Searching Out the Link Between Smoking and Depression

Jerusalem — Countless studies have shown that smoking tobacco cigarettes raises the risks of developing lung cancer, heart disease, high blood pressure and a host of other physical ailments.

But can smoking also bring about depression? 

Researchers in Israel and Serbia are trying to find out.   

A newly published study by a Serbian doctoral student from Jerusalem’s Hebrew University-Hadassah Braun School of Public Health and Community Medicine found that Serbian university students who smoke had double to triple the rates of clinical depression compared to their non-smoking peers.

“Our study adds to the growing body of evidence that smoking and depression are closely linked,” wrote Prof. Hagai Levine, head of Braun’s environmental health track; Braun Ph.D. student Marija Milic, an epidemiologist; and Tatjana Gazibara, an assistant professor at the University of Belgrade.

“While it may be too early to say that smoking causes depression, tobacco does appear to have an adverse effect on our mental health,” Levine and his co-researchers wrote in the study.

Published last month in the journal PLOS ONE, the study highlights the Braun school’s global impact on public health. It focused on university students because “young people are the future of our nation, so it is very important to understand the consequences of smoking in this population,” Milic told The Jewish Week in a phone interview from Serbia.

Nine out of 10 smokers start smoking before adulthood, and 98 percent of smokers try their first cigarette by the age of 26, Milic said. 

The rate of smoking in Serbia is twice the rate in the U.S. and Western Europe, but similar to the rate in Israel.

The researchers selected the two universities whose students participated in the study because they are so different.

The University of Belgrade has about 90,000 students and is located in a politically stable region. The University of Pristina, which has 8,000 students, is located in Kosovo, which the researchers say has an “unstable political situation.”

Kosovo declared independence from Serbia in 2008, but Serbia and several European countries consider it to be part of Serbia. The U.S. considers it an independent country.

The 2,000 students in the study, who were surveyed during their mandatory checkups at student health care services, completed a series of questionnaires related to depression, health-related quality of life and socioeconomic/political status.

The results: Fourteen percent of the Kosovo students who smoked suffered from depression, compared to just 4 percent of their non-smoking peers; at Belgrade University, 19 percent of smokers were depressed compared with 11 percent of the non-smoking students.

“No matter their economic or socio-political backgrounds, students who smoked also had higher rates of depressive symptoms and lower mental health scores (such as vitality and social functioning) than did non-smoking students,” the researchers said.

While the study’s goal was to determine the connection between smoking and depression — and not that smoking causes depression — “it provides more evidence regarding the possible hazards of smoking to public health,” Levine said.

“We know for sure that smoking affects the brain, which develops at least until the age of 25. We know that nicotine is highly addictive.”

While an Israeli study recently concluded that marijuana can cause mental illness in vulnerable teenagers, cigarette smoking is more common than marijuana use, especially in Eastern Europe.

Levine said Milic’s study is important “because we found depression in two different populations, at two different times. One university is in an area of conflict, the other is in the beltway.”

The fact that it was conducted in Eastern Europe was also significant, because most studies are conducted in Western countries. This lack of representation creates an incomplete picture.

“It’s significant to see the smoking-depression link in a different group of people,” Levine said.

Levine and Milic are fairly confident that researchers will eventually prove without a doubt that smoking harms mental health.

In the meantime, while Israel and many other countries have made significant strides in combatting smoking in public places, Levine said, smoking is still portrayed as a fun, relaxing leisure activity.

“The image is that smoking calms you down and makes you happier. Although we now have a smoke-free academia in Israel, for example, you can still publish ads in newspapers for tobacco,” he lamented. “The progress is too slow.”

Milic hopes her study will convince Serbian officials to take smoking by teens and young adults more seriously.

“Special attention should be paid to the symptoms of depression, especially among smokers. We should promote smoking cessation at school, even in high school,” she said. 

Levine said the fact that more than 1,000 Master of Public Health (MPH) students from 100 countries have graduated from the Braun school means it is “heavily invested” in global research, not only during its students’ time in Israel, but long after.

“We have a highly active network of graduates and often work with them” on studies.

“It’s fun and interesting but also makes for good science,” Levine said. “No one leaves Jerusalem and leaves the same. They are changed. I learn from them. And as a teacher it’s changed me, changed how I see the world, changed the way I do my science. I’m much more collaborative.”