A new study on smoking shows that smokers with depression make more attempts to quit smoking than other smokers and that they are more likely to relapse and take up smoking again.
The study, published this month in the journal Addiction found a significant correlation between reported depression and higher number of attempts at quitting over a period of a year. As a result, researchers say that addiction counselors and clinicians should be aware that depressed patients may have a greater motivation to quit than their counterparts.
The study used data from the Four Country International Tobacco Control Study (ITC-4), which surveyed 6,811 tobacco smokers in Canada, the United States, the United Kingdom and Australia between 2006 and 2011 to determine their smoking habits in light of current smoking policies within their respective countries.
Studies have shown that people with clinical depression are twice as likely to smoke as the general population and that this relationship is likely bidirectional; smoking contributes to depression and depressive symptoms while depression increases the likelihood of smoking. Further, it is known that people with depression find quitting more difficult and withdrawal more severe and long-lasting, that they are more likely to relapse after quitting and that the risk of relapse is greater for women than for men.
But in determining that depressed smokers make more attempts to quit over the course of a year, this new research ends up putting into question the characterization of depressed people as unmotivated, so say the study’s authors. “The general finding of increased quitting among people with signs of depression does not support a helplessness model of depression, which would predict less quitting activity,” say the study’s authors.
Commonly, depression is characterized by a lack of motivation and loss of interest in doing activities such as work, household chores and socializing. But according to the ITC-4 survey results, people with depression are more worried about the impact of smoking on their health than other smokers and this, according to the researchers, accounts for their higher number of attempts to quit.
“A possible interpretation of these findings is that smokers with depression have heightened awareness and worry over smoking’s negative impact on them, helping to motivate more quit attempts,” say the study’s authors.
Smoking is the leading cause of premature death in Canada, and lung cancer (for which smoking is the leading cause) itself causes more deaths than other cancers. According to Statistics Canada, in 2011, one in five or about 5.8 million Canadians were smokers. Usage is higher in men (22.3 per cent) than women (17.5 per cent) but has been on an overall decline through the past decade.
The connection between smoking and mood is not yet clearly understood. By some accounts, the nicotine in cigarettes has a positive effect on mood, especially for depressed smokers, but on other views, the uplift in mood and decrease in anxiety from smoking are explained by the body’s positive response to feeling replenished with nicotine after an even short period of withdrawal.
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