A systematic review of longitudinal studies on the association between depression and smoking in adolescents

BMC Public Health. 2009 Sep 22;9:356. doi: 10.1186/1471-2458-9-356.


Background: It is well-established that smoking and depression are associated in adolescents, but the temporal ordering of the association is subject to debate.

Methods: Longitudinal studies in English language which reported the onset of smoking on depression in non clinical populations (age 13-19) published between January 1990 and July 2008 were selected from PubMed, OVID, and PsychInfo databases. Study characteristics were extracted. Meta-analytic pooling procedures with random effects were used.

Results: Fifteen studies were retained for analysis. The pooled estimate for smoking predicting depression in 6 studies was 1.73 (95% CI: 1.32, 2.40; p < 0.001). The pooled estimate for depression predicting smoking in 12 studies was 1.41 (95% CI: 1.21, 1.63; p < 0.001). Studies that used clinical measures of depression were more likely to report a bidirectional effect, with a stronger effect of depression predicting smoking.

Conclusion: Evidence from longitudinal studies suggests that the association between smoking and depression is bidirectional. To better estimate these effects, future research should consider the potential utility of: (a) shorter intervals between surveys with longer follow-up time, (b) more accurate measurement of depression, and (c) adequate control of confounding.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Comorbidity
  • Depression / complications*
  • Disease Progression
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Smoking / adverse effects*
  • Young Adult