History Of Depressive Episodes Research Articles

Depression and Dementia in Old-Old Population: History of Depression May Be Associated with Dementia Onset. The Tome Project.

Background: In this study, we investigated the relationship among a history of depression, depressive states, and dementia in a community-based old-old cohort.Methods: From 2012 to 2013, we recruited 200 subjects residing in Tome, Japan. Ultimately, 181 subjects were enrolled in our study and completed the whole study protocol. We used the World Mental Health-Composite International Diagnostic Interview 3.0 to evaluate whether subjects had a history of depression or other affective disorders. Simultaneously, 3.0 Tesla brain magnetic resonance imaging (MRI) was performed for each subject.Results: Of 181 subjects, 66 were normal (clinical dementia rating [CDR] = 0), 88 had MCI (CDR = 0.5), and 27 had dementia (CDR = 1 or above). Nine of the 181 subjects (4.9%) had a history of depressive episodes. CDR was significantly higher in subjects with a history of depression (0.9 vs. 0.4, p = 0.046) than in those without it. Seventy-two of the 181 subjects (39.7%) exhibited depressive symptoms. Subjects with depression exhibited lower Mini–Mental State Examination scores (21.6 vs. 23.3, p = 0.008), higher CDR scores (0.6 vs. 0.3, p = 0.004), and more atrophy of the medial temporal lobe (4.4 vs. 3.7, p = 0.036).Conclusion: A history of depression should be considered a risk factor for all-cause dementia. In the old-old population, depression is associated with a higher prevalence of dementia, lower cognitive performance, and a smaller hippocampus.

Risk of suicidal behaviours in elderly

IntroductionOlder adults constitute the age group in which suicide more often reaches its most categorical expression: consummation.ObjectiveIdentify risk factors for suicide in older people.MethodSystematic review of the literature on the subject. The databases consulted were Dialnet and Pubmed. The descriptors used have been: “suicide”, “risk factors” and “elderly”, accepting the works found in English and Spanish, with a total of 501 references found after the search, from which 75 have been selected.ResultsAs shown in the reviewed studies, there is a progressive increase in suicide rate with age in males. The purpose of dying in the old man is usually characterized by his firm conviction, not infrequently reflexive and premeditated. In the multifactorial etiology of suicidal behaviour in this age group, the main elements to be considered would be psychosocial factors, psychiatric diseases and chronic somatic diseases, resulting in a potentiation among them due to their frequent interaction. The feeling of abandonment, the feeling of emptiness, the despair of the organic collapse and the self-perception of being a useless person, without projects, generates deterioration in the quality of life.ConclusionsIn the multifactorial etiology of the suicidal behaviour of the elderly, they usually play coprotagonic roles, loneliness, isolation, somatic illness and depression. The most likely profile of the suicidal elder would be represented by a man with a history of depressive episode after age 40, who lives alone, with a family history of depression or alcoholism and a recent loss.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A manic episode induced by herbal preparate golden berry (cape gooseberry) (Physalis peruviana L.)

Herbal preparationsare widely used especially in treatment of cancer, losing weight, analgesia, or for other health problems in folk medicine. In psychiatric disorders they are used especially for insomnia, anxiety, depression, and sexual disorders. The research investigating the efficacy and side effects of these preparations has arrived atdifferent conclusions, also pharmacological mechanisms of these agents and their drug interactions are not very well unknown. Here we report a patient, who applied to our emergency service for concurrent manic symptoms with history of using “golden berry” to lose weight. The patient had a history of depressive episode five years ago, but no manic or hypomanic episodes in the past.

Epilepsia, psicose e religiosidade – Caso clínico

Os autores apresentam o caso de uma paciente de 61 anos, com antecedentes depressivos e história de síncopes, que desenvolve, no espaço de meio ano, alterações de comportamento pautadas por hiper-religiosidade, ideias delirantes de grandiosidade e fenômenos compatíveis com déjà vu. Nesse contexto, foi referenciada pelo médico de família para a urgência de psiquiatria, tendo sido realizada investigação orgânica e identificada epilepsia do lobo temporal após realização de eletroencefalograma. Foi medicada com valproato de sódio, na dose de 750 mg/dia, com esbatimento progressivo da sintomatologia psicótica. Com este trabalho, os autores pretendem sublinhar a importância da exploração orgânica dos sintomas neuropsiquiátricos, antes de atribuir um diagnóstico psiquiátrico ao paciente.

