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REPLY
Reply: Depression, Smoking, and Health Status
Kenneth E. Covinsky, MD, MPH, and
C. Seth Landefeld, MD
15 December 1997 | Volume 127 Issue 12 | Pages 1131-1132
IN RESPONSE:
Dr. Jay raises the question of whether smoking status confounds the relation we observed between symptoms of depression and poor health status outcomes in acutely ill hospitalized older persons. This is an important question, given evidence that the rates of cigarette smoking may be higher in persons with depression [1, 2]. However, we believe it unlikely that smoking status explains the adverse health outcomes we observed in depressed patients. Previous studies have found that smokers have a 30% to 50% greater risk for clinically significant symptoms of depression [1, 2]. Because we found that patients with many symptoms of depression had a two- to threefold greater risk for adverse health outcomes than patients with few symptoms, it is unlikely that a potentially higher smoking rate in the more depressed patients would account for these differences in health outcomes. Nonetheless, we agree with Dr. Jay's conclusion that future studies of the relation between depression and health status outcomes in older persons should control for the potential confounding effects of smoking.
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Author and Article Information
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Case Western Reserve University School of Medicine; Cleveland, OH 44106-4961
1. Glassman AH, Helzer JE, Covey LS, Cottler LB, Stetner F, Tippo JE. Smoking, smoking cessation, and major depression. JAMA. 1990; 264:1546-9.
2. Anda RF, Williamson DF, Escobedo LG, Mast EE, Giovino GA, Remington PL. Depression and the dynamics of smoking: a national perspective. JAMA. 1990; 264:1541-5.
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