Brief report
Depression and smoking amongst older general practice patients

https://doi.org/10.1016/j.jad.2005.02.014Get rights and content

Abstract

Background

Cerebrovascular disease is associated with depression in later life. Smoking is a known risk factor for cerebrovascular disease and, as a consequence, may contribute to the development of depression in the elderly. This study was designed to investigate the association between smoking and depression in people aged 60 years or over.

Methods

Cross-sectional survey of older adults attending a representative sample of general practitioners in Western Australia. Subjects were divided into four groups according to their smoking status: never smoked, ex-light smoker, ex-heavy smoker (> 20 cigarettes/day), and current smoker. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D). CES-D score of 22 or more was used to define the presence of clinically significant depression.

Results

1030 completed the assessment. Their age ranged from 60 to 101 years and 57.2% were female. The mean ± S.D. CES-D score was 10.5 ± 8.1, 10.6 ± 8.3, 12.5 ± 10.2 and 13.1 ± 11.0 for never smokers, ex-light smokers, ex-heavy smokers and current smokers respectively (p = 0.037), with 7.7%, 8.5%, 13.8% and 17.2% having CES-D ≥ 22 (p = 0.016). Current or past heavy smoking was associated with increased risk of clinically significant depression when compared to never or past light smoking (OR = 1.58, 95%CI = 1.01–2.48—after adjustments were made for age, gender, place of birth, social isolation, self-perceived health and harmful or hazardous drinking).

Conclusion

Past heavy smoking and current smoking are associated with increased frequency and severity of depression. Smoking cessation may play an important role in reducing the burden of depression in later life, but the success of smoking cessation interventions in decreasing the incidence and prevalence of depression might be predicated on the timing of the intervention; i.e., before the psychobiological changes associated with smoking become irreversible.

Introduction

Depression is a disabling disorder, affecting as many as 12% of the population of older adults at any one point in time (Copeland et al., 1999). The results of neuroimaging and neuropathological studies indicate that the brains of elderly people with depression have significant cerebrovascular disease (Thomas et al., 2002, Thomas et al., 2004). As a result, there is increasing interest about the potential role that risk factors for cerebrovascular disease might play in facilitating the clinical expression of depression.

Cigarette smoking is an important, but potentially reversible, risk factor for cardiovascular diseases (Burns, 2003, Wolf et al., 1988). Smoking has already been linked to depression amongst young adults (Fergusson et al., 2003, Hämäläinen et al., 2001), but limited information exists as to the relevance of such an association in later life. We designed the present study to systematically address this issue.

Section snippets

Study population

The study population consisted of patients attending 1 of 54 randomly selected GPs in Western Australia. Patients taking part in the study were required to be: (1) aged 60 years or older, (2) fluent in written English, and (3) give written informed consent to participate.

Survey methods and instruments

A consecutive series of patients awaiting general practice consultations were given the study's self-report questionnaire package by the practice nurse or receptionist. This questionnaire gathered information on age, gender,

Results

A total of 1061 subjects agreed to take part in the study, of whom 1030 provided information about smoking. Their mean age was 72.1 (S.D. = 7.4) years (range: 60–101) and 57.2% were female. Thirty percent of the participants were ex-light smokers, 24.0% ex-heavy smokers and 5.6% current smokers. Table 1 summarises subjects' basic demographic, social and clinical information according to their smoking status.

There were more males amongst ex-heavy than never smokers. Ex-heavy smokers were also more

Discussion

The results of this study show that there was a significant trend for CES-D scores to increase according to the smoking status of participants, although such an association was not linear. Depression was more frequent and severe in later life amongst ex-heavy smokers and current smokers than ex-light and never smokers.

Previous observational studies investigating the association between smoking and depression in young adults reported similar findings. Lasser et al. (2000) found that more than

Acknowledgements

The authors wish to thank all general practitioners and older adults who took part in this study. This paper was produced as part of a research program funded by the National Suicide and Prevention Strategy of Australia, National Health and Medical Research Council (NHMRC), the Alcohol Education and Research Foundation (AERF), and Healthway-WA.

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