How is cigarette smoking maintained in depression? Experiences of cigarette smoking in people diagnosed with depression

Using an interpretive Grounded Theory approach, the authors sought to describe and explain the meanings attributed to daily tobacco use by smokers diagnosed with depression. Twelve British smokers (six males and six females) who were currently receiving treatment for depression participated in a one hour semi-structured interview. Three reasons for cigarette smoking emerged: habit, addiction and management of negative affect. In addition, three factors linked to depression were identified to explain how depression maintains smoking behaviour: helplessness, negative thoughts and lack of positive reinforcement. We argue that in the short-term, smoking is perceived to ameliorate negative thoughts and provide a sense of autonomy. In the longer term, smoking sustains depression by reducing opportunities to gain positive reinforcement or more adaptive coping skills, which lead to feelings of helplessness.