Assessing the contribution of borderline personality disorder and features to suicide risk in psychiatric inpatients with bipolar disorder, major depression and schizoaffective disorder

Suicidal behavior often accompanies both borderline personality disorder (BPD) and severe mood disorders, and comorbidity between the two appears to further increase suicide risk. The current study aims to quantify the risk of suicidality conferred by comorbid BPD diagnosis or features in three affective disorders: major depressive disorder (MDD), bipolar disorder (BP) and schizoaffective disorder. One hundred forty-nine (149) psychiatric inpatients were assessed by SCID I and II, and the Columbia Suicide Severity Rating Scale. Logistic regression analyses investigated the associations between previous suicide attempt and BPD diagnosis or features in patients with MDD, BP, and schizoaffective disorder, as well as a history of manic or major depressive episodes, and psychotic symptoms. Comorbid BPD diagnosis significantly increased suicide risk in the whole sample, and in those with MDD, BP, and history of depressive episode or psychotic symptoms. Each additional borderline feature also increased risk of past suicide attempt in these same groups (excepting BP) and in those with a previous manic episode. Of the BPD criteria, only unstable relationships and impulsivity independently predicted past suicide attempt. Overall, among patients with severe mood disorders, the presence of comorbid BPD features or disorder appears to substantially increase the risk of suicide attempts.

Anhedonic depression, history of depression, and anxiety as gender-specific risk factors of myocardial infarction in healthy men and women: The HUNT study

This prospective study examines gender-specific psychological risk factors of myocardial infarction. Out of 41,248 participants free of coronary heart disease at baseline, 822 cases of myocardial infarction were identified in the Nord-Trøndelag Health Study or the mortality register. The participants completed the Hospital Anxiety and Depression Scale. Cholesterol, blood pressure, and waist–hip ratio were measured by medical staff. Smoking, diabetes, non-fatal myocardial infarction, and history of depressive episode were self-reported. Anhedonic depression (Hospital Anxiety and Depression Scale-D ≥8) was a significant predictor of myocardial infarction in women but not in men. Gender difference in risk estimate based on Hospital Anxiety and Depression Scale-D was significant (p < .01). History of depressive episode was a significant predictor of myocardial infarction in men. Symptoms of anxiety (Hospital Anxiety and Depression Scale-A ≥8) reduced the risk of having a myocardial infarction.

Intellectual Disability and Psychiatric Diagnoses of Children and Adolescents with a History of Stressful Events and Social Deprivation in Brazil: Preliminary Results. IQ, Depression and Stress

Background: Studies have shown that stressful events in childhood are associated with impairments in cognitive functions and intellectual disability. Objective: Compare the intellectual functioning in groups of Brazilian children and adolescents with a history of stressful events with lifetime history of depression and without lifetime history of depression. Method: 30 children and adolescents underwent psychiatric evaluation and neuropsychological assessment of estimated intellectual quotient (EIQ), verbal knowledge, and visuospatial skills. Results: 15 patients (50%) had EIQ within the average and 6 had EIQ in the lower average (20%) for Brazilian standardized norms. The other part had at least some degree of intellectual disability and they were classified as: 2 mild mental retardation (6.7%) and 7 borderline (23.3%). Also, half of the sample had at least one lifetime depressive episode, and the performance in EIQ and visuospatial skills was worse in this group. Conclusion: 50% of the children and adolescents with a history of early stressful events and social deprivation had at least some degree of intellectual disability. In addition, a subgroup with history of depressive episodes had worse EIQ performance when compared to those without depression, possibly due to a greater impairment in visuospatial skills. The specific role of impaired right cerebral hemisphere, corpus callosum, and prefrontal cortex associated with depressive disorders and maltreatment should be investigated in further studies.

