Dr Catherine Segana, Professor Kay Wilhelmb, Dr Sunil Bharc, Professor David Dunta
a The University of Melbourne
b St Vincent’s Hospital, Sydney
c Swinburne University of Technology
beyondblue Victorian Centre of Excellence
Project completion year
Many clinicians and scientists believe that smoking cessation increases the risk of major depressive disorder, particularly among smokers with a history of depression. Victoria Quitline is the first in Australia to offer a treatment model for smokers with a history of depression.
This project researched the effectiveness of Victoria Quitline’s tailored counselling service for smokers with a history of depression. The main objectives included to:
- compare quit rates among smokers who were depressed (or had a history of depression) receiving the tailored service with non-depressed smokers receiving the standard service
- determine whether measures of depression predict smoking cessation attempts and outcomes after controlling for other cessation predictors
- determine evidence of the usefulness of the tailored service for smokers with depression.
A prospective research design was used. Assessed at baseline and over six months, each of the 802 smokers was allocated to one of the following three groups:
- Current depression disclosed (199 participants)
- Past depression disclosed (120 participants)
- No depression disclosed (483 participants).
To measure symptoms of depression, the Patient Health Questionnaire was used. At baseline, the recent (that is, previous two weeks) frequency of depressive symptoms was reported by participants. At two and six-month follow-ups, they reported on the frequency of symptoms during the two-week period when they had felt worst, since the last interview.
This project found that Victoria Quitline’s tailored service for smokers with a history of depression produced positive outcomes for smoking cessation and mood. It also found an association between smoking cessation and improved mood for all three groups, independent of depression status.
The key findings were as follows:
- Smokers with current depression had good quitting rates (32 per cent). Rates were higher for smokers with past depression (50 per cent) or no depression (also 50 per cent).
- One in five participants in the current depression group reported sustained cessation, compared to about one in three in the other groups.
- Participants with current or past depression were more likely (75 and 71 per cent, respectively) to talk with their doctor about quitting than those with no depression (60 per cent).
- Most smokers with a history of depression (83 per cent) thought their doctor’s involvement in their quit attempt to be a good idea. Most (80 per cent) also said that consistent advice was given by Quitline and by their doctor.
- Smokers with current depression who received Quitline-doctor co management (52 per cent of this group) were more likely (89 per cent) to attempt quitting than those without this coordinated care (75 per cent).
- Higher confidence levels led to smokers with current depression being more likely to quit. This justified the tailored strategies that targeted both smoking cessation and mood.
- In the group without depression, 6 per cent of participants were found to have suspected undiagnosed depression.
Overall, this project found the tailored Quitline callback service offering doctor-Quitline co-management of smoking cessation and depression to be acceptable, workable and beneficial.
Implications for policy, practice and further research
Important findings from this study, with significant implications for policy and practice, are that quitting smoking was associated with improvements in mood, and that quitting was not associated with the precipitation or exacerbation of depression. This supports the recommendation that Quitline adjusts its mental health policy, to make the process of actively encouraging smoking cessation less complex. For clients with current depression, it is important to gauge the severity of their symptoms as well as their confidence levels in assessing their readiness for a quit attempt. There are also implications for counselling guidelines, such as emphasising to clients the benefits of likely improved mood in the months after quitting smoking.