The impact of quitting smoking on depressive symptoms: findings from the International Tobacco Control Four‐Country Survey
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Aims: To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. Design: Prospective cohort with approximately annual waves. Mixed‐effect logistic regressions tested whether time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether time 1 (T1) symptoms moderated this relationship. Setting: Waves 5–8 of the Four‐Country International Tobacco Control Study: a quasi‐experimental cohort study of smokers from Canada, the United States, the United Kingdom and Australia. Participants: A total of 6978 smokers who participated in telephone surveys. Measurements: T1 and T2 depressive symptoms in the last 4 weeks were assessed with two screening items from the PRIME‐MD questionnaire. Quitting status at T2: (1) no attempt since T1; (2) attempted and relapsed; and (3) attempted and abstinent at T2. Findings: Compared with no attempt, relapse was associated with reporting T2 symptoms [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.33, 1.59]). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was associated positively with T2 symptoms for those without T1 symptoms (OR = 1.71, 95% CI = 1.45, 2.03) and those with T1 symptoms (OR = 1.45, 95% CI = 1.23, 1.70). Abstinence was associated positively for those without T1 symptoms (OR = 1.37, 95% CI = 1.10, 1.71) and negatively for those with T1 symptoms (OR = 0.74, 95% CI = 0.59, 0.94). Age moderated these associations significantly. Relapse did not predict T2 symptoms for those aged 18–39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18–39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40–55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged more than 55 (OR =1.97, 95% CI = 1.35, 2.87). Conclusions: Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people aged more than 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking.
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Previous data from small cessation trials and recent data from population surveys suggested that relapse in a quit attempt may predict an increase in depressive symptoms.
“Previous data from small cessation trials [34, 35] and recent data from population surveys suggested that relapse in a quit attempt may predict an increase in depressive symptoms [36].”
From Depression and smoking cessation: evidence from a smoking cessation clinic with 1-year follow-up (2017) · cites this paper as [36]
The negative effect of depression on cessation is stronger for women.
“there is evidence across all ages that the negative effect of depression on cessation is stronger for women [16, 17].”
From Depression and smoking cessation: evidence from a smoking cessation clinic with 1-year follow-up (2017) · cites this paper as [17]
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- Authors
- Cooper, J., Borland, R., Yong, H., & Fotuhi, O.
- Affiliations
- Cancer Council Victoria (AU)
- University of Waterloo (CA)
- Corresponding author
- Borland, Ron
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2016-04-15
- Volume
- 111
- Issue
- 8
- Pages
- 1448-1456
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC4940259
- OpenAlex
- W2286674077
- Cited by
- 18
- References
- 33
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 2
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion)
- Funders
- Cancer Research UK (450110, P50 CA111236, 014578, C312/A3726, 265903, R01 CA 100362, 57897, 045734)
- University of Waterloo (P50 CA111236, 265903, R01 CA 100362, 045734, 57897, 014578, C312/A3726, 450110)
- Canadian Institutes of Health Research (C312/A3726, R01 CA 100362, 014578, 265903, 045734, 79551, 450110, P50 CA111236, 57897)
- Medical Research Council
- National Health and Medical Research Council (1005922, 014578, 450110, 045734, 57897, P50 CA111236, 265903, C312/A3726, R01 CA 100362)
- National Cancer Institute (450110, C312/A3726, 045734, 57897, P01CA138389, 265903, P50CA111236, R01CA100362, 014578)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- smoking cessation, relapse, depressive symptoms, depression, abstinence, age moderation, PRIME-MD, smokers, tobacco control policy evaluation
- MeSH terms
- Tobacco Smoking, Adolescent, Adult, Age Factors, Australia, Canada, Depression, Female, United Kingdom, Humans, Male, Middle Aged, Prospective Studies, Smoking, United States, Cohort Studies, Smoking Cessation, Young Adult
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