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American Journal of Epidemiology Advance Access originally published online on January 4, 2006
American Journal of Epidemiology 2006 163(5):421-432; doi:10.1093/aje/kwj058
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

Cigarette Smoking and Incidence of First Depressive Episode: An 11-Year, Population-based Follow-up Study

Ole Klungsøyr1, Jan F. Nygård1,2, Tom Sørensen3 and Inger Sandanger1,4

1 Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
2 The Cancer Registry of Norway, Oslo, Norway
3 Institute Group of Psychiatry, University of Oslo, Oslo, Norway
4 Norwegian Health Services Research Centre, Quality Evaluation Department, University of Oslo, Oslo, Norway

Reprint requests to Dr. Ole Klungsøyr, Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.O. Box 1111, Blindern, N-0317 Oslo, Norway (e-mail: ole.klungsoyr{at}medisin.uio.no).

Smoking has been found to be associated with depression. Biologic hypotheses support causation in both directions. This study examined the association between cigarette smoking and a subsequent first depression. In 1990, 2,014 adults in Norway were interviewed about their lifestyle and mental health. A 2001 reinterview by trained interviewers defined the study cohort of 1,190 participants. The cases were those who experienced a first depression whose onset was estimated to occur during the follow-up period, based on retrospective assessment by the Composite International Diagnostic Interview (International Classification of Diseases, Tenth Revision). Cox regression was used to estimate the hazard rate of depression during follow-up. Alternative explanations for a direct causal influence from smoking on subsequent depression were assessed, and a sensitivity analysis was performed. The risk of depression was four times as high for heavy smokers compared with never smokers. A dose-response relation with an increasing hazard for past smokers and for an increasing number of cigarettes smoked per day for current smokers was found. Similarly, increasing smoking time was associated with increasing risk. Failure of other plausible alternatives to explain the observed association between smoking and depression might reflect a direct causal influence of smoking on depression.

causality; depression; prospective studies; smoking

Abbreviations: CI, confidence interval; CIDI, Composite International Diagnostic Interview; FUP, 11-year follow-up period between T1 (baseline) and T2 (reinterview); HR, hazard ratio; OR, odds ratio; pre-T1 depression, a first depressive episode whose estimated onset occurred before T1


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