Associations between Smoking, Drinking and Depression among Korean Adults: The 5th Korea National Health and Nutrition Examination Survey
- Sun Mi Park1, Mi Ah Han1, Jong Park1, So Yeon Ryu1, Seong Woo Choi1, Hwan Ho Shin1,2, Mi Hyun Joo1,2
- Received December 16, 2015 Accepted February 05, 2016
- ABSTRACT
-
- Background
- The prevalence of depression has been steadily increasing. This study aim to identify associations between smoking, drinking and depression in Korean adults.
- Methods
- The study subjects were 17,871 adults aged 19 or over who participated in the 5th Korea National Health and Nutrition Examination Survey (2010–2012). We performed multiple logistic regression to identify whether smoking and drinking were independently significant variables to depression after adjusting for the confounding variables.
- Results
- The proportion of having any depressive episodes was a total of 13.4% with 9.1% of male and 16.6% of female, respectively. Among all of smoking behaviors, higher cigarette consumption was only associated with depression in men. However, for women ever-smoking (adjusted odds ratio [aOR]=1.63, 95% confidence interval [CI]=1.38–1.92), ex-smoking (aOR=1.38, 95% CI=1.10–1.54), current smoking (aOR=1.89, 95% CI=1.53–2.94) and younger initiation of smoking (aOR=2.34, 95% CI=1.73–3.16) had significantly higher odds for depression. Moreover, and higher cigarette consumption (20 or more per day) showed significantly higher odds ratios for depression both in men (aOR=1.21, 95% CI=1.01–1.54) and women (aOR=2.41, 95% CI=1.32–4.41). For alcoholic drinking behaviors, frequent binge drinking (1 per week: aOR=1.46, 95% CI=1.16–1.85, most everyday: aOR=1.79, 95% CI=1.14–2.80) was an independent risk factor for depressive symptoms in female.
- Conclusions
- Smoking and drinking behaviors were independently associated with depression especially in female. Smoking and drinking management may benefit depression control as well as health promotion.
Table 1.
Subjects' characteristics by sex
| Characteristics | Total | Male | Female | Pa |
|---|---|---|---|---|
| (n = 17,871) | (n = 7,573) | (n = 10,298) | ||
| Age, y | <0.001 | |||
| 19–44 | 7,080 (39.6) | 2,954 (39.0) | 4,126 (40.1) | |
| 45–64 | 6,525 (36.5) | 2,785 (36.8) | 3,740 (36.3) | |
| ≥65 | 4,266 (23.9) | 1,834 (24.2) | 2,432 (23.6) | |
| Economic status | <0.001 | |||
| Low | 3,462 (19.6) | 1,332 (17.8) | 2,130 (20.9) | |
| Middle-low | 4,554 (25.8) | 1,940 (25.9) | 2,614 (25.7) | |
| Middle-high | 4,814 (27.2) | 2,116 (28.2) | 2,698 (26.5) | |
| High | 4,849 (27.4) | 2,108 (28.1) | 2,741 (26.9) | |
| Education | <0.001 | |||
| ≤Elementary school | 4,586 (25.7) | 1,332 (17.6) | 3,254 (31.7) | |
| Middle school | 1,942 (10.9) | 890 (11.8) | 1,052 (10.2) | |
| High school | 5,935 (33.3) | 2,695 (35.7) | 3,240 (31.5) | |
| ≥College | 5,363 (30.1) | 2,635 (34.9) | 2,728 (26.6) | |
| Occupation | <0.001 | |||
| Yes | 10,513 (59.0) | 5,657 (74.9) | 4,856 (47.3) | |
| No | 7,316 (41.0) | 1,895 (25.1) | 5,421 (52.7) | |
| Marital status | <0.001 | |||
| Yes | 15,399 (86.2) | 6,382 (84.3) | 9,017 (87.6) | |
| No | 2,466 (13.8) | 1,189 (15.7) | 1,277 (12.4) | |
| Exercise | <0.001 | |||
| No | 9,689 (54.2) | 3,502 (46.3) | 6,187 (60.1) | |
| Yes | 8,172 (45.8) | 4,067 (53.7) | 4,105 (39.9) | |
| Number of chronic disease | <0.001 | |||
| No | 11,092 (62.1) | 4,849 (64.0) | 6,243 (60.6) | |
| 1 | 3,667 (20.5) | 1,619 (21.4) | 2,048 (19.9) | |
| ≥2 | 3,112 (17.4) | 1,105 (14.6) | 2,007 (19.5) | |
| Stress | <0.001 | |||
| Low | 13,140 (73.5) | 5,819 (76.8) | 7,321 (71.1) | |
| High | 4,726 (26.5) | 1,754 (23.2) | 2,972 (28.9) |
Table 2.
