High Smoking Dependence Linked to Depression | Nutrition Fit



Summary: Smokers with a higher dependency on tobacco had a greater probability of reporting symptoms of depression.

Source: University of Helsinki

An international study coordinated by the University of Helsinki provides new information on the connection between symptoms of depression and smoking dependence.

The results support the importance of understanding the reasons behind smoking dependence to be able to help depressed smokers to quit, and thus possibly relieve depression symptoms.

It has been widely reported that smoking is more common among people suffering from depression than in the population in general. The actual mechanism of this association, however, remains unclear.

So far, studies about the association between smoking dependence and depression are very rare. This study, led by researchers from the University of Helsinki, focused on the different self-reported motivation factors for smoking.

The work was carried out in collaboration with the Universities of Wisconsin and Missouri U.S., where the questionnaire was initially developed.

The study was based on more than 1400 Finnish twins who were smokers and provided smoking and depression information by responding to questionnaires.

The results were published on February 24th in the esteemed scientific journal Addiction.

The study found that smokers who were more dependent were also more likely to be depressed. Of the different motives for smoking examined, the motives related to high levels of craving and automatic smoking behavior, as well as smoking to regulate emotional states were found to be the most strongly related to depression.

This shows a young person surrounded by smoke
The study found that smokers who were more dependent were also more likely to be depressed. Image is in the public domain

“Our results suggest that depressed persons are not smoking because of taste or taste-reward related to smoking. Rather, depression seems to be related to primary dependence motives and the regulation of mood,” says Senior Researcher Maarit Piirtola, the first author of the study from the Institute for Molecular Medicine Finland at the University of Helsinki.

The unique twin study setting enabled the study team to rule out familial influences, including shared genetic vulnerability, by examining the association between depression and smoking dependence within twin pairs, especially within identical pairs.

According to Senior Researcher Tellervo Korhonen, who led the study, it is important to understand the individual underlying reasons that maintain smoking dependence, so that tailored and multidisciplinary smoking cessation support can be provided.

Even though this study gives strong new evidence about the relation between smoking dependence and depressive symptoms, the researchers highlight that this was a cross-sectional analysis.

“Therefore, we could not show which happens first: smoking dependence or depression among daily smokers,” says Professor and Research Director Jaakko Kaprio from the University of Helsinki.

About this depression research news

Source: University of Helsinki
Contact: Press Office – University of Helsinki
Image: The image is in the public domain

Original Research: Open access.
The associations of smoking dependence motives with depression among daily smokers” by Maarit Piirtola et al. Addiction


See also

This shows a brain

The associations of smoking dependence motives with depression among daily smokers


To investigate how strongly smoking dependence and smoking dependence motives are associated with depressive symptoms among daily smokers and if these associations are independent of measured confounders and shared familial factors.


Cross‐sectional individual‐based and within‐pair analyses.


Fourth wave of the population‐based Finnish Twin Cohort conducted in 2011.


918 daily smokers born 1945–1957 (48% men), mean age 59.5 years including 38 twin pairs discordant for depression.


Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale with a cut off value ≥20 for depression. Smoking dependence was assessed using the Fagerström Test for Cigarette Dependence (FTCD) and smoking dependence motives with three subscales from the multi‐dimensional Brief Wisconsin Inventory of Smoking Dependence Motives (WISDM): primary dependence motives (PDM), affective enhancement (AE), and Taste. Logistic regressions, using standardized scores of independent variables and adjusted for multiple confounders with correction for sampling as twin pairs, were used in the individual‐based analyses. Conditional logistic regression was used to control for shared familial factors in discordant twin pairs.


Prevalence of depression was 18% (n = 163: 61 [14%] in men, n = 102 [22%] in women). Higher smoking dependence measured by the FTCD (OR 1.45; 95% CI 1.20, 1.75), and dependence motives measured by the PDM (1.56; 1.30, 1.87) and the AE (1.54; 1.28, 1.85) were associated with higher odds of depression. The associations remained after adjusting for individual confounders, except for neuroticism, which attenuated all associations. FTCD, PDM, and AE showed associations with depression within depression‐discordant monozygotic pairs, suggesting an association independent of familial factors.


Depression appears to be associated with smoking dependence and smoking dependence motives related to heavy, automatic use and use to regulate affective states. The associations appear to be confounded or mediated by neuroticism but are independent of shared familial influences.


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