title: Depressive symptoms among heavy cigarette smokers: the influence of daily rate, gender, and race.
abstract: BACKGROUND
  Cigarette smokers experience higher levels of depressive symptoms and are more likely to be diagnosed with depressive disorders than nonsmokers. To date, the nature of the smoking-depression relationship has not been adequately studied among heavy smokers, a group at elevated risk for poor health outcomes. In this study, we examined depressive symptom expression among heavy smokers while considering the moderating roles of smoking status, gender, and race. We also explored whether amount of tobacco usually consumed had an impact.
  
  
  METHODS
  We extracted data from a large, highly nicotine-dependent, nontreatment cigarette smoking study sample (N = 6,158). Participants who consented were screened for major exclusions, and they completed questionnaires.
  
  
  RESULTS
  Smokers reported a higher, clinically meaningful level of depressive symptoms relative to nonsmokers (27.3% of smokers vs. 12.5% of nonsmokers) scored above the clinical cutoff on the Center for Epidemiological Studies Depression (CES-D) scale (p < .001), which differed among race × gender subgroups. Further, amount of daily intake was inversely associated with self-report of depressive symptoms. For every 10-cigarette increment, the likelihood of scoring above the CES-D clinical cutoff decreased by 62% (p < .0001).
  
  
  CONCLUSIONS
  These findings improve our understanding of tobacco's influence on depressive symptom expression among heavy smokers, with implications for tailoring evidence-based tobacco treatments.
authors.affiliation: Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS;
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Payne
authors.forename: Jennie Z
authors.initials: JZ
authors.lastname: Ma
authors.forename: Karen M
authors.initials: KM
authors.lastname: Crews
authors.forename: Ming D
authors.initials: MD
authors.lastname: Li
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires