Negative affectivity and nicotine withdrawal symptoms in smokers applying for smoking cessation clinics.

Introduction: smokers may experience negative affectivity (i.e., sub-threshold depression/anxiety) while quitting and, although properly treated via pharmacological interventions, they can also have symptoms of acute nicotine withdrawal. The present study has the aim to disentangle whether the negative affectivity or the nicotine withdrawal symptoms experienced during a smoking cessation programme might influence the possibility to quit. Methods: we conducted a longitudinal naturalistic study on smokers followed for a quitting programme at the smoking cessation clinic of the University Hospital of Pisa. Smokers received a pharmacological and/or a counselling treatment according to the good clinical practice. Socio-demographic and clinical data (e.g., personal history of smoking) were collected during their first visit together with the level of nicotine dependence (Fagerstrom Test for Nicotine Dependence - FTND) and the presence of anxious/depressive symptoms (Hospital Anxiety Depression scale – HADS). Moreover, negative affectivity was assessed via hetero- (i.e., Montgomery-Asberg Depression Rating Scale, Anxiety Status Inventory) and self-administered (i.e., Profile of Mood States, Beck Depression Inventory, Self Rating Anxiety Scale) scales at baseline as well as at week 1, 3, 6, and 9 after the quit day. Nicotine withdrawal symptoms were assessed at follow up visits via the Smoke Compliant Scale and the DSM-IV-TR checklist of nicotine withdrawal symptoms. Results: participants were 50 (35 males and 15 females) smokers with a mean age of 49.73 ± 13.35 years. Comparing abstainers (17,6%) with non-abstainers (60,8%) at the 9 week follow-up visit for the variables measured at baseline, the first group had lower levels of nicotine dependence than the second one (p < 0.05). The multivariate analyses, adjusted for age, gender, and treatment received, showed that the risk to fail in quitting smoking was higher in those who had higher baseline nicotine dependence and lower anxiety (if measured via the hetero-administered scale). The overtime presence of affective symptoms (i.e., anxious and cognitive depressive symptoms as measured via self-administered scales) seem to increase the probability to fail in quitting when the longitudinal analyses, adjusted for FTND, age, gender, and treatment received, were run while no effect was found for nicotine withdrawal symptoms. Conclusions: the level of nicotine dependence at baseline as well as the level of negative affectivity at baseline and over time seem to influence the possibility to quit smoking. On the contrary, the over time occurrence of nicotine withdrawal symptoms do not have such an effect.