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Journal of the Korean Academy of Family Medicine 1993;14(2):79-87.
Published online February 1, 1993.
The relationship between nicotine dependency and depession in smokers.
Soon Young Oh, Se In Kim, Bang Bu Youn
흡연자의 우울성향과 니코틴 의존도
윤방부, 오순영, 김세인
연세대학교의과대학 가정의학과교실
Abstract
Background
: With reports on the relation between smoking and depression appearing since 1980, it has become clear that depression is one of the psychodynamics of smoking, though there has been little or no progress made in the study of whether or not there is indeed a relation between depression and nicotine dependence. After establishing the hypothesis that an assessment of depression and nicotine dependence is established, as a measurement for predicting the success rate of an attempt on the part of the smoker to stop smoking and that through the treatment of that depression a smoker's sucess rate in quitting can be substantially raised, this study was carried out in order to verify this hypothesis.

Methods : In periodical examination and checkups between the months of June and August, 1992, using 403 adult healthy male, we inquired as to each age, marital status, education level, monthly salary, whether or not they smoked and if so, at what age they started and the number of attempts made at quitting. Stress levels were measured by using the 'Social Readjustment Rating Scale, SRRS', depression levels by using the 'Beck Depression Inventory, short form, SBDI' and nicotine dependence using the 'Fagerstrom Tolerence Questionaire, FTQ'.

Results : The average SBDI was 7.86±5.01, and the depression levels of the subjects who smoke were higher, with the smoking group at 8.85±5.29 and the non-smoking group at 5.44±3.17(P<0.001). In the case of 13 points being the cutoff for the diagnosis of depression noted from the SBDI, 75 men(18.6%) among all study subjects could be diagnosed as depression, and among these 68 of them(90%) were smokers.(P<0.001) The annual Life Change Unit(LCU) of social Readjustment Rating Scale, which is using the level of stress, averaged 202.31±226.65. There were 79 men (18.6%) with an LCU of over 300 points, a high measured level of stress, and among them 66(83.5%) were smokers, notable difference.(P<0.01) The average FTQ of the 286 smokers was 4.81±2.70, and the number of smokers with more than 7 points, which indicates a high dependence on nicotine, was 94(23%), their average SBDI being 12.84±4.93. Futhermore, the average SBDI of those with a FTQ of less than 6 points was 6.89±4.27, indicating a sizable difference(P<0.001), and the average FTQ of 68 smokers which showed signs of depression was 7.00±1.80(P<0.01). As a result of analyzing the independent effect that each variables has upon nicotine dependence using the stepwised multiple regression analysis, we found that among them depression has the most pronounced effect.(P<0.001)

Conclusion : According to this study, an individual smoker's inclination towards depression is the most important factor in predicting the nicotine dependence of that smoker. For an effective strategy to quit smoking, we think that the assessment of depression should be include among the headings for evaluating smokers, and that selecting smokers who show sign of depression and then treating that depression would be a great help in increasing the success rate of those who attempt to quit smoking. We feel that in the future a study on such a treatment will be needed.
초록
연구배경 : 1980년 이후 흡연과 우울성향에 대한 관련성이 보고 되었으나 우울성향과 니코틴 의존도와의 연관성에 대한 연구로는 진행되지 않았다. 흡연자들의 우울성향과 니코틴 의존도와의 연관성 증명을 통한 보다 효과적인 금연전략의 수립을 위하여 본 연구를 실시하였다.

방법 : 1992년 6월에서 8월까지 정기신검 및 건강검진을 위해 내원한 성인 남자 403명을 대상으로 나이, 결혼상태, 교육정도, 월 수입, 흡연여부 및 흡연 시작연령, 금연시도 횟수에 대한 조사를 하였고 스트레스강도의 측정은 '사회재적응척도(Social Readjustment Rating Scale, S.R.R.S)', 우울성향의 측정은 'Beck Depression Inventory, short form(이하 SBDI)', 니코틴의존도의 측정은 'Fagerstrom Tolerence Questionaire(이하 F.T.Q)'를 사용하였다.

결과 : 우울척도(SBDI)의 평균은 7.86±5.01이었으며 흡연군은 8.85±5.29 비흡연군은 5.44±3.17으로 흡연군의 우울척도가 높았으며(P<0.001), 전체 연구대상자중 75명(18.6%)을 우울증이 있다고 평가할 수 있었고 그중 흡연자는 68명으로 90%를 차지하였다. (P<0.001) 스트레스의 강도 즉 사회재적응척도의 생활 변화량(Life Change unit, L.C.U)은 평균 202.31±226.65이었으며 스트레스의 강도가 크다고 판정한 L.C.U 300점 이상은 79명(19.6%)이었고 그중 흡연자는 66명(83.5%)를 차지하여 유의한 차이를 보였다.(P<0.01) 흡연군 286명을 대상으로한 F.T.Q의 평균은 4.81±2.70이었고 니코틴 의존도가 높음을 시사하는 7점이상의 흡연자는 94명(23%)이었으며 이들의 평균 SBDI 점수는 12.84±4.93, 6점이하의 평균은 6.89±4.27으로 유의한 차이가 있었고(ㅖ<0.001), 우울증이 있는 흡연군 68명의 평균 F.T.Q는 7.00±1.80이었다.(P<0.01) 다단계 다중회귀분석을 통하여 각 변수가 니코틴의존도에 독립적으로 미치는 영향을 분석한 결과 우울성향이 가장 크게 영향을 미치고 있음을 알 수 있었다.(P<0.000)

결론 : 본 연구에서 흡연자의 니코틴의존도를 예측할 수 있는 요인으로 가장 중요한 것은 흡연자의 우울성향이었다. 우울성향이 있는 흡연자를 선별하여 이에 대한 치료를 함으로써 금연성공율을 향상시킬 수 있을 것이다.


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