The relationship between smoking and depressive symptoms among Korean adults

한국인에서 흡연과 우울증상의 연관성

Sung, Han Na;Kim, Jong Sung

  • Received : 2016.02.27
  • Accepted : 2016.06.21
  • Published : 2016.06.30


Objectives: This study investigated the relationship between smoking status and depressive symptoms among Korean adults. Methods: We used the data of 17,871 adults aged 19 years or older from the fifth Korea National Health and Nutrition Examination Survey(2010-2012). The subjects were classified as nonsmokers, former smokers, and current smokers by gender. Logistic regression analysis was used to calculate the odds ratios(ORs) and the 95% confidence intervals(CIs) for the effects of smoking status on depressive symptoms, and depression diagnosed by a doctor. Results: Compared to nonsmokers, the ORs of depressive symptoms for current smokers were 1.11(95% CI, 1.11-1.12) among males, and 1.64(95% CI, 1.63-1.64) among females. Compared to former smokers, the ORs of depressive symptoms for current smokers were 1.05(95% CI, 1.05-1.05) among males, and 1.89(95% CI 1.88-1.90) among females. Compared to nonsmokers, the ORs of depression for current smokers were 0.94(95% CI, 0.94-0.95) among males, and 1.40(95% CI, 1.39-1.41) among females. Compared to former smokers, the ORs of depression for current smokers were 1.09(95% CI, 1.09-1.10) among males, and 0.99(95% CI, 0.99-1.00) among females. Conclusions: Smoking is associated with depressive symptoms among Korean adults. Therefore, it is necessary to consider depressive symptoms with the management of tobacco control policies.




