Vaping linked to clinical depression
Smoking e-cigarettes could have potentially deleterious effects on a person’s mental health, according to a JAMA Network Open study that solidified a link between vaping and self-reported clinical depression.
E-cigarettes have been commercially available for a decade or so now, but they weren’t widely popularized until recent years, when companies like e-cig giant Juul Labs started marketing their products directly to teens and pre-teens. In an address dated Dec. 18, 2018, U.S. Surgeon General Jerome Adams deemed youth vaping a national epidemic and singled out Juul for enjoying a 600% surge in sales between 2016 and 2017. By 2018, one in five high-schoolers and one in 20 middle-schoolers were admitting to using vaping products.
Juul shuttered its social media last winter and vowed to stop selling most of its minor-friendly flavored pods—each of which contains just about as much nicotine as a 20-pack of cigarettes—in stores, but it wasn’t the only active e-cig distributor at the time. Use persisted, and by the end of 2019 U.S. officials were looking into more than 2,000 cases of severe lung illness (EVALI) and nearly 40 deaths brought on by vaping.
Some cases of EVALI have been attributed to the possible presence of Vitamin E acetate in vaping products, but first author Olufunmilayo H. Obisesan, MD, MPH, and colleagues pointed out that many e-cigarettes also contain other toxicities like arsenic, lead and propylene glycol. They’re marketed as an approach to smoking cessation, but their contents are largely unrelated.
Obisesan et al. said several studies have established a link between traditional cigarette smoking and depression, but none had really looked into the relationship between mental health and e-cigarette use. People with mental health conditions make up more than one-third of the U.S. population, and those individuals consume more than half of all cigarettes sold in the country.
The researchers conducted a cross-sectional study of 2016-2017 data from the Behavioral Risk Factor Surveillance System, which is the largest telephone-based survey of randomly sampled adults in the U.S. They included 892,394 participants with information on both e-cigarette use and depression in their analysis.
Just 29% of people included in the study were aged 60 or up, the authors said, which makes sense considering the majority of today’s e-cigarette consumers are on the younger side. Just over 4% of study participants reported being current e-cigarette users, 62% of whom were between 18 and 39 years old.
Compared with people who never smoked e-cigarettes, current users in the study were more likely to be:
- Single (48.4% vs. 24.3% of never-users)
- Male (60.1% vs. 46.6%)
- Younger than 40 (62.1% vs. 32.2%)
- Current combustible cigarette smokers (51.8% vs. 7.9%)
Obisesan and co-authors said former e-cigarette users saw 1.60-fold higher odds of reporting a history of clinically diagnosed depression, while current e-cigarette users saw 2.10-fold higher odds. People who reported using e-cigarettes daily were 2.39 times more likely than never-users to report depression; those who used cigarettes “occasionally” were 1.96 times more likely to report the mood disorder.
The authors said their findings suggest a significant link between depression and e-cigarette use—something that could be used to inform future policy decisions. Still, the data in their study was self-reported and therefore subject to considerable bias.
“Our findings, if confirmed in other study designs with longitudinal follow-up, may provide data to inform policies that could protect populations susceptible to depression,” they wrote. “For example, the association between e-cigarette use and depression might justify further regulation of advertisements and marketing strategies, appropriate warning labels that highlight the potential risk of depression associated with e-cigarette use, and public health education about the potential effects of e-cigarettes, especially among those with mental health conditions.
“At the very least, our findings warrant careful and thorough evaluation of e-cigarette use in both youth and adults with depression.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.