Dimensions of depressive symptoms and smoking cessation

Abstract

Because different psychopathologic components of depressive symptoms may have distinct etiologies, examining their differential effects on smoking cessation may elucidate mechanisms underlying the smoking-depression relationship. Negative affect (NA), somatic features (SF), low positive affect/anhedonia (PA), and interpersonal disturbance (IP) have been identified as unique dimensions of depression that can be measured using the Center for Epidemiologic Studies Depression Scale (CESD). This study examined common and unique associations between CESD subscales and baseline smoking characteristics, nicotine withdrawal, and relapse in 157 participants enrolled in a smoking cessation trial for heavy social drinkers. Each dimension was univariately associated with negative and positive reinforcement smoking motives. Only SF had unique relations with tolerance smoking motives and univariate associations with nicotine dependence severity. Only PA predicted cessation-related changes in withdrawal symptoms on quit day. Analyses predicting abstinence at 8, 16, and 26 weeks post quit date showed that NA, SF, and PA each univariately predicted relapse, ps< or =.0083. Only low PA predicted poorer outcomes incrementally to the other dimensions, even when controlling for level of nicotine dependence, smoking frequency, and history of major depression, p = .0018. Interventions targeting anhedonia and low positive affect may be useful for smokers trying to quit.

Figure 1

Center for Epidemiologic Studies Depression Scale (CESD) subscales predicting cessation-related changes in nicotine withdrawal. Standardized regression coefficients (Beta wts.) and standard errors of baseline CESD subscales predicting quit-day withdrawal symptoms when controlling for pre-quit withdrawal scores. Positive Affect scores are reversed to allow comparison with other scales. MNWS=Minnesota Nicotine Withdrawal Scale. ^aAdjusted for the effects of the three other CESD subscales. Effect of subscale: *p<.05, **p<.01.

Figure 2

Center for Epidemiologic Studies Depression Scale (CESD) total scale and subscale scores by abstinence status. Mean levels and standard errors of baseline CESD subscale scores comparing those who are abstinent from smoking at each follow-up to those who are not abstinent at that follow-up. Positive Affect scores are reversed to allow comparison with other scales. Means based on average response per item (possible range: 0–3). Abstinent vs. Non-abstinent comparisons: *p<.05, **p<.0.