  1. Anda, R. F., Williamson, D. F., Escobedo, L. G., Mast, E. E., Giovino, G. A., & Remington, P. L. (1990). Depression and the dynamics of smoking. A national perspective. The Journal of American Medical Association, 264(12):1541-1545.
  2. Awtry T. L. & Werling L. L.(2003). Acute and chronic effects of nicotine on serotonin uptake in prefrontal cortex and hippocampus of rats. Synapse, 50(3),206-211
  3. Benwell, M. E., & Balfour, D. J. (1979). Effects of nicotine administration and its withdrawal on plasma corticosterone and brain 5-hydroxyindoles. Psychopharmacology, 63,7-11.
  4. Bhatia, S. C., & Bhatia, S. K. (1999) Depression in women: diagnostic and treatment considerations. American Family Physician, 60(1):225-234.
  5. Bromet E., Andrade L. H., Hwang I, Sampson N. A., Alonso Girolamo G.,...Kessler R. C.(2011). Cross-national epidemiology of DSM-IV major depressive episode. BMC Medicine, 9, 90.
  6. Chang, S. M., Hahm, B. J., Lee, J. Y., Shin, M. S., Jeon, H. J., Hong, J. P.,..., & Cho, M.J. (2008). Cross-national difference in the prevalence of depression caused by the diagnostic threshold. Journal of Affective Disorders, 106(1-2),159-167.
  7. Cho, H.J. (2014). The status and future challenges of tabacco control policy in Korea. Journal Preventive Medicine and Public Health, 47(3),129-135.
  8. Dani, J. A., & Heinemann, S. (1996). Molecular and cellular aspects of nicotine abuse. Neuron, 16, 905-908.
  9. Escobedo, L.G., Reddy, M., & Giovino, G.A. (1998) The relationship between depressive symptoms and cigarette smoking in US adolescents. Addiction, 93(3):433-440.
  10. Fowler J. S., Volkow N. D., Wang G. J., Pappas N., Logan J., MacGregor R.,..., Cilento R.(1996). Inhibition of monoamine oxidase B in the brains of smokers. Nature, 379(6567),733-736.
  11. Hall S. M., Munoz R. F., Reus V. I., & Sees K. L. (1993). Nicotine, negative affect, and depression. Journal Consulting and Clinical Psychology, 61(5), 761-767.
  12. Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A.,..., & Bauman A. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9),1081-1093.
  13. Hatsukami, D. K., Le, C. T., Zhang, Y., Joseph, A. M., Mooney, M. E., Carmella, S. G., & Hecht S. S. (2006). Toxicant exposure in cigarette reducers versus light smokers. Cancer Epidemiology, Biomarkers and Prevention 15(12),2355-2358.
  14. Husky, M. M., Mazure, C. M., Paliwal, P., & McKee, S. A. (2008). Gender differences in the comorbidity of smoking behavior and major depression. Drug and Alcohol Dependence, 93(1-2), 176-179.
  15. Imperato, A., Mulas, A., & Di Chiara, G. (1986). Nicotine preferentially stimulates dopamine release in the limbic system of freely moving rats. European Journal of Pharmacology, 132, 337-338.
  16. Jung-Choi, K. H., Khang, Y. H., & Cho, H. J. (2012). Hidden female smokers in Asia: a comparison of self-reported with cotinine-verified smoking prevalence rates in representative national data from an Asian population. Tobacco Control 21(6), 536-542.
  17. Kendler K. S., Neale M. C., MacLean C. J., Heath A. C., Eaves L. J., & Kessler R. C.(1993). Smoking and major depression. Archives of General Psychiatry, 50, 36-43.
  18. Killen, J. D., Fortmann, S. P., Schatzberg, A., Hayward, C., & Varady, A. (2003). Onset of major depression during treatment for nicotine dependence. Addictive Behaviors 28(3), 461-470.
  19. Kim, D. H., & Suh, Y. S. (2009). Smoking as a disease. Korean Journal of Family Medicine, 30(7), 494-502.
  20. Kim, T. S., & Kim, D. J. (2007). The association between smoking and depression. Korean Journal of Psychopharmacology, 18(6), 393-398.
  21. Korean Center for Disease Control. (2011). 2010 National Health Statistics: Korea National Health and Nutrition Examination Survey(KNHANES) V-1. Seoul: Korean Center for Disease Control.
  22. Korean Statistical Information Service(KOSIS). (2014). Korean Standard Classification of Occupations(KSCO). Retrieved from
  23. Lee, E. H., Park, S. K., Ko, K. P., Cho, I. H., Chang, S. H., Shin, H. R.,..., Yoo, K. Y. (2010). Cigarette smoking and mortality in the Korean Multi-Center Cancer Cohort(KMCC) study. Journal of Preventive Medicine & Public Health, 43(2),151-158.
  24. Lee, H. K., & Lee, B. H. (2012). The epidemiology of alcohol use disorders. The Journal of Korean Diabetes, 13, 69-75.
  25. Lerman C., Caporaso N., Main D., Audrain J., Boyd N. R., Bowman E. D., & Shields P. G.(1998). Depression and self-medication with nicotine: the modifying influence of the dopamine D4 receptor gene. Health Psychology, 17(1),56-62.
  26. Maurer, D. M. (2012). Screening for depression. American Family Physician 85(2),139-144.
  27. Organization for Economic Co-operation and Development.(2013). OECD factbook 2013: Economic, Environmental and Social Statistics. Paris, France: OECD Publishing.
  28. Park, H. S., Park, C. Y., Oh, S. W., & Yoo, H. J. (2008) Prevalence of obesiy and metabolic syndrome in Korean adults. Obesity Reviews, 9(2), 104-107.
  29. Park J. H. & Kim K. W.(2011). A review of the epidemiology of depression in Korea. Journal of the Korean Medical Association, 54(4), 362-369.
  30. Park, S., Romer, D., & Lim, S. (2013). Does smoking initiation in adolescence increase risk for depression across the lifespan? Evidence from the South Korean National Health and Nutrition Examination Survey. Journal of Addictions Nursing 24(3), 142-148.
  31. Seoul National University College of Medicine (2012). The epidemiological survey of mental disorders in Korea 2011. Seoul: Ministry of Health and Welfare.
  32. Taylor, G., McNeill, A., Girling, A., Farley, A., Lindson-Hawley, N., & Aveyard, P. (2014). Change in mental health after smoking cessation: systematic review and meta-analysis. British Medical Journal, 13;348:g1151.
  33. Whooley, M. A., Avins, A. L., Miranda, J., & Browner, W. S. (1997) Case-finding instruments for depression. Two questions are as good as many. Journal of General Internal Medicine, 12(7):439-445.
  34. World Health Organization. (2013). WHO report on the global tobacco epidemic 2013. Retrieved from
  35. Yun, W. J., Shin, M. H., Kweon, S. S., Ryu, S. Y., & Rhee, J. A. (2012). Association of smoking status, cumulative smoking, duration of smoking cessation, age of starting smoking, and depression in Korean adults. Biomed Central Public Health, 12, 724-730.