Brendon Stubbs1, Davy Vancampfort2, Joseph Firth3, Marco Solmi4, Najma Siddiqi5, Lee Smith6, Andre F Carvalho7, Ai Koyanagi8. 1. South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom. Electronic address: brendon.stubbs@kcl.ac.uk. 2. University Psychiatric Centre, Department of Neurosciences and Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Kortenberg, 3070, Belgium. 3. NICM, School of Science and Health, University of Western Sydney, Australia. 4. University of Padua, Neuroscience Department, Psychiatry Unit, University Hospital of Padua, Azienda Ospedaliera di Padova, Psychiatry Unit, Padua, Italy. 5. Hull York Medical School, Department of Health Sciences, University of York, York and Bradford District Care NHS Foundation Trust, Bradford, United Kingdom. 6. The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, United Kingdom. 7. Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 8. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 0883, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid, 28029, Spain.
Abstract
BACKGROUND: Smoking is a leading modifiable cause of global morbidity and mortality. Research from high-income countries has found a high prevalence of smoking among people with depression and suggested that this may partially contribute to the increased premature mortality in this population. Limited research has investigated smoking behaviors across the depression spectrum and in low- and middle-income countries (LMICs). This study explored the relationship between depression and smoking across 48 LMICs. METHODS: We conducted a cross-sectional, community-based study comprising 242,952 people [mean age 38.4 (SD = 16.1) years, 50.8% females] from the World Health Survey. Multivariable binary logistic regression analyses were performed to investigate the relationship between depression (including subsyndromal, brief depressive episode and depressive episodes) and smoking behaviours. RESULTS: Overall, the prevalence of current smoking was lowest in Africa (13.5%) and highest in Asia (32.2%). A depressive episode was present in 6.7% of the sample. Compared to people without depression, subsyndromal depression, brief depressive episode, and depressive episodes were all significantly associated with smoking with similar effect sizes (ORs: 1.36-1.49). Countrywide meta-analysis found that the pooled overall OR for smoking in depression was 1.42 (95%CI = 1.32-1.52, I2 = 39.7%). Furthermore, alcohol consumption and male gender were consistently associated with smoking across all regions and smoking was consistently less common in those who were wealthier and had a higher education. CONCLUSION: These data suggest that the depression spectrum is consistently associated with high levels of smoking behaivours in LMICs. Given that most of the world's smokers reside in LMICs, future smoking cessation interventions are required to target people with depression.
BACKGROUND: Smoking is a leading modifiable cause of global morbidity and mortality. Research from high-income countries has found a high prevalence of smoking among people with depression and suggested that this may partially contribute to the increased premature mortality in this population. Limited research has investigated smoking behaviors across the depression spectrum and in low- and middle-income countries (LMICs). This study explored the relationship between depression and smoking across 48 LMICs. METHODS: We conducted a cross-sectional, community-based study comprising 242,952 people [mean age 38.4 (SD = 16.1) years, 50.8% females] from the World Health Survey. Multivariable binary logistic regression analyses were performed to investigate the relationship between depression (including subsyndromal, brief depressive episode and depressive episodes) and smoking behaviours. RESULTS: Overall, the prevalence of current smoking was lowest in Africa (13.5%) and highest in Asia (32.2%). A depressive episode was present in 6.7% of the sample. Compared to people without depression, subsyndromal depression, brief depressive episode, and depressive episodes were all significantly associated with smoking with similar effect sizes (ORs: 1.36-1.49). Countrywide meta-analysis found that the pooled overall OR for smoking in depression was 1.42 (95%CI = 1.32-1.52, I2 = 39.7%). Furthermore, alcohol consumption and male gender were consistently associated with smoking across all regions and smoking was consistently less common in those who were wealthier and had a higher education. CONCLUSION: These data suggest that the depression spectrum is consistently associated with high levels of smoking behaivours in LMICs. Given that most of the world's smokers reside in LMICs, future smoking cessation interventions are required to target people with depression.
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