Association of tobacco use with depressive symptoms in adults: Considerations of symptom severity, symptom clusters, and sex

Objective: We aim to assess the association between depressive symptoms, depressive symptom severity and symptom clusters with tobacco use. We will also evaluate sex differences in these associations. Method: This cross-sectional study used data from the National Health and Nutrition Examination Survey (2005-2018). Depressive symptoms were assessed using the Patient Health Questionnaire-9. Tobacco use was categorized into four groups: cigarette use, smoked tobacco products (pipes and cigars), smokeless tobacco products (chewing tobacco and snuff), and non-tobacco use (reference group). Results: This study included 33,509 participants. Cigarette use was associated with a 0.83-unit increase in total PHQ-9 scores (95% CI = [0.63, 1.04]), and 1.73 times higher odds of reporting depressive symptoms (95% CI = [1.48, 2.02]) compared to non-tobacco use. However, the use of smoked and smokeless tobacco was not associated with depressive symptoms. In females, cigarette use showed a stronger association with total PHQ-9 scores (aCoef = 1.23, 95% CI = [0.92, 1.55]) than in males (aCoef = 0.45, 95% CI = [0.21, 0.69]). Additionally, female smoked tobacco users showed positive associations with both PHQ-9 scores and the presence of depressive symptoms, but this relationship was not observed in males. Furthermore, subgroup analysis revealed associations between cigarette use and cognitive-affective and somatic symptom clusters, as well as a relationship between the logarithm of total cigarette consumption and depressive symptoms. Conclusion: Cigarette use was associated with higher odds of depressive symptoms with females having a stronger association. Further studies are needed to replicate these findings and examine the underlying mechanisms.