Use of cigarettes to improve affect and depressive symptoms in a longitudinal study of adolescents

Smoking to alleviate negative affect or improve physiological functioning (i.e., self-medication) is one explanation for the association between depression and smoking in adolescents. This study tests whether using cigarettes to improve mood or physiological functioning is associated with the onset, and change over time, of elevated depressive symptoms. Data were drawn from the Nicotine Dependence in Teens study which followed 1293 participants initially aged 12-13 years in Montreal, Canada every three months for five years. The subsample included 662 adolescents who had been current smokers (reported smoking during the previous three months) at any point during the study. Survival analysis was used to test whether self-medication scores predicted onset of elevated depressive symptoms. Changes over time in depressive symptom scores relative to self-medication scores were modeled in growth curve analyses controlling for sex and number of cigarettes smoked per week. Smokers who reported higher self-medication scores had higher depressive symptom scores. The interaction between self-medication scores and the acceleration rate in depressive symptom scores was significant and negative, suggesting that participants with higher self-medication scores had decelerated rates of change in depression over time compared to participants with lower self-medication scores. Smoking appears to be ineffective at reducing depressive symptoms. These findings are consistent with a version of the Positive Resource Model that suggests that smoking will not lower depressive symptoms, but could slow the rate of change over time. Alternatively, the perceived positive benefits may be the result of alleviation of symptoms of withdrawal and craving resulting from abstinence. The self-medication scale may identify a population at risk of increased levels of depressive symptoms.