Gradual versus abrupt quitting among French treatment-seeking smokers

ObjectiveThis study examined the prevalence and predictors of gradual quitting among treatment-seeking smokers. MethodThis study examined quit attempts among 28,156 adult smokers who attended French smoking cessation services nationwide between 2007 and 2010. Predictors of gradual quitting were determined using multivariate regression models. ResultsOnly 4.4% quit gradually whereas 48.7% quit abruptly and 46.9% continued smoking. 34.1% of abrupt quitters and 31.9% of gradual quitters were abstinent at 1month post-quit (p=0.108). Gradual quitting was associated with: older age, heavy smoking at baseline, no previous quit attempts, low self-efficacy, baseline intake of anxiolytics, symptoms of depression and history of depressive episodes. Gradual quitters had a similar anxio-depressive profile than continued smokers but were more educated and more likely to have reported previous quit attempts. Prescription of oral nicotine replacement therapy (NRT) only as opposed to combination NRT doubled the odds of gradual quitting. Likelihood of gradual quitting compared with continued smoking improved with the number of follow-up visits. ConclusionOur findings suggest that hard-to-treat smokers may be more likely to quit gradually than abruptly. However, intense follow-up with adapted treatment appears to be crucial to achieve cessation gradually in French smoking cessation services.

Brief report of affective state and depression status after traumatic brain injury.

To examine the relationship between affective state (positive and negative affect) and depression status among adults with chronic traumatic brain injury (TBI). This is a cross-sectional cohort study of community-dwelling adults with chronic TBI (n = 64) that assesses the relationship between affective state (positive and negative affect), using the Positive and Negative Affect Schedule (PANAS), and depression status, categorized as no depression, history of depressive episode, and current depressive episode, using the Primary Care Evaluation of Mental Disorders (PRIME-MD). Affective state differed significantly across depression status groups for both positive affect (F (2, 61) = 5.10, p = .009) and negative affect (F ( 2, 61) = 8.19, p = .001). Participants with no depression reported higher positive affect (M = 35.67, SD = 9.08) than those with a current depressive episode (M = 27.64, SD = 8.59, p = .007) and lower negative affect (M = 14.52, SD = 5.08) than those with a history of a depressive episode (M = 20.21, SD = 5.08, p = .006) and those with a current depressive episode (M = 22.29, SD = 6.21, p = .001). Poor affective state, including both low positive affect and high negative affect, is associated with depression diagnosis. High negative affect is present, even in the absence of a current depressive episode, after TBI. These data highlight the need to assess affective state in addition to screening for mood disorders among adults with chronic TBI.

2834 – Comparison of clinical and the sociodemographic characteristics of bipolar patients according to the presence of a history of depressive episode

Introduction The aim of this study was to compare the sociodemographic and clinic characteristics of patients with bipolar disorder type I with and without history of depressive episode. Method In this study the data of 108 bipolar type I patients who were admitted to psychiatry clinic of a university hospital due to manic episode between 2007–2009 were examined. Results According to these data, 16 of 108 bipolar disorder type I patients (14.8%) had inhabited at least 4 manic episodes throughout their lives and there was no history of depressive episode although the disease had continued at least 4 years. With and without a history of depressive episode of bipolar type I patients have not been identified differ in terms of sociodemographic and clinical characteristics, but patients not having a history of depressive episode during their lifetime was found to be more than the number of hospitalizations. Conclusion Current information seem to be not sufficient to define unipolar mania as a separate nosological class. Largescale, prospective designs and illuminating the pathophysiology and etiology studies needs to be done in this issue.

Gastric Lavage Guided by Ultrathin Transnasal Esophagogastroduodenoscopy in a Life-threatening Case of Tobacco Extract Poisoning: A Case Report

Nicotine, which is found in tobacco, is one of the most toxic of all known poisons. A 31-year-old woman was brought to our emergency department 2 hours after ingesting a usually fatal dose of a tobacco extract. Although gastric lavage was once commonly used to treat poisoning cases of this type, lavage can lead to such complications as aspiration, hypoxia, oropharyngeal and gastric trauma, and electrolyte disturbances. Recent guidelines have suggested less-aggressive gastric-emptying procedures as initial treatments. Currently, there are no absolute indications for gastric lavage use. The present patient had a history of depressive episodes and had attempted suicide by ingesting an extract derived from 20 cigarettes mixed with alcohol. There was no evidence of vomiting or seizures occurring before arrival of the ambulance. Physical examination revealed no signs of sweating, although the patient appeared to be confused, which is often seen with nicotine intoxication. She admitted using 2 kinds of cigarette, each of which typically contain 11.2 mg of nicotine. The patient's nicotine level was suspected to be higher than 40 to 60 mg, which is normally fatal. To determine whether gastric lavage was indicated in this case, we performed ultrathin transnasal esophagogastroduodenoscopy, which neither requires sedation nor compromises the airways. Although 2 hours had passed since ingestion, the tobacco extract and food were directly visualized within the stomach. Subsequently, gastric lavage was performed with 2,000 mL of water administered through a nasogastric tube. Ultrathin esophagogastroduodenoscopy made it possible to directly observe the gastric lavage and to ensure the stomach contents had been completely removed. No changes were noted in the vital signs, and no obstruction of the airways was observed. The patient recovered quickly and was discharged the following day. Ultrathin esophagogastroduodenoscopy helped determine the diagnosis and ensure that gastric lavage had been performed without complications.