Smoking and drinking behavior by sex
| Characteristics | Total | Male | Female | Pa |
|---|---|---|---|---|
| Smoking behavior | ||||
| Lifetime smoking experience | <0.001 | |||
| Never smoker | 10,564 (59.1) | 1,391 (18.4) | 9,173 (89.1) | |
| Ever-smoker | 7,306 (40.9) | 6,181 (81.6) | 1,125 (10.9) | |
| Current smoking behavior | <0.001 | |||
| Never smoker | 10,564 (59.1) | 1,391 (18.4) | 9,173 (89.1) | |
| Ex-smoker | 3,632 (20.3) | 3,071 (40.6) | 561 (5.4) | |
| Current smoker | 3,673 (20.6) | 3,109 (41.0) | 564 (5.5) | |
| Smoking initiation at | <0.001 | |||
| Never smoker | 10,564 (59.1) | 1,391 (18.4) | 9,173 (89.1) | |
| ≥19 yo | 4,803 (26.9) | 3,942 (52.1) | 861 (8.4) | |
| <19 yo | 2,504 (14.0) | 2,240 (29.6) | 264 (2.6) | |
| Cigarette consumption per day | <0.001 | |||
| Nob | 14,196 (79.4) | 4,462 (58.9) | 9,734 (94.5) | |
| <20 | 2,223 (12.4) | 1,715 (22.6) | 508 (4.9) | |
| ≥20 | 1,452 (8.2) | 1,396 (18.5) | 56 (1.6) | |
| Alcohol drinking behavior | ||||
| Lifetime drinking experience | <0.001 | |||
| Never drinker | 2,499 (14.0) | 379 (5.0) | 2,120 (20.6) | |
| Ever-drinker | 15,371 (86.0) | 7,193 (95.0) | 8,178 (79.4) | |
| Drinking initiation at | <0.001 | |||
| Never drank | 2,500 (14.0) | 379 (5.0) | 2,121 (20.6) | |
| ≥19 yo | 10,776 (60.3) | 4,035 (53.3) | 6,741 (65.5) | |
| <19 yo | 4,595 (25.7) | 3,159 (41.7) | 1,436 (13.9) | |
| Drinking frequency | <0.001 | |||
| Nonec | 5,095 (28.6) | 1,237 (16.4) | 3,858 (37.6) | |
| <4 per month | 8,993 (50.6) | 3,452 (45.8) | 5,541 (54.1) | |
| ≥2 per week | 3,701 (20.8) | 2,851 (37.8) | 850 (8.3) | |
| Binge drinking | <0.001 | |||
| Nonec | 5,095 (28.5) | 1,237 (16.4) | 3,858 (37.5) | |
| No | 4,467 (25.0) | 1.351 (17.9) | 3,116 (30.2) | |
| ≤1 per month | 5,092 (28.5) | 2.515 (33.3) | 2,577 (25.0) | |
| 1 per week | 2,473 (13.8) | 1,839 (24.3) | 634 (6.2) | |
| Almost everyday | 735 (4.1) | 621 (8.2) | 114 (1.1) |
Table 3.
