The association between depressive symptoms and cigarette smoking in an urban primary care sample

Objective: To examine the relationship between cigarette smoking and depres sive symptoms in an urban primary care sample. Methods: Eligible participan ts were 526 patients aged eighteen to sixty-four presenting in the waiting rooms of two university affiliated internal medicine clinics. Participants were asked to complete a brief interview which ascertained current depressi ve symptoms using the Center for Epidemiologic Studies Depression Scale (CE S-D), demographic information, and smoking status using a modified version of the Fagerstrom Test for Nicotine Dependence (FTND). Results: Smoking sta tus differed significantly by age, gender, education, and employment status . Mean level of depressive severity also differed by smoking status. Curren t smokers with nicotine dependence symptoms had significantly higher CES-D scores than those who had never smoked, ex-smokers, and non-dependent smoke rs. Logistic regression analyses indicated that gender, employment status, age, and smoking status were significantly associated with CES-D scores gre ater than or equal to 16. Exploratory analyses suggested that among smokers with a symptom of nicotine dependence, significantly more women than men h ad clinically significant levels of depressive symptoms. Conclusions: The a ssociation between smoking behavior and depressive symptoms in the present study is consistent with that reported in population-based and psychiatric samples. Symptoms of nicotine dependence were significantly associated with clinical levels of depressive symptoms. Primary care physicians may wish t o inquire about depressive symptoms among smokers, because these symptoms m ay interfere with patients' efforts to quit.