2083 – Prevalence of unipolar mania and evaluation of the characteristics in unipolar and bipolar mania in kerman (Iran)

Background Some study suggest that unipolar mania could be a separate subtype, while there is no unipolar mania listing in DSM. We compared sociodemographic and clinical data of unipolar and bipolar mania. Methods In an analytical-observation study,through 850 patients with bipolar I disorder, in 10 years of illness duration, 240 patients were included. We evaluated demographic and clinical information and interview with patients and their families consistent with DSM, then we assessment the comorbidities and other clinical conditions and analysed our data by using the mann-witney test, chi-squar test and fisher exact test. Results 22.4% of 219 patients presented a course of illness characterized by unipolar manic episodes without history of major or mild depression. When this group was compared with 170 manic patients with a previous history of depressive episodes, we found significant similarities in most demographic, familial, and clinical characteristics. Just positive family history for MDD was higher in bipolar mania significantly (P Discussion There is no prominent differences between two groups and inform clinical and psychopathological have common characteristics in unipolar and bipolar mania. So, biologic, physiologic and anatomical bases of unipolar and bipolar mania could be similar. Literature on this topic is still insufficient, and it is necessary to ongoing unipolar manic studies in future.

P-243 - An insulinoma presenting with neuropsychiatric symptoms

Introduction An insulinoma is a neuroendocrine tumor derived from pancreatic islet cells responsible for the secretion of exaggerated amounts of insulin. Consequently, they induce recurrent states of hypoglicemia and manifest clinically with a wide range of symptoms including confusion, behavioral disturbances and impaired consciousness. Objectives To report a case of a patient with an insulinoma presenting with neuropsychiatric symptoms. Aims To highlight the diagnostic difficulties of medical or surgical disorders presenting with clinical features overlapping psychiatric syndromes. Methods Review of the scientific literature and the patient's clinical notes. Results A 68-year old male, with a previous history of depressive episode, was admitted to the psychiatric ward following behavioral disturbances and neuropsychiatric symptoms with the provisional diagnosis of “depressive episode with hypochondriac features”. Despite some overall improvement with antidepressants and antipsychotics, unremitting episodes of weakness, sweating, tachycardia, palpitations associated with hypoglicemia were apparent. Complementary workup disclosed hyperinsulinism and a pancreatic insulinoma. Following surgical ablation of the tumor, the patient improved dramatically from the neuropsychiatric symptoms. Conclusions Neuropsychiatric symptoms are a common clinical presentation of an insulinoma. A high level of clinical expertise is crucial to avoid that patients are misdiagnosed with psychiatric illnesses before insulinoma is recognized.

History of depressive episodes as a risk factor for illness severity in early inflammatory arthritis

Objective Psychosocial research in arthritis consistently demonstrates a relationship between depression and disease characteristics such as severity of illness and physical disability. In this study, we examine how a history of clinical depression identified through diagnostic interviews influences disease outcome measures in patients with early inflammatory arthritis (EIA) in the absence of current depression. Methods Patients in the early phase (more than 6-weeks, less than 1-year duration) of inflammatory arthritis were recruited from a larger EIA registry, which recorded sociodemographic data, current depressive symptoms and measures of disease severity. Current and history of major depression was assessed by a structured clinical interview. Eighty-one patients without current major depression were divided into two groups: 28 with and 53 without a history of depression. Results There were no significant differences between the two groups in age, sex, education, income, or level of current depressive symptoms. Compared with patients with no history of major depression, those with a history of depressive episodes had higher self-ratings of disease activity and were assessed as having more severe disease and poorer physical functioning by their physicians. Conclusion This study indicates that a history of major depression represents a risk factor for disease severity in EIA. This may reflect an enduring physiological effect of depression that influences subsequent inflammatory arthritis or an underlying shared process between these two disease entities.

