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Developmental Heterogeneity in Adolescent Depressive Symptoms: Associations With Smoking Behavior

From the Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.

Address correspondence and reprint requests to Daniel Rodriguez, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104. E-mail: drodrig2{at}mail.med.upenn.edu

Objective: Previous research has indicated an association between smoking and depression in adolescents, although the nature of the relationship is controversial. We sought to understand this relationship better in a prospective study by investigating whether there are subpopulations of adolescents with different relationships between smoking and depressive symptoms.

Methods: Our sample was 925 adolescents attending one of five Northern Virginia high schools, grades 9 to 12. We used General Growth Mixture Modeling as our method because it allowed identification and characterization of depressive symptoms trajectories and assessment of the effects of trajectory on 12th grade smoking. We defined the binary variable 12th grade current smoking as smoking on 1 or more of the past 30 days and more than 100 cigarettes smoked in a lifetime, versus not having smoked in the past 30 days.

Results: We identified three trajectories: high, medium, and low depressive symptoms. For adolescents with high symptoms, 9th grade (baseline) smoking was associated with an overall deceleration of depressive symptoms, whereas for adolescents with moderate symptoms, baseline smoking was associated with an overall acceleration in depressive symptoms. Baseline smoking was not associated with rate of change in depressive symptoms for adolescents with low symptoms, nor was it associated with baseline depressive symptoms in any trajectory.

Conclusion: These findings demonstrate that there is a relationship between smoking and depressive symptoms in adolescents, and that the relationship can vary by developmental trajectory, suggesting etiological heterogeneity.

Key Words: depression • smoking • trajectories • General Growth Mixture Modeling

Abbreviations: GGMM = General Growth Mixture Modeling; CES-D = Center for Epidemiological Studies Depression; GMM = Growth Mixture Modeling; BIC = Bayesian Information Criterion; LMR LRT = Lo-Mendell-Rubin Likelihood Ratio; OR = odds ratio; CI = confidence interval.

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