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History of Single Episode and Recurrent Major Depressive Disorder Among Smokers in Cessation Treatment
Abstract
OBJECTIVES: Research and theory provide initial support for the potential utility in distinguishing between recurrent and single episode MDD smokers for cessation treatment. However, no study to date has examined differences in clinical presentation at the outset of treatment among these two groups and whether these clinical profiles are indicative of early cessation failure (smoking on quit day). METHODS: In a secondary analysis of a sample of 179 smokers entering cessation treatment, we examined baseline differences in dysfunctional attitudes, maladaptive coping, self-efficacy to manage negative affect, depressive symptoms, depressed mood, and experienced pleasure from life events between smokers with a history of recurrent major depression (MDD-R; 54.7%) and single episode major depression (MDD-S). RESULTS: Results showed that MDD-R smokers reported lower self-efficacy to cope with negative affect, greater depressive symptoms, and greater depressed mood than MDD-S smokers, although no differences were found on dysfunctional attitudes, avoidance coping, and level of experienced pleasure from daily life events. A greater number of MDD-R compared to MDD-S smokers were not abstinent on their quit day, however a history of recurrent MDD did not increase risk for early cessation failure. CONCLUSIONS: The findings indicate that although depressed mood, negative affect-regulation ability, and depression severity distinguish recurrent and single episode MDD smokers at the start of cessation treatment, these differences do not necessarily portend greater risk for cessation failure in the early stages of treatment.
... This suggests there is something unique about menthol in tobacco products that links it to affective vulnerability. Such findings are concerning given the robust association between psychiatric distress, particularly depression, with more severe nicotine dependence, smoking persistence, and higher rates of smoking relapse among adult tobacco users [20,[67][68][69][70]. Thus, mental health may be one factor explaining why menthol smokers have worse cessation outcomes and greater nicotine dependence relative to non-menthol smokers in some studies [7]. ...
Background:
Depression and anxiety are correlated with greater nicotine dependence, smoking persistence, and relapse back to smoking after a quit attempt. Menthol cigarette smoking, which is prevalent in young adults, is associated with nicotine dependence, progression to regular smoking, and worse cessation outcomes than non-menthol smoking. Few have established a link between menthol tobacco use, beyond just smoking, with mental health in this high-risk age group. This study examined the association of menthol tobacco use to anxiety and depression in a national sample of young adults.
Methods:
Data were from Waves 1 through 7 (n = 9720, weighted) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18 to 34 assessed every 6-months. Demographics, past 30-day use of non-menthol and menthol tobacco products, and current alcohol, marijuana, and other drug use were assessed among those with depression and anxiety.
Results:
Thirty nine percent of current tobacco users used menthol as their preferred brand. Using a cross-sectional analysis (collapsed across waves), past 30-day menthol tobacco was uniquely associated with greater odds of both depression and anxiety, beyond the effects of demographic and substance correlates and non-menthol tobacco product use.
Conclusions:
Menthol is disproportionately used among young adults tobacco users with mental health problems, above and beyond the impact of a variety of other mental health and tobacco use risk factors. Findings suggest a strong link between menthol tobacco use and poor health outcomes. Policies should be developed to deter menthol tobacco use in vulnerable groups.
... For example, Piper et al. (2010) have obtained significant association between past MDD and lower abstinence at 6 months. The distinction between history of single episode and recurrent MDD may explain these results because recurrent MDD increase the intensity of withdrawal symptoms (Cohn, Strong, Abrantes, & Brown, 2010; Covey, Bomback, & Yan, 2006; Ziedonis et al., 2008). ...
Introduction:
Smoking is significantly more common among persons with major depressive disorders (MDDs). Furthermore, smokers with MDD report more difficulties when they quit smoking (greater withdrawal symptoms, higher probability of relapse). The aim of this narrative review is to describe research on exercise and depression and exercise and smoking cessation.
Methods:
We have critically reviewed various smoking cessation intervention programs for depressive smokers examining (a) the protective effect of exercise against relapse for smokers with MDD and (b) the benefits of exercise for treating withdrawal symptoms. We have also reviewed the current literature investigating the mechanisms between exercise-depression and exercise-smoking.
Results:
This review suggests that exercise may reduce depressive symptoms following cessation and provide a useful strategy for managing withdrawal symptoms in smokers with MDD. Various psychological, biological, and genetic hypotheses have been tested (e.g., distraction hypothesis, expectations hypothesis, cortisol hypothesis) and few have obtained significant results.
Conclusions:
It might be beneficial for health professionals to recommend physical activity and promote supervised exercise sessions for smokers with MDD during smoking cessation. Future research needs to examine relationships between exercise, smoking, and depression with transdisciplinary and ecological momentary assessment.
... The history of recurrent depressive disorder did not increase the risk for early cessation failure. 74 Findings from a clinical trial examining the addition of cognitive-behavioral treatment for depression (CBT-D) to standard smoking cessation treatment in smokers with past MDD indicated that smokers with a history of recurrent MDD had significantly higher abstinence rates at 12-months follow-up than those with a history of single episode MDD. 75 Conversely, a recent study showed that mood disorders within the past year increased risk for tobacco cessation failure at 8 weeks (RR = 0.45, 95% CI = 0.25-0.79, ...
