Effect of Depression on Smoking Cessation Outcomes. SC (n=153). TAU (n=72). Test . Statistic. Characteristic. Mean Age. 41.6 (10.2). 41.0 (8.6). NS. % Male. 51%. 53%. NS. Education (yrs). 11.4 (2.3). 11.9 (2.1). NS. Race. % Caucasian. 37%. 42%. NS. % African Am. 28% 35%.
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% African Am.
Sonne SC1, Nunes EV2, Jiang H2, Gan W2, Tyson C1, Reid MS3
1Medical University of South Carolina, 2Columbia University/New York Psychiatric Institute, 3New York University School of Medicine
ABSTRACT:A great deal of literature has been published on the effect of both cigarette smoking and cessation on mood. Less information is available on the effect of mood on smoking cessation outcomes, particularly in a substance abusing population. The NIDA Clinical Trials Network recently completed a randomized, open label trial comparing the use of nicotine patches plus group counseling and treatment as usual (TAU) to TAU alone for substance-dependent outpatients interested in quitting smoking. We evaluated the effect of depression on smoking cessation outcomes. A total of 225 individuals were randomized in a 2:1 ratio to either Smoking Cessation (SC; n=153) or TAU (n=72). Approximately 31.1% of the sample (n=70) had baseline Beck Depression Inventory (BDI) scores > 20, and approximately half of the sample (n=110) reported a lifetime history of major depression (MDD). Individuals with a history of MDD reported an earlier age of onset for cigarette smoking (13.1 (3.7) vs. 14.3 (4.6) yrs; p=0.032), an earlier age of regular smoking (15.2 (3.7) vs. 16.7 yrs; p=0.010) as well as a higher baseline Fagerstrom score (6.6 (1.9) vs. 5.3 (2.0; p<0.001). Individuals with baseline BDI scores > 20 smoked 26.3 (14.6) cigarettes/day vs. 21.3 (9.0) p=0.002) as well as started regular smoking at an earlier age (15.0 (3.8) vs. 16.5 (4.9); p=0.034). Although there was not a statistically significant effect of lifetime history of major depression on smoking abstinence rates (9.3% MDD, vs. 4.3% no MDD), there was a greater probability for smoking abstinence for those with lower baseline BDI scores (p=0.041). These data suggest that for individuals with substance dependence who are interested in quitting smoking, evaluation and treatment of depressive symptoms may play an important role in improving smoking cessation outcomes.
RESULTS- Baseline (continued)
Also in Table 3, alcohol was more often the primary substance of abuse for those with a BDI > 20 compared to those with a BDI<20 (p=0.015), and there was a trend (p=0.07 and; p=0.06, respectively) for a higher percentage of cocaine and amphetamine as primary for those with a BDI score <20.
Table 1. Describes the total sample of 225 participants. As can be seen, there were no statistically significant differences in demographics between treatment groups.
Although there is a great deal of data on the effect of smoking cessation on mood, there is less information on the effect of mood on smoking cessation outcomes. The Clinical Trials Network recently completed an 8-week, open-label trial comparing the use of nicotine patches plus group counseling and treatment as usual (TAU) to TAU alone in a group of substance dependant outpatients interested in quitting smoking. We conducted a secondary analysis to evaluate the effect of depression on smoking cessation outcomes.
Table 3. Clinical Characteristics
Table 1. Demographics by Treatment Group
This study was an 8-week open-label trial comparing TAU plus nicotine patches and smoking cessation counseling (SC) to TAU alone; participants were randomized in a 2:1 ratio.
As can be seen in Table 4, those with a history of MDD had earlier age of smoking initiation as well as an earlier age of regular smoking. Individuals with a higher baseline BDI were found to smoke more cigarettes than those with a BDI < 20. Individuals with history of MDD or a baseline BDI score > 20 were found to have higher Fagerstrom scores for nicotine dependence.
In order to evaluate the effect of depression on smoking cessation outcomes, the total sample was divided into those who reported ever being treated for depression (MDD) vs. those had not (no MDD); the total was also divided into those with a baseline BDI score < 20 vs. those with a baseline BDI score of > 20. As can be seen in Table 2, those with a history of MDD were less likely to be employed at baseline (p=0.034), and there was a trend for the same group to be less educated (p=0.061)
Table 4. Smoking Characteristics by Affective Group
Table 2. Demographics by Affective Group
As can be seen in Table 3, opioids were the primary substance of abuse for the majority of participants. Most of the recruitment sites used in this trial were opioid replacement programs. When evaluating primary substance by affective group, there was a trend for there to be more primary opioid use in those without a history of MDD (p=0.08).
Sponsored by the NIDA Clinical Trials Network