Rumination as a Vulnerability Factor to Depression in Adolescents in Mainland China: Lifetime History of Clinically Significant Depressive Episodes

The current study tested the vulnerability and sex differences hypotheses of the response styles theory of depression (Nolen-Hoeksema, 1991). Participants included 494 tenth-grade students (M = 15.25 years, SD = 0.47) recruited from two secondary schools in Beijing, China. Participants completed self-report measures assessing rumination and neuroticism as well as a semistructured clinical interview assessing current and past clinically significant depressive episodes. Higher levels of rumination were associated with a greater likelihood of exhibiting both a current depressive episode and a past history of depressive episodes even after controlling for neuroticism. Higher levels of rumination were also associated with greater severity and duration of current depressive episodes and greater severity of past depressive episodes even after controlling for neuroticism. Contrary to the sex differences hypothesis of the response styles theory, girls and boys did not differ in levels of rumination.

Temporomandibular dislocation due to aripiprazole induced dystonia

We wish to report the case of a patient who developed temporomandibular joint dislocation due to dystonia following a single dose of aripiprazole. Our patient was a 23-year-old woman presenting with persistent low mood, fatiguability, insomnia and suicidal ideation. There was no past history of psychiatric morbidity. There was family history of depressive episode and deliberate self harm in her husband who was her paternal cousin. She was given 10 mg escitalopram and 0.5 mg clonazepam for insomnia on a diagnosis of a moderate depressive episode and improved over the next 3 weeks. However she developed irritability and agitation while on the above medications for which she was given a single dose of aripiprazole 10 mg at night by another psychiatrist not attached to our institution, which was not appropriate for her condition. The patient had taken 10 mg escitalopram in the morning. There was no history of intake of any over the counter drugs or herbal preparations. Twelve hours after the first dose she developed sedation and salivation and her care givers withheld subsequent doses of aripiprazole, escitalopram and clonazepam. Twenty hours after the first dose, she developed painful spasms of the muscles of her neck on the right side. She also had forced opening and deviation of jaw, both to the left and right. This was followed by persistent deviation of the jaw to the left and pain in the left temporomandibular joint. She was unable to close her mouth, swallow or talk for which she was brought to the emergency department of our hospital. A left-sided temporomandibular dislocation was diagnosed and a manual reduction was performed, after which the pain subsided. The next morning she was examined by us and seen to have forced mouth opening, excessive salivation and bilateral hand tremors. There were no other dystonic reactions. The dystonia and temporomandibular joint dislocation could not be part of the somatic symptoms of depression. We gave her 50 mg promethazine intramuscularly on suspicion of an aripiprazole induced dystonia. Two hours later, the dystonic movements subsided and the patient was sent home on oral promethazine. She did not have dystonic movements on follow-up the next morning. A rechallenge with aripiprazole could not be done for ethical reasons. The dystonia was rated as possibly due to aripiprozole according to the Naranjo adverse drug reaction probability scale [1]. She was restarted on escitalopram and clonazepam. A 1 month follow-up did not reveal any dystonic reactions. The adverse drug reaction was reported to the regional pharmacovigilance reporting centre. Aripiprazole is a second generation anti-psychotic which has a low propensity to cause extra-pyramidal side effects [2]. There are reports of acute dystonia induced by aripiprazole in drug-naive [3], and cocaine dependent patients [4] and in a patient on sertraline [5]. It has been proposed that aripiprazole caused dystonia because it lacked a protective anti-cholinergic action unlike other second generation anti-psychotics like clozapine [3]. Temporomandibular joint dislocations have been reported with conventional neuroleptics [6, 7] but no case has been reported with aripiprazole. Aripiprazole has been found to have no meaningful effect on the pharmacokinetics of escitalopram [8].We propose that our patient developed temporomandibular dislocation due to a dystonic reaction to aripiprazole possibly mediated through a pharmacodynamic synergism with escitalopram as selective serotonin re-uptake inhibitors can cause extrapyramidal side effects including dystonias through serotonergically mediated inhibition of the dopaminergic system [9]. From our case report we recommend a lower starting dose of aripiprazole especially in drug naive non psychotic patients and close monitoring of such patients.

A prospective study of stress autonomy versus stress sensitization in adolescents at varied risk for depression.