The factors predicting smoking abstinence in depressive smokers, and the role of physical activity in precessation, were investigated. One hundred thirty-three smokers with current major depressive disorders (score ≥10 on the Depression subscale of Hospital Anxiety and Depression Scale) were recruited from a large prospective cohort of smokers (n = 1,119). Over a maximum period of 3 years, regression modeling, adjusted for potential confounders, showed that physical activity was associated with relapse (relapse rate = 0.54, 95% confidence interval = 0.34-0.85, p = .008). Also, antidepressants, anxiolytics, level of education, and number of attempts to quit were associated with relapse. The protective role of physical activity on relapse rate could be a modifiable factor in smoking cessation for smokers with depressive disorders.
Mental health problems like anxiety, depression, and substance use problems commonly co-occur with cigarette smoking and are linked to poor cessation outcomes. Although millions of smokers seek online quitting assistance each year, few studies have examined links between website utilization and cessation outcomes among smokers with mental health problems. This study recruited 600 smokers with anxiety, depression, and alcohol use disorders (AUDs) who were new users of a publicly available Internet cessation treatment. Among participants with 3-month outcome data (n = 247, 42%), structural equation models (SEM) examined the association of symptoms of anxiety/depression (combined) and AUD diagnosis on website engagement and 3-month quit rates, controlling for covariates. The 3-month 30-day abstinence rate among those who completed follow-up was 28%, but only 14% among smokers with an AUD and 24.7% among smokers with symptoms of anxiety/depression. SEM results showed that treatment engagement significantly mediated the effect of mental health problems on 3-month abstinence: those with symptoms of anxiety/depression or an AUD had lower quit rates overall, however engagement with the website had a buffering effect on 3-month cessation outcomes. Engagement with an evidence-based Internet cessation program may be particularly useful for smokers with mental health comorbidities in increasing the chances of cessation. Future work should examine what level of treatment engagement meaningfully impacts behavior change for smokers with mental health problems who access Internet cessation programs.
Aims:
To update our prior meta-analysis that showed past major depression (MD+) to be unrelated to smoking cessation outcome.
Methods:
Eligible trials included 14 from our original review and 28 identified through an updated systematic review (2000-2009). We coded for assessment of past MD, exclusion for recent MD episode (MDE; ≤6 months versus no exclusion), duration/modality of cognitive behavioral treatment (CBT; face-to-face versus self-help) and other factors. To minimize influence of experimental treatments that may selectively benefit MD+ smokers we analyzed placebo/lowest intensity control arms only. Study-specific ORs for the effect of past MD on short-term (≤3 months) and long-term (≥6 months) abstinence were estimated and combined using random effects. Two-way interaction models of past MD with study methodology and treatment factors were used to evaluate hypothesized moderators of the past MD-abstinence association.
Results:
MD+ smokers had 17% lower odds of short-term abstinence (n = 35, OR = 0.83, 95% CI = 0.72-0.95, P = 0.009) and 19% lower odds of long-term abstinence (n = 38, OR = 0.81, 95% CI = 0.67-0.97, P = 0.023) than MD- smokers after excluding the sole study of varenicline because of its antidepressant properties. The association between past MD and abstinence was affected by methodological (recent MDE exclusion, type of MD assessment) and treatment (CBT modality) factors.
Conclusions:
Past major depression has a modest adverse effect on abstinence during and after smoking cessation treatment. An increased focus on the identification of effective treatments or treatment adaptations that eliminate this disparity in smoking cessation for MD+ smokers is needed.
Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes.
The authors examined patterns of change in depressive symptoms during smoking cessation treatment in 163 smokers with past major depressive disorder (MDD). Cluster analysis of Beck Depression Inventory (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) scores identified 5 patterns of change. Although 40% of participants belonged to clusters characterized by increasing depressive symptoms during quitting (rapid increasers, n = 31, and delayed increasers, n = 35), almost 47% were in clusters characterized by decreasing symptoms (delayed decreasers, n = 24, and rapid decreasers, n = 52). Both rapid and delayed increasers had especially poor smoking cessation outcomes. Results suggest that among smokers with an MDD history there is substantial heterogeneity in patterns of depressive symptoms during quitting and that patterns involving increased symptoms are associated with low abstinence rates.
Earlier research indicated that a 10-session mood management (MM) intervention was more effective than a 5-session standard intervention for smokers with a history of major depressive disorder (MDD). In a 2 × 2 factorial design, the present study compared MM intervention to a contact-equivalent health education intervention (HE) and 2 mg to 0 mg of nicotine gum for smokers with a history of MDD. Participants were 201 smokers, 22% with a history of MDD. Contrary to the earlier findings, the MM and HE interventions produced similar abstinence rates: 2 mg gum was no more effective than placebo. History-positive participants had a greater increase in mood disturbance after the quit attempt. Independent of depression diagnosis, increases in negative mood immediately after quitting predicted smoking. No treatment differences were found in trends over time for measures of mood, withdrawal symptoms, pleasant activities and events, self-efficacy, and optimism and pessimism. History-positive smokers may be best treated by interventions providing additional support and contact, independent of therapeutic content.