Proportions and aOR(95% CI) for depression by smoking behavior
| Characteristics | Male | Female | ||
|---|---|---|---|---|
| Depressiona | aOR (95% CI)b | Depressiona | aOR (95% CI)b | |
| Total | 686 (9.1) | 1,706 (16.6) | ||
| Lifetime smoking experience | ||||
| Never smoker | 104 (7.5) | 1 | 1,418 (15.5) | 1 |
| Ever-smoker | 582 (9.4) | 1.12 (0.88–1.41) | 288 (25.6) | 1.63 (1.38–1.92) |
| Current Smoking status | ||||
| Never smoker | 104 (7.5) | 1 | 1,418 (15.5) | 1 |
| Ex-smoker | 261 (8.5) | 1.03 (0.80–1.34) | 120 (21.4) | 1.38 (1.10–1.73) |
| Current smoker | 321 (10.3) | 1.19 (0.93–1.53) | 168 (29.8) | 1.89 (1.53–2.94) |
| P for trend | <0.001 | <0.001 | ||
| Smoking initiation at | ||||
| Never smoker | 104 (7.5) | 1 | 1,418 (15.5) | 1 |
| ≥19 yo | 380 (9.6) | 1.19 (0.96–1.46) | 205 (23.8) | 1.46 (1.21–1.75) |
| <19 yo | 202 (9.0) | 1.00 (0.77–1.30) | 83 (31.4) | 2.34 (1.73–3.16) |
| P for trend | 0.217 | <0.001 | ||
| Cigarette consumption per day | ||||
| Noc | 365 (8.2) | 1 | 1.538 (15.8) | 1 |
| <20 | 155 (9.0) | 1.10 (0.89–1.36) | 146 (28.7) | 1.77 (1.42–2.21) |
| ≥20 | 166 (11.9) | 1.21 (1.01–1.54) | 22 (39.3) | 2.41 (1.32–4.41) |
| P for trend | <0.001 | <0.001 | ||
Table 4.
Proportions and aOR (95% CI) for depression by alcohol drinking behavior
| Characteristics | Male | Female | ||
|---|---|---|---|---|
| Depressiona | aOR (95% CI)b | Depressiona | aOR (95% CI)b | |
| Total | 686 (9.1) | 1,706 (16.6) | ||
| Lifetime drinking experience | ||||
| Never-drank | 40 (10.6) | 1 | 390(18.4) | 1 |
| Ever-drinker | 646 (9.0) | 0.75 (0.55–1.02) | 1,316(16.1) | 0.95 (0.83–1.08) |
| Drinking initiation at | ||||
| Never drank | 40 (10.6) | 1 | 390(18.4) | 1 |
| ≥19 yo | 370 (9.2) | 0.84 (0.58–1.21) | 1.068(15.8) | 0.96 (0.83–1.11) |
| <19 yo | 276 (8.7) | 0.75 (0.52–1.10) | 248(17.3) | 1.20 (0.97–1.48) |
| P for trend | 0.936 | 0.004 | ||
| Drinking frequency | ||||
| Nonec | 124 (10.0) | 1 | 672(17.4) | 1 |
| <4 per month | 287 (8.3) | 0.94 (0.74–1.21) | 850(15.3) | 1.00 (0.88–1.31) |
| ≥2 per week | 273 (9.6) | 1.00 (0.78–1.29) | 176(20.7) | 1.10 (0.92–1.33) |
| P for trend | 0.883 | 0.919 | ||
| Binge drinking | ||||
| Nonec | 124 (10.0) | 1 | 672(17.4) | 1 |
| No | 121 (9.0) | 0.99 (0.75–1.32) | 449(14.4) | 0.91 (0.79–1.51) |
| ≤1 per month | 194 (7.7) | 0.84 (0.64–1.09) | 406(15.8) | 1.08 (0.92–1.26) |
| 1 per week | 170 (9.2) | 1.05 (0.81–1.42) | 141(22.2) | 1.46 (1.16–1.85) |
| Almost everyday | 75 (12.1) | 1.14 (0.81–1.60) | 38(33.3) | 1.79 (1.14–2.80) |
| P for trend | 0.535 | 0.042 | ||
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