Abstract
BackgroundIt is well-established that smoking and depression are associated in adolescents, but the temporal ordering of the association is subject to debate.MethodsLongitudinal studies in English language which reported the onset of smoking on depression in non clinical populations (age 13-19) published between January 1990 and July 2008 were selected from PubMed, OVID, and PsychInfo databases. Study characteristics were extracted. Meta-analytic pooling procedures with random effects were used.ResultsFifteen studies were retained for analysis. The pooled estimate for smoking predicting depression in 6 studies was 1.73 (95% CI: 1.32, 2.40; p < 0.001). The pooled estimate for depression predicting smoking in 12 studies was 1.41 (95% CI: 1.21, 1.63; p < 0.001). Studies that used clinical measures of depression were more likely to report a bidirectional effect, with a stronger effect of depression predicting smoking.ConclusionEvidence from longitudinal studies suggests that the association between smoking and depression is bidirectional. To better estimate these effects, future research should consider the potential utility of: (a) shorter intervals between surveys with longer follow-up time, (b) more accurate measurement of depression, and (c) adequate control of confounding.
Highlights
It is well-established that smoking and depression are associated in adolescents, but the temporal ordering of the association is subject to debate
There is no consensus on whether smoking causes depression or depression causes smoking in the natural course of tobacco use and depression.[16]
The "self-medication" hypothesis suggests that depression may lead to smoking because people smoke to relieve symptoms of depression. [17,18,19,20] In contrast, other authors have suggested that cigarette smoking causes depression as nicotine exposure may damage neurochemical pathways, such as monoamine neurotransmission. [21,22,23] Bi-directional mechanisms in which smoking and depression reinforce each other have been postulated.[12,23,24]
Summary
It is well-established that smoking and depression are associated in adolescents, but the temporal ordering of the association is subject to debate. Co-occurrence of tobacco use and depression has long been a major concern because of the substantially increased risk to health.[1] Most [2,3,4,5,6,7,8,9,10,11,12] but not all [1315], cross-sectional studies report a strong positive association between smoking and depression. How these health risks inter-relate temporally remains a topic of debate. The "self-medication" hypothesis suggests that depression may lead to smoking because people smoke to relieve symptoms of depression. [17,18,19,20] In contrast, other authors have suggested that cigarette smoking causes depression as nicotine exposure may damage neurochemical pathways, such as monoamine neurotransmission. [21,22,23] Bi-directional mechanisms in which smoking and depression reinforce each other have been postulated.[12,23,24] Kendler (1993) hypothesizes that there is no causal relationship and that the perceived association is a function of underlying shared environmental and genetic risk factors.[24]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