Studied (a) the validity of 2 methods of identifying reinforcing and punishing events, (b) their interrelations and dimensional structure, and (c) their relation to depression. A total of 909 Ss who were screened with the MMPI and classified as depressed, nondepressed psychiatric, or normal control rated the frequency and the subjective enjoyability or aversiveness of 320 pleasant (the Pleasant Event Schedule Form III) and 320 unpleasant events (the Unpleasant Events Schedule Form I). Some Ss also monitored the occurrence of pleasant and unpleasant events and rated their mood on a daily basis (Depression Adjective Check List). Correlations between each event and mood were calculated and used to identify 49 pleasant and 35 unpleasant "mood-related events." The proportion of Ss for whom the events correlated with mood and the mean enjoyability and aversiveness of the items were hypothesized to be measures of reinforcing or punishing impact. As predicted, statistically significant correlations between these 2 measures were obtained. The mood-related events also discriminated more strongly between depressed and nondepressed groups than the non-mood-related events did. The intercorrelations between pleasant and unpleasant events yielded separate and orthogonal dimensions of punishment and of reinforcement. (28 ref)
Do negative cognitive styles provide similar vulnerability to first onsets versus recurrences of depressive disorders, and are these associations specific to depression? The authors followed for 2.5 years prospectively college freshmen (N = 347) with no initial psychiatric disorders at high-risk (HR) versus low-risk (LR) for depression on the basis of their cognitive styles. HR participants had odds of major, minor, and hopelessness depression that were 3.5-6.8 times greater than the odds for LR individuals. Negative cognitive styles were similarly predictive of first onsets and recurrences of major depression and hopelessness depression but predicted first onsets of minor depression more strongly than recurrences. The risk groups did not differ in incidence of anxiety disorders not comorbid with depression or other disorders, but HR participants were more likely to have an onset of anxiety comorbid with depression.
The Pleasant Events Schedule is a behavioral self-report inventory of potentially reinforcing events. The test–retest method, involving 181 Ss of various ages and social classes, demonstrated good to excellent stability for the 8 most used scales of the schedule across periods of 1, 2, and 3 mo. Concurrent validity was assessed by comparison with peer and observer ratings. Predictive validity of the test's frequency ratings was studied in relation to subsequent self-monitoring data, while predictive validity of test enjoyability ratings was determined by comparison with subsequent choice behavior. Construct validity was inferred from the results of other research. Adequate validity of all types was found. Scale intercorrelations are also reported, and the question of response bias is addressed. (29 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We examine and refine the Fagerström Tolerance Questionnaire (FTQ; Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).
In Behavioral Activation (BA) for depression (Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001)), which has recently
received empirical support in a large randomized trial, therapists pay close attention to the function of behavior and the
role of aversive controlling stimuli and escape and avoidance behavior in depression. A key variable to measure in studies
of BA is when and how clients become more activated over the course of treatment. This study sought to develop an initial
set of items for the Behavioral Activation for Depression Scale (BADS), submit these items to an exploratory factor analysis
in an initial administration (Study 1, N = 391), and submit the resulting scale to a confirmatory factor analysis in a second administration (Study 2, N = 319). Results indicated four factors (Activation, Avoidance/Rumination, Work/School Impairment, and Social Impairment)
with good factor structure, internal consistency, and test-retest reliability. Evidence for construct and predictive validity
is presented.
We examine and refine the Fagerström Tolerance Questionnaire (FTQ: Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).
The dimensionality of coping, as measured by 65 items from 3 commonly used instruments, and the relation of coping and stress to concurrent and future depression were studied in a community sample of 742 older (greater than or equal to 50 years old) adults. Measures of coping, stress, and depression were obtained at 2 time points over a 2-year period. Depression was assessed by symptom checklist and by diagnostic interview. Three coping factors--Cognitive Self-Control, Ineffective Escapism, and Solace Seeking--that had adequate psychometric properties and accounted for 25% of the total item variance were identified. Ineffective Escapism was associated with current depression and had a direct and interactive effect on future depression, exacerbating the negative impact of stress rather than acting as a buffer. Although Cognitive Self-Control was unrelated to either concurrent or future depression, Solace Seeking significantly buffered the effect of stress in predicting a future diagnosis of depression. Stress and initial depression level predicted both measures of future depression. Gender (being female) predicted the future diagnosis of depression but not the increase of depressive symptoms.
Seventy-one heavy smokers who had failed in previous attempts to stop smoking participated in a randomized clinical trial to test the efficacy of clonidine as an aid in smoking cessation. The success rate in clonidine-treated subjects (verified by serum cotinine concentration) was more than twice that in the placebo-treated subjects. When the data were stratified by gender, a strong effect present in women was not apparent in men. After six months, cessation rates remained significantly higher among smokers treated with clonidine than those receiving placebo. The data also revealed an unexpectedly high prevalence (61%) of a history of major depression in this sample and a significant negative effect of such a history on cessation regardless of treatment. These findings, highly suggestive of an important role of clonidine in smoking cessation, warrant further studies to establish the long-term (greater than or equal to 12 months) efficacy of this drug and to replicate the association between nicotine dependence and depression.
