Analysis of patient health questionnaire-9 (PHQ-9) based depression prevalence according to a discordance between quantitative urinary cotinine levels and self-report of second-hand smoke exposure among adults: A cross-sectional study

• Published in: Heliyon Vol. 10; no. 11; p. e32125
• Main Authors: Lee, Hyun-Seung, Lee, Young-Jin, Cho, Ji-Hyun, Park, Do-Sim
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 15.06.2024; Elsevier
• Subjects: Cotinine; Depression; PHQ-9; Second-hand smoke; Self-report; Stress; Depression; Cotinine; PHQ-9; Self-report; Stress; Second-hand smoke
• ISSN: 2405-8440; 2405-8440
• DOI: 10.1016/j.heliyon.2024.e32125

Second-hand smoke (SHS) exposure appears to be more common among individuals with depression. However, self-report of SHS exposure is an inaccurate classification compared to confirming SHS exposure using urinary cotinine (UC). Additionally, the dose-response relationship between depression and UC is controversial. The severe stress rate and depression prevalence was estimated among 14530 Korean participants aged ≥19 years using data patient health questionnaire-9 (PHQ-9) and on UC from the Korean National Health and Nutrition Examination Survey. Measured UCs were divided into four categories: UC– (≤0.3 μg/L), UC± (0.4 μg/L–0.9 μg/L), UC+ (1.0 μg/L–11.9 μg/L), and UC++ (≥12.0 μg/L). About 55.0 % participants were female and participants’ mean age was 51.1 years. Non-smokers were 80.3 %. Among non-smokers, non-SHS exposure participants (SR–) and SHS exposure participants (SR+) were 83.0 % and 17.0 %, respectively. When UC– was used as the reference subgroup, the UC++ subgroup showed a higher depression prevalence, whereas the UC ± subgroup showed a lower prevalence. In the same UC categories, the depression prevalence and severe stress rate were higher among females than among males. Furthermore, the SR + subgroup had a higher severe stress rate than the SR– subgroup. Our study showed a paradoxical reduction in the depression prevalence and severe stress rate in the UC ± subgroup compared to the UC– subgroup. Additionally, the dose-response relationship between the SHS exposure biomarker and the depression prevalence was not linear. Our study indicates that an emotional stress-based model may be more appropriate for explaining the relationship between depression and SHS exposure.