Association of mental distress with smoking status in the community: Results from the Gutenberg Health Study

Background: Exposition to tobacco smoke is among the major modifiable risk factors in the general population. There is strong evidence for a close association between smoking exposure and mental disorders.

Methods: Cross-sectional associations of different conditions of smoking status (former, current, and second hand smoking (SHS)) with indicators of mental distress were analyzed in a sample of N=5000 participants (aged 35-74 years) of the population-based survey "Gutenberg Health Study".

Results: In the general population clinically significant depression (OR 1.59, 95%CI 1.17-2.17) and a previous diagnosis of depression (OR 1.50, 95%CI 1.16-1.94) were associated with current smoking. Each cigarette per day was associated with a 3% increase for the likelihood of clinically significant depression. We did not find a decreased prevalence for current first and second hand exposure in persons with established cardiovascular or lung disease. In this subgroup mental distress was strongly associated with SHS at home.

Limitations: Main limitations of the study pertain to the reliance on self-report of distress and smoking status and the cross-sectional nature of the data.

Conclusions: Despite public health efforts, smoke exposure is still alarmingly high in the general population, especially in persons with mental distress and with established cardiovascular or lung disease. In the management of persons with chronic cardiovascular and lung disease, enquiry of the medical history should include exposure to SHS at home and offer special counseling.