Anxiety, depression and smoking in schoolchildren--implications for smoking prevention.

The prevalence of smoking among 14 to 18-year-old adolescents (one out of three) is as high as in the general population in Hungary. Depression and anxiety disorders are also major public health problems. Our objective was to investigate the correlations between smoking status and anxiety and depressive symptoms, as well as to identify potential implications for the prevention of nicotine dependence. We used a self-developed questionnaire to survey smoking behaviour, and standard self-evaluation tests (the Hungarian version of the Spielberger's State-Trait Anxiety Inventory for Children and the Children's Depression Inventory) to capture anxiety and depressive symptoms in 215 students from randomly selected technical and high schools. Smoking students showed significantly more anxiety and depressive symptoms compared to their non-smoking peers. Importantly, occasional smokers appeared to be more anxious than non-smokers, whereas daily smokers scored higher on the depression inventory than either non-smokers or occasional smokers. The majority of students with high scores suggestive of anxiety or depressive disorders were smokers. Interestingly, Levels of anxiety and depression were associated with smoking status in boys but not in girls. The strong association found between anxiety and depressive symptoms and youth smoking, particularly in boys, suggests that reducing these symptoms (especially high, school-related anxiety) may be preventive against the onset of addictive smoking. This, together with the high level of anxiety and depression found in girls, makes it essential for all professionals dealing with adolescents and education to recognise these symptoms and their significance, and to be aware of the ways of reducing them by changes in the educational system, or medically, if necessary.