Smoking, health risks, coping mechanisms and depression in the age of COVID-19: A cross-sectional study of the Lebanese population

Abstract

Introduction: We compared depression of people who smoke and those who do not, depending on whether they have an underlying disease making them at risk for COVID-19. Moreover, we analyzed the factors associated with their depression. Methods: We recruited 948 Lebanese residents, ages 18 and above. Our survey included the Patient Health Questionnaire-9 (PHQ-9) to assess depression. We divided participants, based on smoking and having a disease making one at risk for a COVID19 infection into four groups: non-smokers not at risk (NSNR), non-smokers at risk (NSR), smokers not at risk (SNR), and smokers at risk (SR). Results: SR had PHQ-9 scores higher than other groups. The diet was not changed during the pandemic, whereas weight increased in all groups but SR. Those not at risk slept longer, while sports were decreased in NSR and SNR. Hobbies were decreased in all groups except SNR. Depending on the group, factors such as age, sex, residency, diet, exercise, sleep duration, and hobbies were associated with PHQ-9 scores. Limitations: we cannot draw causal relationships. Participation required internet access, and participants might not represent the actual population due to the snowball effect. Also, recall bias might skew results. We did not inquire about sexual activity, which could be an essential coping mechanism. Conclusion: Factors associated with depression for one group did not necessarily do so for another. Controlling the underlying risk or smoking cessation could move a patient to a group with more options associated with depression, thereby additional methods to decrease depression.