Past major depression and smoking cessation outcome: A systematic review and meta-analysis update
Open accessAbstract
Aims: To update our prior meta‐analysis that showed past major depression (MD+) to be unrelated to smoking cessation outcome. Methods: Eligible trials included 14 from our original review and 28 identified through an updated systematic review (2000–2009). We coded for assessment of past MD, exclusion for recent MD episode (MDE; ≤6 months versus no exclusion), duration/modality of cognitive behavioral treatment (CBT; face‐to‐face versus self‐help) and other factors. To minimize influence of experimental treatments that may selectively benefit MD+ smokers we analyzed placebo/lowest intensity control arms only. Study‐specific ORs for the effect of past MD on short‐term (≤3 months) and long‐term (≥6 months) abstinence were estimated and combined using random effects. Two‐way interaction models of past MD with study methodology and treatment factors were used to evaluate hypothesized moderators of the past MD‐abstinence association. Results: MD+ smokers had 17% lower odds of short‐term abstinence (n = 35, OR = 0.83, 95% CI = 0.72–0.95, P = 0.009) and 19% lower odds of long‐term abstinence (n = 38, OR = 0.81, 95% CI = 0.67–0.97, P = 0.023) than MD‐ smokers after excluding the sole study of varenicline because of its antidepressant properties. The association between past MD and abstinence was affected by methodological (recent MDE exclusion, type of MD assessment) and treatment (CBT modality) factors. Conclusions: Past major depression has a modest adverse effect on abstinence during and after smoking cessation treatment. An increased focus on the identification of effective treatments or treatment adaptations that eliminate this disparity in smoking cessation for MD+ smokers is needed.
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The odds of achieving abstinence after a quit attempt are 19% lower in people with mental illness compared with those without.
“the odds of achieving abstinence after a quit attempt are 19% lower in people with mental illness compared with those without [8].”
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 [8]
The Results (Sensitivity Analysis) report 19% lower odds of long-term abstinence (OR=0.81) for smokers with past major depression versus those without, after excluding a varenicline trial. The claim broadens past major depression to mental illness generally and omits both the long-term outcome and the trial exclusion. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPast major depression is associated with a modest decrease in short- and long-term abstinence rates.
“A recent review and meta-analysis found that past major depression was associated with a statistically significant, but modest, decrease in both short- and long-term abstinence rates [13].”
From Depression and smoking cessation: evidence from a smoking cessation clinic with 1-year follow-up (2017) · cites this paper as [13]
People with mental ill-health have a 19% reduction in the odds of achieving abstinence when attempting to stop.
“People with mental ill-health have a 19% reduction in the odds of achieving abstinence when attempting to stop (Hitsman et al., 2013), but are as motivated to stop as those without mental ill-health (Siru et al., 2009).”
From An application of the stress-diathesis model: A review about the association between smoking tobacco, smoking cessation, and mental health (2023) · cites this paper as Hitsman et al., 2013
People with depression/anxiety suffer from worse withdrawal.
“They are more heavily addicted, suffer from worse withdrawal [9, 10]”
People with depression/anxiety are more heavily addicted than people without depression/anxiety.
“They are more heavily addicted, suffer from worse withdrawal [9, 10]”
People with depression/anxiety experience a 19% reduction in the odds of quitting (OR 0.81, 95% CI 0.67 to 0.97).
“and experience a 19% reduction in the odds of quitting (odds ratio 0.81, 95% CI 0.67 to 0.97) [10]”
People with depression/anxiety are less responsive to standard tobacco treatments.
“People with depression/anxiety are twice as likely to smoke and are less responsive to standard tobacco treatments”
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- Authors
- Hitsman, B., Papandonatos, G. D., McChargue, D. E., DeMott, A., Herrera, M. J., Spring, B., Borrelli, B., & Niaura, R.
- Affiliations
- Northwestern University (US)
- Brown University (US)
- University of Nebraska–Lincoln (US)
- Truth Initiative (US)
- Corresponding author
- Hitsman, Brian
- ORCID
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2013-01-17
- Volume
- 108
- Issue
- 2
- Pages
- 294-306
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC3593055
- OpenAlex
- W2124905812
- Cited by
- 162
- References
- 75
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 4 · 2023: 11 · 2022: 10 · 2021: 7 · 2020: 21 · 2019: 13 · 2018: 19 · 2017: 15 · 2016: 15 · 2015: 18 · 2014: 10 · 2013: 6
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000150)
- Warren Alpert Medical School, Brown University
- National Institute on Drug Abuse (K08DA017145)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- major depressive disorder, smoking cessation, smoking abstinence, cognitive behavioral therapy, self-help treatment, varenicline, treatment moderators
- MeSH terms
- Smoking Prevention, Major Depressive Disorder, Humans, Smoking, Time Factors, Cognitive Behavioral Therapy, Smoking Cessation, Treatment Outcome
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