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

  • Hualiang Lin (a1), Yanfei Guo (a2), Paul Kowal (a3), Collins O. Airhihenbuwa (a4), Qian Di (a5), Yang Zheng (a2), Xing Zhao (a6), Michael G. Vaughn (a4), Steven Howard (a4), Mario Schootman (a7), Aaron Salinas-Rodriguez (a8), Alfred E. Yawson (a9), Perianayagam Arokiasamy (a10), Betty Soledad Manrique-Espinoza (a8), Richard B. Biritwum (a11), Stephen P. Rule (a12), Nadia Minicuci (a13), Nirmala Naidoo (a14), Somnath Chatterji (a14), Zhengmin (Min) Qian (a4), Wenjun Ma (a1) and Fan Wu (a2)...
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=41785). 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 10 μg/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.

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Copyright
Corresponding author
Zhengmin (Min) Qian, College for Public Health and Social Justice, Saint Louis University, Saint Louis 63104, Missouri, USA, Email: zqian2@slu.edu; Wenjun Ma, Guangdong Institute of Public Health, Guangzhou 511430, China; or Fan Wu, Shanghai Municipal Centre for Disease Control, Shanghai 200336, China
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Declaration of interest

None.

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

  • Hualiang Lin (a1), Yanfei Guo (a2), Paul Kowal (a3), Collins O. Airhihenbuwa (a4), Qian Di (a5), Yang Zheng (a2), Xing Zhao (a6), Michael G. Vaughn (a4), Steven Howard (a4), Mario Schootman (a7), Aaron Salinas-Rodriguez (a8), Alfred E. Yawson (a9), Perianayagam Arokiasamy (a10), Betty Soledad Manrique-Espinoza (a8), Richard B. Biritwum (a11), Stephen P. Rule (a12), Nadia Minicuci (a13), Nirmala Naidoo (a14), Somnath Chatterji (a14), Zhengmin (Min) Qian (a4), Wenjun Ma (a1) and Fan Wu (a2)...
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eLetters

Air Pollution and Mental Health in Developing Countries

K.A.L.A. Kuruppuarachchi, Senior Professor of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
Chirantha S. Kuruppuarachchi, Medical Student, South Asian Institute of Technology and Medicine, Malabe, Sri Lanka
03 December 2017

The article on exposure to air pollution and tobacco smoking and their combined effects on depression in six low- and middle – income countries (Lin et al. 2017) raises some important issues related to global mental health.

Obviously rapid urbanization which seems to be unplanned has been occurring in many developing countries over the last few decades. Increasing number of motor vehicles in cities is alarming and many improperly constructed roads are congested and noisy. Even though emission tests are done in some countries , poorly maintained vehicles add to the burden further. The traffic congestion is noted more during the school hours which leads to “developing brains” exposed to toxic substances causing neuropsychiatric and behavioural problems. Most cities appear to be poorly planned and not much conducive to human existence. There are studies showing an association between city dwelling and adverse effects on mental health(Gruebner et al. 2017).

We are going to have more problems as there is poorly planned rapid development and industrialization destroying the eco system. On the other hand the beneficial effects of “ greenspace”on mental health has been highlighted(Barton & Rogerson 2017).

It is note worthy that the occupational stress as well as vulnerable personalities of the people who are migrating to cities may be contributing to mood disturbances and mental health. There may be other vulnerability factors such as poor dietary habits, overcrowding and poorly constructed houses/buildings.These factors act as compounding variables too. Passive smoking as well as combined effect of indoor air pollution due to commonly used unclean fuels such as wood in overcrowded houses need to be seriously considered.

Whilst commending the work and the effort of the authors which is shedding some light into this important area, we feel it is worthwhile pursuing further studies to unravel the contribution of air pollution as well as smoking including passive smoking to poor mental health particularly in our part of the world.

References;

Lin H et al. Exposure to air pollution and tobacco smoking and their combined effects on depression in six low- and middle – income countries. British Journal of Psychiatry 2017; 211: 157 – 162.

Gruebner O et al. Cities and mental health. Dtsch Arztebl Int 2017; 114(8): 121-127.

Barton J, Rogerson M. The importance of greenspace for mental health. BJPsych International 2017; 14(4): 79-81.

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Conflict of interest: None Declared

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