The impact of quitting smoking on depressive symptoms: findings from the International Tobacco Control Four-Country Survey

Abstract

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.

Keywords: Abstinence; depression; relapse; smoking cessation.

Figure 1

This figure shows data from all observations included in the study. The percentage that reported one or two symptoms at T2 (y-axis) is stratified by reported symptoms at T1 (x-axis) and smoking status at T2 (columns). Total number of observations: No symptoms at T1 = 7,635, 63% no attempt; 24.5% relapse; 12.1% abstinent; One or both symptoms at T1 = 5,468, 58.1% no attempt; 31.6% relapse; 10.2% abstinent.

Figure 2

This figure includes observations from only those who reported symptoms at T1. The percentage that reported one or two symptoms at T2 (y-axis) is stratified by age group (x-axis) and smoking status at T2 (columns). Total number of observations: Age 18 to 39 = 1,552, 57.2% no attempt; 31.3% relapse; 11.5% abstinent. Age 40 to 55 = 2,410, 59.3% no attempt; 31.5% relapse; 9.2% abstinent. Age 55+ = 1,506, 57.3% no attempt; 32.2% relapse; 10.6% abstinent.

Figure 3

This figure includes observations from only those who reported no symptoms at T1. The percentage that reported one or two symptoms at T2 (y-axis) is stratified by age group (x-axis) and smoking status at T2 (columns). Total number of observations: Age 18 to 39 = 1,911, 60.6% no attempt; 25.3% relapse; 14.0% abstinent. Age 40 to 55 = 3,245, 66.0% no attempt; 23.1% relapse; 10.8% abstinent. Age 55+ = 2,479, 62.2% no attempt; 25.5% relapse; 12.2% abstinent.