Smoking cessation interventions for patients with depression: a systematic review and meta-analysis.
OBJECTIVE
We conducted a systematic literature review of smoking cessation interventions for patients with histories of depressive disorders or current significant depressive symptoms. We examined the comparative effectiveness of smoking cessation strategies on abstinence rates, differential effects of cessation strategies by depression status (i.e., history positive vs. current depression), and differential effects by gender.


METHODS
Peer-reviewed literature in MEDLINE, Embase, PsycINFO, and Cochrane Library.


METHODS
Randomized controlled trials or secondary analysis of RCT data comparing two or more smoking cessation interventions or intervention to control, and reporting cessation outcomes in adults with depression.


METHODS
Two trained researchers screened articles for inclusion. When possible, we estimated pooled risk ratios with 95% confidence intervals by using a random effects model with the Mantel-Haenszel method. We synthesized other studies qualitatively. We classified each intervention as antidepressants, nicotine replacement therapy (NRT), brief smoking cessation counseling, smoking cessation behavioral counseling, or behavioral mood management.


RESULTS
We identified 16 unique RCTs, of which, only three trials recruited participants with current depression. Meta-analysis demonstrated a small, positive effect of adding behavioral mood management (RR = 1.41, 95% CI 1.01-1.96). All included antidepressant trials showed small, positive effects, but risk ratio summary was not significant (RR = 1.31, 95% CI 0.73-2.34). Three NRT trials demonstrated small, positive effects on smoking cessation rates. We found insufficient evidence to examine gender and depression status moderator effects.


CONCLUSIONS
Few RCTs exist that test smoking cessation interventions among adults with depression. To make meaningful comparisons, we created broad intervention categories that contained heterogeneity.


CONCLUSIONS
Few trials enrolled smokers with current depression. Most of data identified were from subgroup analyses of patients history-positive for depression. However, several promising interventions exist. Healthcare providers should consider encouraging their patients with significant depressive symptoms or depression histories to seek smoking cessation services that include NRT and behavioral mood management.
Center for Health Services Research in Primary Care, Durham Veteran Affairs Medical Center (152), 508 Fulton Street, Durham, NC 27705, USA. j.gierisch@duke.edu
Jennifer M
JM
Gierisch
Lori A
LA
Bastian
Patrick S
PS
Calhoun
Jennifer R
JR
McDuffie
John W
JW
Williams
D003376:Counseling; D003863:Depression / Q000453:epidemiology*; D006293:Health Promotion; D006801:Humans; D015994:Incidence; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation / Q000379:methods*; D014481:United States / Q000453:epidemiology