Depression, whether conceptualized as a trait, symptom, or as a diagnosable disorder, is overrepresented among smokers. Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse. This article documents these relationships and explores several potential links between smoking and depression. The potential efficacy of antidepressant therapy, cognitive-behavioral therapy, and nicotine replacement therapy for smokers with depressive disorders or traits is discussed. Clinical implications and the role of patient treatment matching are also discussed.
This article describes the test of the hypothesis that a cognitive-behavioral mood management intervention would be effective for smokers with a history of major depressive disorder (MDD). The method was randomized trial; the assessments occurred at Weeks 0, 8, 12, 26, and 52. Ss were 149 smokers; 31% had a history of MDD. All received 2 mg of nicotine gum. Mood management was provided in 10 group sessions over 8 weeks. Standard treatment was provided in 5 group sessions over 8 weeks. Outcome was continuous abstinence. History-positive Ss were more likely to be abstinent when treated with mood management. Treatment condition differences were not significant for history-negative Ss. For history-positive Ss, less anger at baseline predicted abstinence. For history-negative Ss, more years smoked and higher baseline carbon monoxide (CO) predicted abstinence. Cognitive-behavioral therapy did not affect mood after quitting. Abstinence predictors differed as a function of baseline diagnosis.
The authors examined the incidence and predictors of major depression following successful smoking cessation treatment, with special attention to the influence of past major depression.
Three-month follow-up data were obtained from 126 subjects who successfully completed a 10-week smoking cessation program.
The 3-month incidence of new major depression following treatment for nicotine dependence was 2%, 17%, and 30% among subjects with histories of no major depression, single major depression, and recurrent major depression, respectively. A history of major depression and persistent withdrawal symptoms independently predicted posttreatment major depression.
Continued patient care beyond the 2-4-week period associated with the nicotine withdrawal syndrome is indicated when abstinence is attempted by smokers with prior major depression.
Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking.
To assess rates of smoking and tobacco cessation in adults, with and without mental illness.
Analysis of data on 4411 respondents aged 15 to 54 years from the National Comorbidity Survey, a nationally representative multistage probability survey conducted from 1991 to 1992.
Rates of smoking and tobacco cessation according to the number and type of psychiatric diagnoses, assessed by a modified version of the Composite International Diagnostic Interview.
Current smoking rates for respondents with no mental illness, lifetime mental illness, and past-month mental illness were 22.5%, 34.8%, and 41.0%, respectively. Lifetime smoking rates were 39.1%, 55.3%, and 59.0%, respectively (P<.001 for all comparisons). Smokers with any history of mental illness had a self-reported quit rate of 37.1% (P =.04), and smokers with past-month mental illness had a self-reported quit rate of 30. 5% (P<.001) compared with smokers without mental illness (42.5%). Odds ratios for current and lifetime smoking in respondents with mental illness in the past month vs respondents without mental illness, adjusted for age, sex, and region of the country, were 2.7 (95% confidence interval [CI], 2.3-3.1) and 2.7 (95% CI, 2.4-3.2), respectively. Persons with a mental disorder in the past month consumed approximately 44.3% of cigarettes smoked by this nationally representative sample.
Persons with mental illness are about twice as likely to smoke as other persons but have substantial quit rates. JAMA. 2000;284:2606-2610.
Cigarette smokers with past major depressive disorder (MDD) received 8 group sessions of standard, cognitive-behavioral smoking cessation treatment (ST; n = 93) or standard, cognitive-behavioral smokiig cessation treatment plus cognitive-behavioral treatment for depression (CBT-D; n = 86). Although abstinence rates were high in both conditions (ST, 24.7%; CBT-D, 32.5%, at 1 year) for these nonpharmacological treatments, no main effect of treatment was found. However, secondary analyses revealed significant interactions between treatment condition and both recurrent depression history and heavy smoking ( > or =25 cigarettes a day) at baseline. Smokers with recurrent MDD and heavy smokers who received CBT-D were significantly more likely to be abstinent than those receiving ST (odds ratios = 2.3 and 2.6, respectively). Results suggest that CBT-D provides specific benefits for some, but not all, smokers with a history of MDD.
The authors examined patterns of change in depressive symptoms during smoking cessation treatment in 163 smokers with past major depressive disorder (MDD). Cluster analysis of Beck Depression Inventory (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) scores identified 5 patterns of change. Although 40% of participants belonged to clusters characterized by increasing depressive symptoms during quitting (rapid increasers, n = 31, and delayed increasers, n = 35), almost 47% were in clusters characterized by decreasing symptoms (delayed decreasers, n = 24, and rapid decreasers, n = 52). Both rapid and delayed increasers had especially poor smoking cessation outcomes. Results suggest that among smokers with an MDD history there is substantial heterogeneity in patterns of depressive symptoms during quitting and that patterns involving increased symptoms are associated with low abstinence rates.
