title: Depressive symptoms and smoking cessation after hospitalization for cardiovascular disease.
abstract: BACKGROUND
  Although smoking cessation is essential for prevention of secondary cardiovascular disease (CVD), many smokers do not stop smoking after hospitalization. Mild depressive symptoms are common during hospitalization for CVD. We hypothesized that depressive symptoms measured during hospitalization for acute CVD would predict return to smoking after discharge from the hospital.
  
  
  METHODS
  This was a planned secondary analysis of data from a placebo-controlled, double-blind, randomized trial of bupropion hydrochloride therapy in 245 smokers hospitalized for acute CVD. All subjects received smoking counseling in the hospital and for 12 weeks after discharge. Depressive symptoms were measured during hospitalization with the Beck Depression Inventory (BDI), and smoking cessation was biochemically validated at 2-week, 12-week, and 1-year follow-up. The effect of depressive symptoms on smoking cessation was assessed using multiple logistic regression and survival analyses.
  
  
  RESULTS
  Twenty-two percent of smokers had moderate to severe depressive symptoms (BDI >or= 16) during hospitalization. These smokers were more likely to resume smoking by 4 weeks after discharge (P= .007; incidence rate ratio, 2.40; 95% confidence interval, 1.48-3.78) than were smokers with lower BDI scores. Smokers with low BDI scores were more likely to remain abstinent than were those with high BDI scores at 3-month follow-up (37% vs 15%; adjusted odds ratio, 3.02; 95% confidence interval, 1.28-7.09) and 1-year follow-up (27% vs 10%; adjusted odds ratio, 3.77; 95% confidence interval, 1.31-10.82). We estimate that 27% of the effect of the BDI score on smoking cessation was mediated by nicotine withdrawal symptoms.
  
  
  CONCLUSIONS
  Moderate to severe depressive symptoms during hospitalization for acute CVD are independently associated with rapid relapse to smoking after discharge and lower rates of smoking cessation at long-term follow-up. The relationship was mediated in part by the stronger nicotine withdrawal symptoms experienced by smokers with higher depressive symptoms.
authors.affiliation: Tobacco Research and Treatment Center, General Medical Division, and Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114, USA. athorndike@partners.org
authors.forename: Anne N
authors.initials: AN
authors.lastname: Thorndike
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
authors.forename: Kathleen
authors.initials: K
authors.lastname: McKool
authors.forename: Richard C
authors.initials: RC
authors.lastname: Pasternak
authors.forename: Susan
authors.initials: S
authors.lastname: Swartz
authors.forename: Nancy
authors.initials: N
authors.lastname: Torres-Finnerty
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
mesh_terms: D002318:Cardiovascular Diseases / Q000523:psychology*; D003863:Depression / Q000150:complications* / Q000175:diagnosis*; D004311:Double-Blind Method; D005260:Female; D005544:Forecasting; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011581:Psychological Tests; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*