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

Hualiang Lin, Yanfei Guo, Paul Kowal, Collins O. Airhihenbuwa, Qian Di, Yang Zheng, Xing Zhao, Michael G. Vaughn, Steven Howard, Mario Schootman, Aaron Salinas-Rodriguez, Alfred E. Yawson, Perianayagam Arokiasamy, Betty Soledad Manrique-Espinoza, Richard B. Biritwum, Stephen P. Rule, Nadia Minicuci, Nirmala Naidoo, Somnath Chatterji, Zhengmin QianWenjun Ma, Fan Wu

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


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=41 785). 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% Cl 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.

Original languageEnglish (US)
Pages (from-to)157-162
Number of pages6
JournalBritish Journal of Psychiatry
Issue number3
StatePublished - Sep 2017

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health


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