Exposure to air pollution and tobacco smoking and their combined effects on depression in six low- and middle-income countries

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Abstract

Background

Little is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countries.

Aims

To investigate the effects of exposure to ambient fine particulate matter pollution (PM2.5) and smoking and their combined (interactive) effects on depression.

Method

Multilevel logistic regression analysis of baseline data of a prospective cohort study (n=4l785). The 3-year average concentrations of PM2.5 were estimated using US National Aeronautics and Space Administration satellite data, and depression was diagnosed using a standardised questionnaire. Three-level logistic regression models were applied to examine the associations with depression.

Results

The odds ratio (OR) for depression was 1.09 (95% CI 1.01–1.17) per 10μg/m3 increase in ambient PM2.5, and the association remained after adjusting for potential confounding factors (adjusted OR=1.10, 95% CI 1.02–1.19). Tobacco smoking (smoking status, frequency, duration and amount) was also significantly associated with depression. There appeared to be a synergistic interaction between ambient PM2.5 and smoking on depression in the additive model, but the interaction was not statistically significant in the multiplicative model.

Conclusions

Our study suggests that exposure to ambient PM2.5 may increase the risk of depression, and smoking may enhance this effect.

Declaration of interest

None.

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