This longitudinal study investigated the stress autonomy, stress sensitization, and depression vulnerability hypotheses in adolescents across 6 years (i.e., Grades 6 through 12). Participants were 240 children (Time 1 mean age = 11.86, SD = 0.57) who varied in risk for depression on the basis of their mother's history of mood disorders. All analyses were conducted as multilevel models to account for nesting in the data. Results were consistent with the stress sensitization hypothesis. The within-subject relation of stress levels to depressive symptoms strengthened with increasing numbers of prior depressive episodes. In addition, evidence consistent with the vulnerability hypothesis was found. The relation of stress levels to depressive symptoms was stronger for adolescents who were at risk for depression on the basis of maternal depression history and for those who had experienced more depressive episodes through Grade 12. These findings suggest that onsets of depression in adolescents may be predicted by both relatively stable and dynamic transactions between stressful life events and vulnerabilities such as maternal depression and youths' own history of depressive episodes.

Impaired cognitive function in healthy offspring of bipolar patients

Materials and methods Fifty persons (17 male, 33 female), aged 18-52 (30 ± 7) years made the total adult offspring population of patients with bipolar mood disorder. Among them, two had a history of depressive episodes, and another eight scored positively on Mood Disorder Questionnaire [4]. The head-to-head ageand gender-matched healthy subjects were used as a comparison group. The computer version of WCST designed by Heaton et al. (1993) adapted with instructions in Polish was used in all subjects. The following domains of WCST were measured: the percentage of perseverative errors (WCST-P), the percentage of non-perseverative errors (WCST-NP), the number of correctly completed categories (WCST-CC), the percentage of conceptual level responses (WCST-% conc), and the set to the first category (WCST-1st cat).

Cultural Dimensions of Depression in Bangladesh: A Qualitative Study in Two Villages of Matlab

This article reports the results of a qualitative study conducted in two villages of Matlab to explore the cultural dimensions of depression. Participants included adult men and women with and without a history of depressive episode (n=42), formal and informal healthcare providers (n=6), and caregivers (n=2). Adults (n=10) with a history of depressive episode were selected from a 2005 survey conducted by ICDDR,B. A case vignette was used for eliciting local terms for depression, perceived causes, impact, and treatments. Hardly anyone recognized the term bishonnota (literal translation of depression) used in the past survey. The participants thought that the vignette was about chinta rog (worry illness), and they spoke of somatic symptoms in relation to this condition. When explored further, they mentioned sadness and psychological complaints. Men felt that it affected them more while women felt the opposite. They associated chinta rog with poverty and social issues with impacts on marriage, work, and education. From their responses, it seemed that they preferred a psychosocial framework attributing the cause to thoughts and emotions, resulting from social causes. Commonly-suggested treatments were more income, better relationships, and tablets. Former health providers were often the first choice for help-seeking. The study hopes to 'culturally inform' the formal healthcare providers and programme planners.

Prevalence of tobacco smoking in teachers following anti-smoking policies: results from two French surveys (1999 and 2005)

French public health policies aimed at reducing smoking were reinforced in France between 1999 and 2004 to decrease tobacco consumption. The consequences of these policies are of particular interest to teachers who play a role model for young people. Depression and alcohol problems were particularly studied as they may influence smoking behaviour. Two large cross-sectional health surveys conducted in 1999 (N = 2931) and 2005 (N = 3702) included teachers, aged 20-59 years. Smoking status, socio-demographic characteristics, history of depressive episode in the previous year and problems with alcohol were collected using self-administered postal questionnaires. From 1999 to 2005, the prevalence of smoking decreased significantly from 25.7 to 18.2% for men (P < 0.001), from 20.0 to 16.5% (P < 0.001) for women; and the proportion of never-smokers increased. In smokers, the number of cigarettes consumed per day decreased significantly. Multivariate analysis revealed a significant decrease of the risk of being a smoker in 2005 compared with 1999 [odds ratio (OR) = 0.68 for men; OR = 0.78 for women]. Risk factors of smoking were: men aged 20-34 years (OR = 1.81), CAGE score > or =2, (OR = 1.95 for men, 2.12 for women) history of a major depressive episode in the previous 12 months (OR = 1.46 for men, 1.44 for women). Anti-smoking policies resulted in a decrease of teachers' tobacco consumption between 1999 and 2005. However, people with more difficulties in quitting smoking, in particular people with depressive episodes or problems with alcohol, might benefit from comprehensive programmes, including training of health professionals.