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@ARTICLE{Vlker:284334,
      author       = {Völker, Maja P and Callies, Carolin M and Frank, Josef and
                      Foo, Jerome C and Reinhard, Iris and Zillich, Lea and
                      Klinger-König, Johanna and Grabe, Hans and Beule, Achim G
                      and Erhardt-Lehmann, Angelika and Pabst, Alexander and
                      Riedel-Heller, Steffi G and Baune, Bernhard T and
                      Trenkwalder, Claudia and Wagner, Michael and Krist, Lilian
                      and Keil, Thomas and Pischon, Tobias and Nimptsch, Katharina
                      and Schulze, Matthias B and Schmidt, Börge and Mikolajczyk,
                      Rafael and Obi, Nadia and Harth, Volker and Klett-Tammen,
                      Carolina J and Becher, Heiko and Greiser, Karin H and Karch,
                      André and Schipf, Sabine and Meinke-Franze, Claudia and
                      Bohmann, Patricia and Leitzmann, Michael and Brenner,
                      Hermann and Mons, Ute and Schwarz, Emanuel and Berger, Klaus
                      and Mata, Jutta and Witt, Stephanie H and Streit, Fabian},
      title        = {{F}rom cigarettes to symptoms: the association between
                      smoking and depression in the {G}erman {N}ational {C}ohort
                      ({NAKO}).},
      journal      = {BMC public health},
      volume       = {26},
      number       = {1},
      issn         = {1471-2458},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DZNE-2026-00109},
      pages        = {301},
      year         = {2025},
      abstract     = {Although the association between smoking and depression is
                      well-established, the underlying mechanisms and contextual
                      factors remain insufficiently understood. We examined the
                      association between smoking and depression, including
                      detailed dose-response and timing-related relationships,
                      using baseline data from a large population-based cohort,
                      the German National Cohort (NAKO).The analysis comprised
                      173,890 participants (19-72 years, $50.21\%$ female).
                      Lifetime and current depression were assessed via
                      self-reported physician's diagnosis, the Major Depressive
                      Disorder module of the MINI International Neuropsychiatric
                      Interview (MINI), and the depression scale of the Patient
                      Health Questionnaire (PHQ-9). Smoking behavior was assessed
                      using self-reported smoking status, age at initiation,
                      cigarettes per day, and time since smoking cessation.
                      Associations between smoking and depression measures were
                      analyzed using regression models adjusted for sex, age,
                      age², education, Body Mass Index, and alcohol
                      consumption.Lifetime depression was more prevalent among
                      individuals who currently or formerly smoked compared to
                      those who never smoked. Currently smoking individuals also
                      reported most current depressive symptoms, followed by
                      formerly smoking individuals and those who never smoked. A
                      dose-response relationship was observed, with more
                      cigarettes per day being associated with more current
                      depressive symptoms. Later age at smoking initiation was
                      associated with later depression onset. Time since smoking
                      cessation was positively associated with time since last
                      depressive episode and negatively with current depressive
                      symptoms.Our findings support an association between smoking
                      and depression. Robust dose-response relationships were
                      found, with higher cigarette consumption associated with
                      more severe depressive symptoms, and longer time since
                      cessation linked to lower depression levels. These results
                      highlight smoking as a meaningful and modifiable contributor
                      to current and lifetime depression, suggesting that quitting
                      smoking or reducing cigarette consumption may benefit mental
                      health. Early prevention of smoking initiation, along with
                      integrated approaches that combine smoking cessation support
                      with mental health care, may help reduce both smoking rates
                      and depression burden.},
      keywords     = {Humans / Female / Male / Adult / Germany: epidemiology /
                      Middle Aged / Aged / Smoking: epidemiology / Smoking:
                      psychology / Depression: epidemiology / Cohort Studies /
                      Young Adult / Prevalence / Age of onset (Other) / Cigarette
                      smoking (Other) / Depressive disorder (Other) / Smoking
                      cessation (Other)},
      cin          = {AG Wagner},
      ddc          = {610},
      cid          = {I:(DE-2719)1011201},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41413802},
      pmc          = {pmc:PMC12831396},
      doi          = {10.1186/s12889-025-25959-0},
      url          = {https://pub.dzne.de/record/284334},
}