Differences in Anxiety, Depression According to Current and Former Smoking Status

woman smoking cigarette
Both stable current smokers and individuals who had quit exhibited significantly less anxiety but more depression.

After careful consideration, the American Thoracic Society canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from May 15-20, because of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting. A virtual event is being planned for later this year.

Current smoking was associated with higher self-reported anxiety, according to results of an analysis intended to be presented at the American Thoracic Society (ATS) International Conference. (Select research is slated to be presented in a virtual format later this year.)

Smoking cessation has been linked to increased symptoms of anxiety and depression, mainly as a result of acute withdrawal symptoms. Using data from the COPDGene® cohort study — a cohort of heavy smokers who were followed longitudinally from 2008 to the present — the study authors evaluated the differences in symptoms of depression and anxiety in heavy smokers (ie, ≥10 pack-years) who were grouped according to change in their current smoking status (current vs former smoker) during a 5-year period.

A total of 4 groups were included: (1) stable current smokers; (2) current to former smokers; (3) stable former smokers; and (4) former to current smokers. The Hospital Anxiety and Depression Scale (HADS) was administered to all participants at both the phase 2 and phase 3 visits, with these encounters separated by 5 years.

Overall, 982 individuals reported their smoking status, and completed the HADS in both phase 2 and phase 3 of the study. Anxiety (HADS-A) scores and depression (HADS-D) scores were compared across the participants, who were grouped according to their phase 2 to phase 3 change in smoking status. The participants were grouped as follows: (1) stable: current smoker in both phase 2 and phase 3, (2) quitters: change from current smoker in phase 2 to former smoker in phase 3; (3) stable former: former smoker in both phase 2 and phase 3; and (4) relapsing: former smoker in phase 2 who reinitiated smoking.

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Results demonstrated distinct demographic patterns. Individuals who were stable former smokers were older, were less likely to be black, and were inclined to have lower forced expiratory volume in 1 second percent predicted compared with participants from other smoking status groups. Stable former smokers reported significantly higher HADS-A and HADS-D scores at baseline (P <.001 for both).

Individuals in the relapsed group had significantly lower HADS-A scores at baseline and stable HADS-D scores (P <.001 for both). Quitters exhibited significantly less anxiety but more depression at phase 3 (P <.001 for both). Similarly, stable current smokers also had significantly less anxiety but more depression at phase 3 (P <.001 for both). Stable former smokers reported lower HADS-A and HADS-D scores, whereas individuals in the relapsed group reported lower levels of anxiety and no increase in depression.

The investigators concluded that differences in HADS-A and HADS-D scores were apparent when smokers who were grouped based on change in their smoking status were compared. Overall, current smoking was linked to higher self-reported anxiety in the study participants. 


Watts S, Regan EA, Hoth K, Kim V, Hanania NA. Symptoms of anxiety and depression by current and former smoking status in the COPDGene® cohort. Am J Respir Crit Care Med. 2020;201:A4832.

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