The assessment of cognition and cognitive change is important for case conceptualization, monitoring the efficacy of specific interventions, and evaluating treatment outcome in cognitive-behavioral therapy. Unfortunately, a paucity of normative data exists on cognitive measures used for psychotherapy outcome research in depression, and little information is available to guide a practitioner's understanding of the magnitude and clinical significance of a patient's cognitive change. This article presents normative data on 6 self-report instruments that assess negative and positive automatic thoughts, hopelessness, cognitive biases and errors, and dysfunctional attitudes. Normative data were derived from studies published from the date of inception of a given cognitive index to the year 2000. Recommendations for the use of these normative data are provided.
Depression, whether conceptualized as a trait, symptom, or as a diagnosable disorder, is overrepresented among smokers. Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse. This article documents these relationships and explores several potential links between smoking and depression. The potential efficacy of antidepressant therapy, cognitive-behavioral therapy, and nicotine replacement therapy for smokers with depressive disorders or traits is discussed. Clinical implications and the role of patient treatment matching are also discussed.
We examined baseline differences in dysfunctional attitudes and coping associated with a history of major depressive disorder (MDD) among 435 smokers participating in a smoking cessation trial. Consistent with expectations, MDD history was associated with greater dysfunctional attitudes, greater use of maladaptive coping, less use of adaptive coping, and greater dysphoria and negative mood. The effects of MDD history on cognition and coping were independent from the effects of a history of alcohol dependence (AD), indicating that MDD history is a unique risk factor for variables associated with vulnerability to depression. Finally, regression analyses showed that the effects of MDD history on depressive symptoms and negative mood were mediated by dysfunctional attitudes and by both adaptive and maladaptive coping. Results indicate that smokers with an MDD history seeking cessation treatment possess characteristics that may be targets for cognitive–behavioral treatments (CBT) aimed at addressing vulnerability to depression and negative moods during smoking cessation.
To the Editor.—
The article entitled "Heavy Smokers, Smoking Cessation, and Clonidine" by Glassman et al1 raised interesting questions about using a nonnicotine medication as an adjunct in smoking cessation. However, there were several points that could have been clarified to help with evaluating the trial.First, the authors mention eligibility criteria for the study, using a modified Fagerström2 tolerance scale to determine those individuals who were heavily nicotine dependent, but excluding smokers who had not cut down to 50% of baseline level. This inclusion criterion may have selected out those smokers who were the most nicotine dependent, simply because they were unable to tolerate the withdrawal period. Including these individuals may have influenced the outcome, positively or negatively. Comparing a numerical score from the Fagerström scale would clarify this.Second, although serum nicotine and cotinine levels were measured at the end of four week's of clonidine treatment
The Structured Clinical Interview for DSM-III-R [Diagnostic and Statistical Manual, Revised] (SCID) is a semistructured interview for making the major Axis I and Axis II diagnoses. It is administered by a clinician or trained mental health professional who is familiar with the DSM-III-R classification and diagnostic criteria (1). The subjects may be either psychiatric or general medical patients or individuals who do not identify themselves as patients, such as subjects in a community survey of mental illness or family members of psychiatric patients. The language and diagnostic coverage make the SCID most appropriate for use with adults (age 18 or over), but with slight modification, it may be used with adolescents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Traces the development of the cognitive approach to psychopathology and psy hotherapy from common-sense observations and folk wisdom, to a more sophisticated understanding of the emotional disorders, and finally to the application of rational techniques to correct the misconceptions and conceptual distortions that form the matrix of the neuroses. The importance of engaging the patient in exploration of his inner world and of obtaining a sharp delineation of specific thoughts and underlying assumptions is emphasized. (91/4 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Efficacy expectations are postulated to mediate all behavior change. This study examined the construct of self-efficacy in the self-change of smoking behavior. A 31-item measure of self-efficacy was used that included ratings of both temptation (cue strength) and confidence (efficacy). The subjects were 957 volunteers representing five stages of self change: (1) immotives, (2) contemplators, (3) recent quitters, (4) long-term quitters, and (5) relapsers. Subjects were assessed initially and at a 3- to 5-month follow-up. The self-efficacy scale proved to be an extremely reliable and coherent instrument with identifiable but not clearly interpretable subcomponents. Groups of subjects demonstrated significant differences in total self-efficacy scores. Efficacy expectations demonstrated small but significant relationships with smoking history variables and the pros and cons of smoking, but not with demographic, life stress, or persistence measures. Subject's efficacy evaluations at the initial assessment were related to changes in status for recent quitters and contemplators at the follow-up. The relationship between temptation and efficacy ratings is complex and varies for subjects in the various stages of change. Correlations between total self-efficacy and temptation scores were largest for contemplators (r = –.65) and relapsers (r = –.67) and smallest for the recent quitters (r = –.18). Finally, the magnitude of the difference between temptation and efficacy increased with length of abstinence for subjects in maintenance.
