Exposure to secondhand smoke and depression and anxiety: a report from two studies in the Netherlands

J Psychosom Res. 2013 Nov;75(5):431-6. doi: 10.1016/j.jpsychores.2013.08.016. Epub 2013 Aug 31.


Objective: Previous population-based studies suggest that exposure to secondhand smoke (SHS) is related to increased depressive symptoms and poor mental health among non-smokers. We examined whether these associations could be replicated in two independent Dutch samples.

Methods: Non-smoking adults were selected from two studies: 1) the Netherlands Study of Depression and Anxiety (NESDA), comprising individuals with current and remitted depressive and/or anxiety disorders, and healthy controls and 2) the Netherlands Twin Register (NTR), comprising twin-family studies on health-related behaviors. In both studies, SHS exposure was assessed with plasma cotinine levels (1-14ng/ml vs. <1ng/ml). In NESDA, outcomes were current depressive and/or anxiety disorders, and depression and anxiety symptom severity scores. In NTR, the Adult Self Report derived DSM-subscales for depressive and anxiety problems, and anxious depressive scores were analyzed.

Results: In NESDA non-smokers (n=1757), increased plasma cotinine level (≥1ng/ml) was not related to current depressive and/or anxiety disorders [odds ratio (OR) 0.96, P=.77], nor to depression or anxiety severity indicators. Similarly, in NTR non-smokers (n=1088) cotinine levels ≥1ng/ml were not associated with the DSM-subscale for depressive problems [unstandardized regression coefficient (B) 0.04, P=.88], nor to other depression and anxiety measures.

Conclusions: In non-smoking adults from patient and population samples, we found no evidence that plasma cotinine levels were related to either depressive and/or anxiety disorders, or to depressive and anxiety symptoms. This suggests that SHS exposure is not related to depression and anxiety in non-smoking adults.

Keywords: Anxiety; Cotinine; Depression; Passive smoking; Secondhand smoke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety / blood
  • Anxiety / diagnosis
  • Anxiety / epidemiology*
  • Anxiety Disorders / blood
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology*
  • Biomarkers / blood
  • Case-Control Studies
  • Cotinine / blood*
  • Depression / blood
  • Depression / diagnosis
  • Depression / epidemiology*
  • Depressive Disorder / blood
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology*
  • Female
  • Humans
  • Male
  • Mental Health
  • Middle Aged
  • Netherlands / epidemiology
  • Odds Ratio
  • Registries
  • Self Report
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Tobacco Smoke Pollution / adverse effects
  • Tobacco Smoke Pollution / statistics & numerical data*
  • Twin Studies as Topic


  • Biomarkers
  • Tobacco Smoke Pollution
  • Cotinine