive Behaviors · doi:10.1016/j.addbeh.2014.05.020 · Cited by 36
Quitting smoking does not increase the risk of major depressive episodes among users of Internet smoking cessation interventions
Torres, L. D., Barrera, A. Z., Delucchi, K., Penilla, C., Pérez‐Stable, E. J., & Muñoz, R. F. (2009) · Psychological Medicine · doi:10.1017/s0033291709990560 · Cited by 35
“while yet others have found that smoking itself predicts later depression (Brown et al. 1996 ; Klungsøyr et al. 2006 ; Munafò et al. 2008).”
BackgroundResultInfluential
Changes in prevalence of depression and anxiety following smoking cessation: results from an international cohort study (ATTEMPT)
Shahab, L., Steptoe, A., & West, R. (2013) · Psychological Medicine · doi:10.1017/s0033291713000391 · Cited by 35
“…(Brown et al. 1996; Patton et al. 1998; Breslau et al. 1998, 2004) and that starting to smoke increases the risk of subsequent psychiatric morbidity (Johnson et al. 2000; Klungsoyr et al. 2006; Steuber & Danner, 2006; Boden et al. 2010; Kang & Lee, 2010), suggesting a reciprocal relationship.”
Background
What are candidate biobehavioral mechanisms underlying the association between secondhand smoke exposure and mental health?
Bandiera, F. C. (2011) · Medical Hypotheses · doi:10.1016/j.mehy.2011.08.036 · Cited by 33
“It is possible for depressed persons to smoke and ‘‘selfmedicate’’ [9], or it is possible that smoking precedes the onset of poor mental health [11].”
Background
Emotional and affective temperaments and cigarette smoking in a large sample
Bisol, L. W., Soldado, F. A., Albuquerque, C., Lorenzi, T. M., & Lara, D. R. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.04.016 · Cited by 30
“This is the first study evaluating smoking with the construct of affective temperaments, originally proposed by Kraepelin (1921) as fundamental states and expanded by Akiskal (1998) and recently by Lara et al.”
BackgroundResult
Household food insecurity is associated with depressive symptoms in the Canadian adult population
Shafiee, M., Vatanparast, H., Janzen, B. L., Serahati, S., Keshavarz, P., Jandaghi, P., & Pahwa, P. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.10.057 · Cited by 36
Gender Differences in Smoking Behaviour and Cessation
Torchalla, I., Okoli, C. T. C., Hemsing, N., & Greaves, L. (2011) · The Journal of Smoking Cessation · doi:10.1375/jsc.6.1.9 · Cited by 36
Effects of Smoking Cessation on Pain in Older Adults
Shi, Y., Hooten, W. M., & Warner, D. O. (2011) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntr097 · Cited by 31
Genome-wide association study identifies glutamate ionotropic receptor GRIA4 as a risk gene for comorbid nicotine dependence and major depression
Zhou, H., Cheng, Z., Bass, N. J., Krystal, J. H., Farrer, L. A., Kranzler, H. R., & Gelernter, J. E. (2018) · Translational Psychiatry · doi:10.1038/s41398-018-0258-8 · Cited by 32
The 2016 Tips From Former Smokers® Campaign: Associations With Quit Intentions and Quit Attempts Among Smokers With and Without Mental Health Conditions
Prochaska, J. J., Gates, E., Davis, K., Gutierrez, K., Prutzman, Y. M., & Rodes, R. (2018) · Nicotine & Tobacco Research · doi:10.1093/ntr/nty241 · Cited by 29
Secondhand Smoke Policy and the Risk of Depression
Bandiera, F. C., Caban-Martinez, A. J., Arheart, K. L., Davila, E. P., Fleming, L. E., Dietz, N. A., Lewis, J. E., Fabry, D. A., & Lee, D. J. (2010) · Annals of Behavioral Medicine · doi:10.1007/s12160-010-9174-8 · Cited by 28
“smoking may precede the onset of their depression [ 13 ].”
Background
The causal impact of mental health on tobacco and alcohol consumption: an instrumental variables approach
Mitrou, F., Nguyen, H. T., Le, H., & Zubrick, S. R. (2023) · Empirical Economics · doi:10.1007/s00181-023-02483-x · Cited by 28
“…associations in both directions: some studies found substance use disorders were associated with subsequent anxiety disorders (Johnson et al. 2000; Klungsøyr et al. 2006; Marsden et al. 2019) while other studies reported mental distress was associated with later substance use (Zubrick et al.…”
Neurobiology of Addiction
Koob, G. F., Kandel, D. B., Baler, R., & Volkow, N. D. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_29-1 · Cited by 31
Cigarette Smoking and Dimensions of Depressive Symptoms: Longitudinal Analysis Among Finnish Male and Female Twins
Korhonen, T., Koivumaa-Honkanen, H. T., Varjonen, J., Broms, U., Koskenvuo, M., & Kaprio, J. A. (2011) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntq251 · Cited by 27

Authors: Klungsøyr, O., Nygård, J. F., Sørensen, T., & Sandanger, I.
Affiliations: University of Oslo (NO)
Corresponding author: Klungsøyr, Ole
ORCID: Klungsøyr, Ole
Nygård, Jan F.
Sørensen, Tom
Venue: American Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 2006-01-04
Volume: 163
Issue: 5
Pages: 421-432
ISSN: 0002-9262 (ISSN-L)
1476-6256
DOI: 10.1093/aje/kwj058
OpenAlex: W2152013172
Cited by: 269
References: 54
Citations by year: 2026: 2 · 2025: 3 · 2024: 9 · 2023: 6 · 2022: 5 · 2021: 14 · 2020: 28 · 2019: 12 · 2018: 9 · 2017: 9 · 2016: 7 · 2015: 21 · 2014: 17 · 2013: 16 · 2012: 17
FWCI: 10.94
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Epidemiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords: cigarette smoking, depression, first-episode depression, dose-response relationship, smoking duration, heavy smoking, causal inference, mental health
MeSH terms: Adult, Aged, Aged, 80 and over, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Norway, Prospective Studies, Surveys and Questionnaires, Risk Factors, Smoking, Time Factors, Incidence, Confidence Intervals, Proportional Hazards Models

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Cigarette Smoking and Incidence of First Depressive Episode: An 11-Year, Population-based Follow-up Study

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