Research studies focusing on the psychometric properties of the Beck Depression Inventory (BDI) with psychiatric and nonpsychiatric samples were reviewed for the years 1961 through June, 1986. A meta-analysis of the BDI's internal consistency estimates yielded a mean coefficient alpha of 0.86 for psychiatric patients and 0.81 for nonpsychiatric subjects. The concurrent validitus of the BDI with respect to clinical ratings and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were also high. The mean correlations of the BDI samples with clinical ratings and the HRSD were 0. 72 and 0.73, respectively, for psychiatric patients. With nonpsychiatric subjects, the mean correlations of the BDI with clinical ratings and the HRSD were 0.60 and 0.74, respectively. Recent evidence indicates that the BDI discriminates subtypes of depression and differentiates depression from anxiety.
The authors review recent literature that has demonstrated an association between cigarette smoking behavior and major depression. Persons with major depression are more likely to smoke and to have difficulty when they try to stop. When they manage to succeed in stopping, such persons are at increased risk of experiencing mild to severe states of depression, including full blown major depression. The period of vulnerability to a new depressive episode appears to vary from a few weeks to several months after cessation. This knowledge suggests a relationship between smoking and depression that is complex, pernicious, and potentially life-long. It is recommended that cessation treatments incorporate screening procedures that will identify those patients with a propensity to depression and monitor the emergence of postcessation depression, particularly in those with a history of depression.
Qualitative research suggests that a shared route of administration (i.e. via inhalation) for the common forms of both tobacco (i.e. cigarettes) and cannabis (i.e. joints) may contribute to their co-occurring use.
We used data on 43,093 U.S. adults who participated in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether cannabis use and abuse/dependence were associated with smoked (cigarettes, cigars, pipes) versus smokeless (snuff, chewed tobacco) forms of tobacco use, even after controlling for socio-demographic, psychiatric and substance-related covariates.
Tobacco smoking was associated with a 3.3-4.5 times increased risk for cannabis use and abuse/dependence respectively. After covariate adjustment, importantly for nicotine dependence, smoking tobacco (but not smokeless tobacco) was still significantly associated with both cannabis use (multinomial odds-ratio (MOR) 1.99) and cannabis dependence (MOR 1.55). In contrast, use of smokeless tobacco was not significantly correlated with elevated rates of cannabis use (MOR 0.96) or abuse/dependence (MOR 1.04).
Route of administration may play an important role in the observed association between tobacco and cannabis use. This may represent a physiological adaptation of the aero-respiratory system and/or index social and cultural influences surrounding the use of smoked versus smokeless forms of tobacco.
To determine whether nicotine dependence, classified by level of severity, was associated with other substance dependence, major depression, and anxiety disorders, we studied a random sample of 1007 young adults in the Detroit (Mich) area using the National Institute of Mental Health Diagnostic Interview Schedule, revised according to DSM-III-R. The systematic coverage of DSM-III-R criteria of nicotine dependence provides an unprecedented opportunity to separate persons with nicotine dependence from the larger class of persons with a history of smoking and to examine the prevalence of psychiatric disorders among persons with nicotine dependence and among nondependent smokers. The lifetime prevalence of nicotine dependence was 20%. Nicotine dependence was associated with alcohol, cannabis, and cocaine dependence. Controlling for the effects of other substance dependencies, persons with nicotine dependence had higher rates of major depression and anxiety disorders. The strength of these associations varied by level of severity of nicotine dependence. Nondependent smokers had higher rates of other substance dependencies, but not of major depression or anxiety disorders.
Because recurrent depression represents a major public health problem, the successful long-term treatment of individuals who develop repeated episodes of depression has become a high clinical priority. Effective preventive treatment requires continued pharmacologic management for most individuals with recurrent depression. Although the efficacy of tricyclic antidepressants or lithium carbonate in preventive treatment has been well established, evidence is less clear for monomaine oxidase inhibitors and the newer antidepressants. In addition to the need for more long-term studies on the new compounds, the role of psychotherapy as combination treatment needs to be further elucidated.
A relationship between cigarette smoking and major depressive disorder was suggested in previous work involving nonrandomly selected samples. We conducted a test of this association, employing population-based data (n = 3213) collected between 1980 and 1983 in the St Louis Epidemiologic Catchment Area Survey of the National Institute of Mental Health. A history of regular smoking was observed more frequently among individuals who had experienced major depressive disorder at some time in their lives than among individuals who had never experienced major depression or among individuals with no psychiatric diagnosis. Smokers with major depression were also less successful at their attempts to quit than were either of the comparison groups. Gender differences in rates of smoking and of smoking cessation observed in the larger population were not evident among the depressed group. Furthermore, the association between cigarette smoking and major depression was not ubiquitous across all psychiatric diagnoses. Other data are cited indicating that when individuals with a history of depression stop smoking, depressive symptoms and, in some cases, serious major depression may ensue.
