文章基本信息

标题：Treating Tobacco Dependence in Clinically Depressed Smokers: Effect of Smoking Cessation on Mental Health Functioning
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作者：Judith J. Prochaska ; Sharon M. Hall ; Janice Y. Tsoh 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2008
卷号：98
期号：3
页码：446-448
DOI：10.2105/AJPH.2006.101147
语种：English
出版社：American Public Health Association
摘要：We analyzed data from a randomized trial of 322 actively depressed smokers and examined the effect of smoking cessation on their mental health functioning. Only 1 of 10 measures at 4 follow-up time points was significant: participants who successfully stopped smoking reported less alcohol use than did participants who continued smoking. Depressive symptoms declined significantly over time for participants who stopped smoking and those who continued smoking; there were no group differences. Individuals in treatment for clinical depression can be helped to stop smoking without adversely affecting their mental health functioning. Despite elevated rates of tobacco use among individuals who have mental illness, very little is known about how best to treat their tobacco dependence. Prevailing beliefs among mental health professionals, tobacco control advocates, and researchers that patients need to smoke to manage their psychiatric symptoms may reduce access to tobacco treatment. Alarming case studies have reported the recurrence of major depression following tobacco cessation in smokers who have a history of depression. 1 These studies could not, of course, control for the elevated risk of depression recurrence among individuals who had histories of depression. Two empirical studies examined depression recurrence and smoking cessation. In the first study, 100 individuals who had a history of depression were part of an investigation of the use of sertraline for smoking cessation. Glassman et al. 2 reported a 7-fold increase in depression recurrence among participants who successfully stopped smoking. However, 39% of smokers who relapsed were lost to follow-up and their depression status was undetermined; only 5% of successful quitters were lost to follow-up. In the second study, Tsoh et al. 3 investigated 304 smokers who were receiving smoking cessation treatment, 32% of whom had a history of depression. They reported a 14% 12-month incidence of major depression. Recurrence of depression was predicted by depression history and not by smoking status. A recent randomized clinical trial was one of the first to examine tobacco dependence treatment in actively depressed smokers. 4 The staged-care intervention, which matched intervention services to participants’ readiness to quit smoking, demonstrated significant cessation effects at 12- and 18-month follow-ups. At 18 months, cessation rates were 20% and 25% in the control and treatment groups, respectively. These data made it possible to examine the effect of smoking cessation on mental health functioning among depressed smokers. If tobacco use serves to self-medicate depressive symptoms, one would expect psychiatric symptoms to worsen and mental health service use to increase following smoking cessation. We tested this hypothesis.