Mental health and associations with tobacco smoking and quitting behaviour in the population of Germany

We aimed to estimate prevalence rates of symptoms of anxiety, depression, and overall psychological distress by smoking status in the population of Germany, and associations between such symptoms and tobacco dependence, and motivation and attempts to quit smoking.

We analysed aggregated cross-sectional data (N=11,937, aged >18) of the German Study on Tobacco Use (DEBRA Study), a representative face-to-face household survey. Symptoms of anxiety, depression, and overall psychological distress (12-level scale) were assessed using the Patient Health Questionnaire-4. Associations with smoking status (current, former, and never smoker), dependence (measured with the six-level Strength of Urges to Smoke Scale (SUTS)), motivation to quit (measured with the seven-level Motivation to Stop Scale and dichotomised: motivation/no motivation), and >1 self-reported past-year quit attempt (yes/no) were explored using adjusted linear and logistic regression among the total group, and among current smokers (n=3,248) and past-year smokers (stopped <12 months ago, n=3,357).

Weighted prevalence of mental health symptoms among current, former, and never smokers were for anxiety: 4.1%, 2.4%, 2.5%, for depression: 5.4%, 4.7%, 4.0%, and for overall psychological distress: 3.1%, 2.5%, 2.4%. Current smokers were more likely to report anxiety (Odds ratio (OR)=1.22, 95% confidence interval (CI)=1.02-1.48) and depression (OR=1.20, 95%CI=1.02-1.42) than never smokers. Smokers reporting higher versus lower levels of dependence were more likely to report higher levels of mental health symptoms (e.g., overall distress: regression coefficient B=0.21, 95%CI=0.07-0.34 per SUTS level). Higher versus lower levels of distress were associated with a high motivation to quit (OR=1.10, 95%CI=1.04-1.14 per level) and, among past-year smokers, with higher odds of reporting a past-year quit attempt (OR=1.07, 95%CI = 1.03-1.11 per level).

We found important associations between mental health and smoking and quitting behaviour. Healthcare professionals need to be informed about these associations and trained to effectively support affected smokers in translating their motivation into successful abstinence.