It's commonly thought that teen depression can lead to cigarette smoking, but a new study, published in the October edition of Pediatrics, shows it's the smoking that increases the risk of depression.
"Cigarette use is a powerful determinant of developing high depressive symptoms," says Elizabeth Goodman, M.D., associate professor of pediatrics in the division of Adolescent Medicine at Children's Hospital Medical Center of Cincinnati and lead author of the study. "In fact, nondepressed teens who smoke face approximately a four times greater risk of developing depression than non-smoking teens."
Smoking's effect on the development of depression may be attributable to central nervous system effects of nicotine or other smoking by-products, according to Dr. Goodman. "The effectiveness of antidepressants in smoking cessation, independent of previous or current depression, provide additional support for this view," she says.
While heavy cigarette use is not necessarily a result of depression, Dr. Goodman's study shows that other social factors do predict progression to heavy smoking. These include previous experimentation with tobacco products, poor school performance, peer tobacco use, more frequent use of alcohol, and parental report of bad temper.
For healthcare providers, the study highlights the importance of providing "anticipatory guidance" regarding psychosocial functioning and tobacco use to teenagers, according to Dr. Goodman, and of encouraging adolescents to stop smoking. "The findings of this study suggest that problem behavior, physical dependence, and social influence all impact on the progression to heavy smoking in adolescents," she says.
The study used data from thousands of adolescents who were surveyed for the National Longitudinal Study of Adolescent Health.
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PEDIATRICS