The relationships among depression, depressogenic cognitions, and mood-related activities were examined in clinic and nonclinic populations. Fifty-seven participants in a treatment program for depression and 143 undergraduate subjects were administered a questionnaire battery that included the Beck Depression Inventory (BDI), Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitude Scale (DAS), and the mood-related items of both the Pleasant Events Schedule (PES) and Unpleasant Events Schedule (UES). Depressogenic cognitions and mood-related activities were correlated with one another and with depression in both populations: As depression increased, depressogenic cognitions and unpleasant activities increased while pleasant activities decreased. In addition, partial correlational analyses demonstrated that both depressogenic cognitions and mood-related activities, independent of one another, were correlated significantly with depression. This demonstrates that cognitive and behavioral variables, while related to one another, contribute independent information concerning depression.
This study analyzes the ways 100 community-residing men and women aged 45 to 64 coped with the stressful events of daily living during one year. Lazarus's cognitive-phenomenological analysis of psychological stress provides the theoretical framework. Information about recently experienced stressful encounters was elicited through monthly interviews and self-report questionnaires completed between interviews. At the end of each interview and questionnaire, the participant indicated on a 68-item Ways of Coping checklist those coping thoughts and actions used in the specific encounter. A mean of 13.3 episodes was reported by each participant. Two functions of coping, problem-focused and emotion-focused, are analyzed with separate measures. Both problem- and emotion-focused coping were used in 98% of the 1,332 episodes, emphasizing that coping conceptualized in either defensive or problem-solving terms is incomplete- both functions are usually involved. Intraindividual analyses show that people are more variable than consistent in their coping patterns. The context of an event, who is involved, how it is appraised, age, and gender are examined as potential influences on coping. Context and how the event is appraised are the most potent factors. Work contexts favor problem-focused coping, and health contexts favor emotion-focused coping. Situations in which the person thinks something constructive can be done or that are appraised as requiring more information favor problem-focused coping, whereas those having to be accepted favor emotion-focused coping. There are no effects associated with age, and gender differences emerge only in problem-focused coping: Men use more problem-focused coping than women at work and in situations having to be accepted and requiring more information. Contrary to the cultural stereotype, there are no gender differences in emotion-focused coping.
Psychiatry has been essentially uninterested in cigarette smoking and nicotine. However, it is the view of this author that both cigarette smoking and smoking cessation are highly relevant to the clinical psychiatrist in the care of patients and that they are potentially a source of important insights into psychopathology. To support that view, the author reviews the evidence that both major depression and depressive symptoms are associated with a high rate of cigarette smoking and that lifetime history of major depression has an adverse impact on smoking cessation. He also reviews the data available on the influence of cigarette smoking cessation on the course of major depression, the relationship between cigarette smoking and other psychiatric diagnoses, particularly schizophrenia, and the neuropharmacology that might underlie these associations. Finally, the implications of these relationships for psychiatry are discussed.
Synopsis
This paper reports the course with respect to remission and relapse of a cohort of predominantly in-patient RDC major depressive subjects, who were followed at 3-monthly intervals to remission and for up to 15 months thereafter. Remission was comparatively rapid with 70% of subjects remitting within 6 months. Only 6% failed to do so by 15 months. However, 40% relapsed over the subsequent 15 months, with all the relapses occurring in the first 10 months. Greater severity of the depression and longer duration of the illness predicted a longer time to remission. Greater initial severity of depression also predicted relapse. Subjects with a worse outcome had not received less adequate treatment than the remainder. Our results confirm the comparatively poor outcome subsequent to remission that has been reported in recent literature, in spite of the availability of modern methods of treatment. The clustering of relapses in the first 10 months gives some support to the distinction between relapse and later recurrence.
Earlier research indicated that a 10-session mood management (MM) intervention was more effective than a 5-session standard intervention for smokers with a history of major depressive disorder (MDD). In a 2 x 2 factorial design, the present study compared MM intervention to a contact-equivalent health education intervention (HE) and 2 mg to 0 mg of nicotine gum for smokers with a history of MDD. Participants were 201 smokers, 22% with a history of MDD. Contrary to the earlier findings, the MM and HE interventions produced similar abstinence rates: 2 mg gum was no more effective than placebo. History-positive participants had a greater increase in mood disturbance after the quit attempt. Independent of depression diagnosis, increases in negative mood immediately after quitting predicted smoking. No treatment differences were found in trends over time for measures of mood, withdrawal symptoms, pleasant activities and events, self-efficacy, and optimism and pessimism. History-positive smokers may be best treated by interventions providing additional support and contact, independent of therapeutic content.
A history of major depressive disorder (MDD) predicts failure to quit smoking. We determined the effect of nortriptyline hydrochloride and cognitive-behavioral therapy on smoking treatment outcome in smokers with a history of MDD. The study also addressed the effects of diagnosis and treatment condition on dysphoria after quitting smoking and the effects of dysphoria on abstinence.
This was a 2 (nortriptyline vs placebo) x 2 (cognitive-behavioral therapy vs control) x 2 (history of MDD vs no history) randomized trial. The participants were 199 cigarette smokers. The outcome measures were biologically verified abstinence from cigarettes at weeks 12, 24, 38, and 64. Mood, withdrawal, and depression were measured at 3, 5, and 8 days after the smoking quit date.
