Prevalence and Correlates of Smoking Status Among Veterans Affairs Primary Care Patients with Probable Major Depressive Disorder

Published in: Addictive Behaviors, v. 39, no. 3, Mar. 2014, p. 538-545

Posted on RAND.org on February 13, 2014

by Anayansi Lombardero, Duncan G. Campbell, Kari J. Harris, Edmund Chaney, Andrew B. Lanto, Lisa V. Rubenstein

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Research Questions

  1. How prevalent is smoking among VA primary care patients with major depression?
  2. Do these patients have other characteristics that could complicate success for smoking cessation programs?

In an attempt to guide planning and optimize outcomes for population-specific smoking cessation efforts, the present study examined smoking prevalence and the demographic, clinical and psychosocial characteristics associated with smoking among a sample of Veterans Affairs primary care patients with probable major depression. Survey data were collected between 2003 and 2004 from 761 patients with probable major depression who attended one of 10 geographically dispersed VA primary care clinics. Current smoking prevalence was 39.8%. Relative to nonsmokers with probable major depression, bivariate comparisons revealed that current smokers had higher depression severity, drank more heavily, and were more likely to have comorbid PTSD. Smokers with probable major depression were also more likely than nonsmokers with probable major depression to have missed a health care appointment and to have missed medication doses in the previous 5 months. Smokers were more amenable than non-smokers to depression treatment and diagnosis, and they reported more frequent visits to a mental health specialist and less social support. Alcohol abuse and low levels of social support were significant concurrent predictors of smoking status in controlled multivariable logistic regression. In conclusion, smoking prevalence was high among primary care patients with probable major depression, and these smokers reported a range of psychiatric and psychosocial characteristics with potential to complicate systems-level smoking cessation interventions.

Key Findings

  • VA primary care patients with major depression have double the rates of smoking found in the general population.
  • These smokers have other mental health and psychosocial problems—including alcohol abuse and low levels of social support—that planners need to account for when designing smoking cessation programs.

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