Ecological momentary analysis of the relations among stressful events, affective reactivity, and smoking among smokers with high versus low depressive symptoms during a quit attempt

Aims To assess whether individuals trying to quit smoking who have high depressive symptoms (HD), compared with low-depressive-symptom (LD) symptoms: 1) report more frequent stressful events (SEs), 2) are more likely to smoke after SEs, 3) experience greater acute or persistent changes in affect after a SE, and 4) are at greater risk of smoking following affective changes. Design Smoking cessation data were analyzed using multilevel path modeling to examine the moderating effects of depressive symptoms on relations among SEs, subsequent affect, and smoking. Setting An academic research center in Central New Jersey, USA. Participants Seventy-one adult treatment-seeking daily smokers recruited from 2010 to 2012. Measurements Baseline depressive symptoms (HD: Center for Epidemiological Studies Depression Scale [CES-D] ≥ 16 vs. LD: CES-D < 16); and real-time ecological momentary assessment (EMA) reports of SEs, affect, and smoking assessed over 21 days post-quit. Findings Multilevel models indicated that HD smokers were more likely than LD smokers to report stressful events (OR = 2.32, p = .009), but had similar post-stress acute affective changes (negative affect: b = - .12, p = .137, positive affect: b = .02, p = .805). Only HD smokers reported increased negative affect (NA) (b = .20, p = .030) and decreased positive affect (PA) up to 12 hours later (b = -.22, p = .021), and greater lapse risk up to 24 hours after an SE (OR = 3.21, p = .017). The persistence of elevated NA and suppressed PA was partially explained by increased odds of subsequent SEs among HD smokers. However, the heightened stress-lapse association over 24 hours found in HD smokers was not fully explained by sustained aversive affect or subsequent SEs. Conclusions Depressed and non-depressed smokers trying to quit appear to experience similar acute affective changes following stress: however, depressed smokers experience higher rates of exposure to stress, longer-lasting post-stress affective disturbance, and greater risk of replase to smoking 12-24 hours after a stressful event than non-depressed smoker.