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

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 two weeks after an unassisted smoking cessation attempt. A three-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 7,112 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: Two-level structural equation model suggested that on the situational level, negative affect increased the urge to smoke and decreased self-efficacy (? = .20; ? = -.12, respectively), but had no direct effect on lapse risk. A higher urge to smoke (? = .09) and lower self-efficacy (? = -.11) were confirmed as situational antecedents of lapses. Depressive symptoms at baseline were a strong predictor of a person's average negative affect (? = .35, all p <.001). However, the baseline characteristics influenced smoking frequency three 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 strongly associated 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.