Effects of depressive symptoms on antecedents of lapses during a smoking cessation attempt: an ecological momentary assessment study

Brodbeck, Jeannette; Bachmann, Monica S.; Brown, Anna; Znoj, Hans Jörg (2014). Effects of depressive symptoms on antecedents of lapses during a smoking cessation attempt: an ecological momentary assessment study. Addiction, 109(8), pp. 1363-1370. Wiley-Blackwell 10.1111/add.12563

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AIMS:
To investigate pathways through which momentary negative affect and depressive symptoms affect risk of lapse during smoking cessation attempts.
DESIGN:
Ecological momentary assessment was carried out during 2 weeks after an unassisted smoking cessation attempt. A 3-month follow-up measured smoking frequency.
SETTING:
Data were collected via mobile devices in German-speaking Switzerland.
PARTICIPANTS:
A total of 242 individuals (age 20-40, 67% men) reported 7112 observations.
MEASUREMENTS:
Online surveys assessed baseline depressive symptoms and nicotine dependence. Real-time data on negative affect, physical withdrawal symptoms, urge to smoke, abstinence-related self-efficacy and lapses.
FINDINGS:
A two-level structural equation model suggested that on the situational level, negative affect increased the urge to smoke and decreased self-efficacy (β = 0.20; β = -0.12, respectively), but had no direct effect on lapse risk. A higher urge to smoke (β = 0.09) and lower self-efficacy (β = -0.11) were confirmed as situational antecedents of lapses. Depressive symptoms at baseline were a strong predictor of a person's average negative affect (β = 0.35, all P < 0.001). However, the baseline characteristics influenced smoking frequency 3 months later only indirectly, through influences of average states on the number of lapses during the quit attempt.
CONCLUSIONS:
Controlling for nicotine dependence, higher depressive symptoms at baseline were associated strongly with a worse longer-term outcome. Negative affect experienced during the quit attempt was the only pathway through which the baseline depressive symptoms were associated with a reduced self-efficacy and increased urges to smoke, all leading to the increased probability of lapses.

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