Nortriptyline produced higher abstinence rates than placebo, independent of depression history. Cognitive-behavioral therapy was more effective for participants with a history of depression. Nortriptyline alleviated a negative affect occurring after smoking cessation. Increases in the level of negative affect from baseline to 3 days after the smoking quit date predicted abstinence at later assessments for MDD history-negative smokers. There was also a sex-by-depression history interaction; MDD history-positive women were less likely to be abstinent than MDD history-negative women, but depression history did not predict abstinence for men.
Nortriptyline is a promising adjunct for smoking cessation. Smokers with a history of depression are aided by more intensive psychosocial treatments. Mood and diagnosis interact to predict relapse. Increases in negative affect after quitting smoking are attenuated by nortriptyline.
Case studies suggest cigarette abstinence may precipitate a major depressive episode. This study examined the incidence and predictors of major depression in the 12 months after treatment for smoking cessation.
Participants (N=304, 172 women) were recruited from two trials of smoking cessation. Both trials provided psychological group intervention, but one group received treatment with nicotine gum and the other was given nortriptyline or placebo. The incidence of major depressive episodes was identified by the Inventory to Diagnose Depression, which was administered at follow-up assessments.
The 12-month incidence of major depression after treatment for smoking cessation was 14.1% (N=43). Multiple logistic regression analyses indicated that history of depression, baseline Beck Depression Inventory score, college education, and age at smoking initiation were significant predictors of major depression after treatment. Abstinence at the end of treatment did not significantly predict major depression.
Patients who achieved abstinence from smoking showed a risk of developing depressive episodes similar to those who failed to achieve abstinence. As expected, patients who had a history of depression were more likely to experience depressive episodes after treatment for smoking cessation. The 12-month incidence of major depression in this study group was higher than that observed in the general population, but reasons for the elevation were not clear.
Few prospective studies of course for first admission depressives are reported.
One hundred consecutive depressed inpatients were followed prospectively over 18 months. Course was defined operationally using the Hamilton Depression scale and ICD-10 criteria. Results were analysed using life-tables.
The cumulative probabilities of remission onset by 3 and 18 months were 0.67 (95% C.I.=0.57-0.77) and 0.82 (95% C.I.=0.74-0.90). The cumulative probability of relapse was 0.25 (95% C.I.=0.15-0.35); 53% of those relapsing did so in the first 2 months. Younger age at onset, longer illness length, higher depression and anxiety ratings, predicted delayed remission onset. ICD-10 episode severity predicted relapse.
The chances of remission onset at 3 months and relapse were increased relative to other studies; risk of chronicity was similar. Predictors of outcome to emerge were similar to other studies.
Adoption of these remission onset criteria may identify earlier (at 3 months), subjects at high risk of chronicity. After remission onset, subjects with severe illnesses warrant careful follow-up to detect relapse, particularly during the first 2 months.
The operational criteria used were different to other prospective studies. Relatively few psychosocial variables were included in the analysis.
History of depression in smokers has been associated with an inability to quit smoking and with an increased likelihood of smoking relapse. This study prospectively tracked nicotine withdrawal symptoms, symptoms of depression, and ability to quit smoking between smokers with and without a probable history of major depression who were trying to quit smoking with minimal assistance. Results indicated that prior to quitting, smokers with a history of depression smoked to reduce negative affect, in response to craving, and in social situations. Additionally, positive history smokers scored higher on the Center for Epidemiological Studies Depression Scale (CES-D) than did smokers without such a history. Following a quit attempt, positive history smokers were somewhat more likely to experience greater symptoms of nicotine withdrawal than negative history smokers. However, among the positive history smokers, depressive symptoms as measured by the CES-D increased significantly 4 weeks after trying to quit, compared to a decline among negative history smokers. Positive and negative history smokers did not significantly differ on ability to quit smoking within the 30-day follow-up period. History of depression appears to be associated with a delayed increase in symptoms of depression following a quit attempt. However, it remains to be demonstrated whether such an increase in depressive symptoms may influence later probability of relapse.
Depressive disorders are a significant public health issue. They are prevalent, disabling, often chronic illnesses, which cause a high economic burden for society, related to both direct and indirect costs. Depressive disorders also influence significantly the outcome of comorbid medical illnesses such as cardiac diseases, diabetes, and cancer. In primary care, underrecognition and undertreatment of depressive disorders are common, despite their relatively high prevalence, which accounts typically for more than 10% of patients. Primary care physicians should be aware of the common risk factors for depressive disorders such as gender, neuroticism, life events and adverse childhood experiences, and they should be familiar with associated features such as a positive psychiatric family history and prior depressive episodes. In primary care settings, depressive disorders should be considered with patients with multiple medical problems, unexplained physical symptoms, chronic pain or use of medical services that is more frequent than expected. Management of depressive disorders in primary care should include treatment with the newer antidepressant agents (given the fact they are typically well tolerated and safe) and focus on concomitant unhealthy behaviors as well as treatment adherence, which may both affect patient outcome. Programs aimed at improving patient follow-up and the coordination of the primary care intervention with that of specialists have been found to improve patient outcomes and to be cost effective.
Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes.