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Nicotine & Tobacco Research Advance Access originally published online on May 12, 2009
Nicotine & Tobacco Research 2009 11(6):707-714; doi:10.1093/ntr/ntp053
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© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

The association of depressive, anxiety, and stress symptoms and postpartum relapse to smoking: A longitudinal study

Elyse R. Park, Yuchiao Chang, Virginia Quinn, Susan Regan, Lee Cohen, Adele Viguera, Christina Psaros, Kaile Ross and Nancy Rigotti

Elyse R. Park, Ph.D., M.P.H., Tobacco Research and Treatment Center, Institute for Health Policy, and Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
Yuchiao Chang, Ph.D., Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA
Virginia Quinn, Ph.D., Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA
Susan Regan, Ph.D., Tobacco Research and Treatment Center and Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA
Lee Cohen, M.D., Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
Adele Viguera, M.D., Department of Psychiatry, Cleveland Clinic, Cleveland, OH
Christina Psaros, Ph.D., Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
Kaile Ross, B.A., Tobacco Research and Treatment Center and Institute for Health Policy, Massachusetts General Hospital/Harvard Medical School, Boston, MA
Nancy Rigotti, M.D., Tobacco Research and Treatment Center, Institute for Health Policy, and Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA

Corresponding Author: Elyse R. Park, Ph.D., M.P.H., Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, USA. Telephone: 617-724-6836; Fax: 617-724-4738; E-mail: epark{at}partners.org


  Abstract

Introduction: The aim of this prospective repeated measures, mixed-methods observational study was to assess whether depressive, anxiety, and stress symptoms are associated with postpartum relapse to smoking.

Methods: A total of 65 women who smoked prior to pregnancy and had not smoked during the last month of pregnancy were recruited at delivery and followed for 24 weeks. Surveys administered at baseline and at 2, 6, 12, and 24 weeks postpartum assessed smoking status and symptoms of depression (Beck Depression Inventory [BDI]), anxiety (Beck Anxiety Inventory [BAI]), and stress (Perceived Stress Scale [PSS]). In-depth interviews were conducted with women who reported smoking.

Results: Although 92% of the participants reported a strong desire to stay quit, 47% resumed smoking by 24 weeks postpartum. Baseline factors associated with smoking at 24 weeks were having had a prior delivery, not being happy about the pregnancy, undergoing counseling for depression or anxiety during pregnancy, and ever having struggled with depression (p < .05). In a repeated measures regression model, the slope of BDI scores from baseline to the 12-week follow-up differed between nonsmokers and smokers (–0.12 vs. +0.11 units/week, p = .03). The slope of PSS scores also differed between nonsmokers and smokers (–0.05 vs. +0.08 units/week, p = .04). In qualitative interviews, most women who relapsed attributed their relapse and continued smoking to negative emotions.

Discussion: Among women who quit smoking during pregnancy, a worsening of depressive and stress symptoms over 12 weeks postpartum was associated with an increased risk of smoking by 24 weeks.

Received: July 7, 2008; Accepted: February 26, 2009
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