Original Article

Yonago Acta medica 2015;58:81–84

Psychological Characteristics in Patients during Treatment for Tobacco Dependence
Akiko Matsuda,* Junichi Hasegawa,† Xinhui Wang,† Satoshi Tsuno† and Norimasa Miura†*Department of Fundamental Nursing, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan and†Division of Pharmacotherapeutics, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University
Faculty of Medicine, Yonago 683-8503, Japan

ABSTRACT

BackgroundFew studies compare mood in tobacco
cessation patients with mood in continuing smokers andthen estimate the effects of a tobacco cessation program
according to status of mood. We investigated whether
mood in patients (n = 7) dependent on tobacco improved
through the standard Japanese 12-week program forsmoking cessation comparing smokers (n = 11) and nonsmokers (n = 16).
Methods A brief Japanese version of the short profile
of mood states (POMS) was used in this study. The subscale includes 5 negative mood factors (tension-anxiety,depression, anger-hostility, fatigue and confusionbewilderment) and positive mood factors (vigor-activity).
We also examined expiratory CO concentration (ppm),
percentage of COHb, urinary nicotine and its metabolite
concentration, Brinkman index, and tobacco dependence score (TDS) for both smoking cessation groupand smokers group.
Results All the short profiles for mood state points
in nonsmokers were below 50. Two of TDS items insmoking cessation patients were significantly higher inpercentage than those in smokers. Brinkman indices andexpiratory CO concentration were significantly higher insmoking cessation patients than those in smokers. The
rate of improvement in tension-anxiety points in smoking cessation patients was significantly higher than thatin smokers.
Conclusion Counseling according to the standard program in the treatment of tobacco dependence may be aneffective procedure to improve mood status.

mood. We investigated whether mood in patients withtobacco dependence improved through the Japanese 12week standard program for smoking cessation comparing smokers and nonsmokers.
SUBJECTS AND METHODS
Participants for this study were recruited through information on posters at Tottori University hospital andcampus. Thirty-four male volunteers aged 25–70 wereenrolled in this study from March to September in 2011.
Written informed consent for this study was obtained
from all participants. Inpatients and patients with cancer
and allergic diseases were excluded. The subjects weresmoking cessation patients (n = 7), smokers (n = 11) andnonsmokers (n = 16).
The age, presence of complications, smoking status
of family members, occupation, smoking environment,
and mood states at work were examined. Mood states ofpatients were estimated by questionnaire in a brief Japanese version of the short profile of mood states (POMS)4
at base line and end point. It contains 30 items based on
a 5-point scale from 0 (not at all) to 4 (extremely). The
subscale includes 5 negative mood factors (tension-anxiety, depression, anger-hostility, fatigue, and confusionbewilderment) and positive mood factors (vigor-activity).
We examined expiratory CO concentration, percentage
of COHb, urinary nicotine and its metabolite concentration (NicCheck I Mossman Associates, MA, USA) expressed by 0-14 degrees, Brinkman index, and tobacco
dependence score (TDS)5 of both the smoking cessationgroup and smokers group at base line. Smokers were
defined as participants who currently smoked more than
10 cigarettes per day. Smoking cessation patients were
defined by the 4 conditions below: i) smoking every day
up to examination (high COHb); ii) diagnosis of tobacco

Key words

tobacco dependence; smoking cessation;smoker; psychological characteristic; mood states

It is known that tobacco/nicotine dependence causes
cognitive, behavioral, and physiological symptoms, andsmoking cessation affects mood in smoking patients.1, 2
The status of mood was reported to be worse in smokers
than in nonsmokers.3 Many studies showed the moderate effects of smoking cessation treatment programs on
physiological function; however, few studies compare
mood in smoking cessation patients and that in smokers
and estimate the effects of the program on the status ofCorresponding author: Akiko Matsuda
Present address: Faculty of Nursing, School of medicine, Nara
Medical University, Kashihara 634-8521, Japanamatuda@naramed-u.ac.jp
Received 2015 March 5
Accepted 2015 March 17
Abbreviations: POMS, short profile of mood states; TDS, tobacco
dependence score81

A. Matsuda et al.

RESULTS
Characteristics of patients were indicated in Table 1.
Mean of age in smoking cessation patients was significantly higher than that in smokers. Oral varenicline (n =6) or nicotine patch (n = 1) were used as smoking cessation medications. There were no significant differences
in POMS points among the three groups at the base line
(Table 2). All POMS points in nonsmokers were below
50. Two of TDS items in smoking cessation patientswere significantly higher in percentage than those insmokers. Smoking cessation patients felt much more difficulty in quitting smoking and had some serious illness(Table 3). Brinkman indices and expiratory CO concentration were significantly higher in smoking cessation
patients than those in smokers (Table 4).
There were no significant differences in POMS
points among the three groups between the base line andthe endpoint. In subscales of POMS, depression–dejection points in smoking cessation patients tended to decrease in the base line to the endpoint (P = 0.095; Table 2).
The rate of improvement (reduction) on tension-anxiety
points in smoking cessation patients was significantly
higher than that in smokers (Table 5).

dependence syndrome (TDS: more than 5); iii) a highBrinkman index (more than 200) and iv) having the intention to quit smoking.
Smoking cessation patients were treated by thestandard Japanese program for treatment of tobacco
dependence for 12 weeks, while the smokers were justobserved without treatment.6 Patients received the appropriate advice for the problem of smoking cessation.
Statistical analysis

The continuous variables on baseline were compared
between the 3 groups by analysis of variance. The continuous variables before and after the observation were
examined by Wilcoxon’s signed-rank test (two-side).
The decrease from the baseline to the end point ineach POMS points is defined as “improvement”, and its
increase is defined as “aggravation”. The rate was compared between smoking cessation patients and smokers
by Pearson’s product moment correlation. P < 0.05 wasconsidered statistically significant. Analysis was performed by SPSS/Ver. 11.0J for Windows (SPSS Japan,
Tokyo, Japan).
The Ethics Committee of Tottori University Facultyof Medicine approved the study protocol.

Table 1. Characteristics in subjects
Smoking cessation patients [n = 7]

Smokers [n = 11]

Non-smokers [n = 16]

Age (mean ± SD)

58.6 ± 11.9

42.5 ± 11.9

42.6 ± 10.6

Past history (%)

4 (57.1)

1 (5.6)1 (6.3)Complication

1 (14.3)

2 (11.1)

3 (18.8)

Smoker in family member

4 (57.1)

10 (55.6)

14 (87.5)

Data are expressed in number of patients, except for age.

Table 2. Change of POMS point on the 3 groups
Smoking cessation patients [n = 7]

Smokers [n = 11]

Non-smokers [n = 16]

Base line

Endpoint

Base line

Endpoint

Base line

Endpoint

Tension-anxiety

51.7 ±10.1

48.0 ± 6.8

50.2 ±12.3

52.4 ±10.948.8 ± 8.9

49.5 ±11.1

Depression-dejection

50.7 ±11.2

48.8 ± 9.2

50.6 ±10.754.0 ±13.547.7 ± 7.5

47.7 ± 7.1

Anger-hostility

52.3 ±10.851.1 ±10.849.9 ±10.050.8 ± 7.6

47.2 ± 7.3

48.8 ±11.9

Vigor-activity

53.7 ±11.2

51.2 ± 5.2

50.2 ± 8.7

49.9 ± 9.1

49.0 ±10.450.6 ±12.1

Fatigue

46.4 ± 5.2

44.7 ± 5.7

53.8 ±12.652.1 ±11.2

47.8 ± 8.3

51.3 ±10.5

Confusion

53.0 ± 9.2

50.7 ± 9.4

52.2 ±11.1

52.2 ± 8.1

46.5 ± 9.2

49.0 ±11.4

Data are expressed in mean ± SD. POMS, short profile of mood states.

82

Mood change during smoking cessation
Table 3. TDS in smoking cessation patients and smokers
Smoking cessation patients [n = 7]n (%)
1. Smoking more than he/she intended to
6 (85.7)

Smokers [n = 11]n (%)
4 (36.4)

2. Unsuccessful effort to quit smoking

7 (100)5 (45.5)

3. Craving for tobacco

6 (85.7)

7 (63.6)

4. Withdrawal symptoms

5 (71.4)

6 (54.5)

5. Smoking to avoid withdrawal symptoms

5 (71.4)

6 (54.5)

6. Smoking despite a serious illness

5 (71.5)

2 (18.2)

7. Smoking despite health problems

6 (85.7)

11 (100)

8. Smoking despite mental problems

6 (85.7)

8 (72.7)

9. Feeling dependent on tobacco

6 (85.9)

8 (72.7)

10. Giving up important activities to smoke

2 (28.6)

2 (18.2)

High score (≥ 5) patients

7 (100)6 (54.5)

TDS (mean ± SD)

7.71 ± 3.0

5.18 ± 2.6***P < 0.05. TDS, tobacco dependence score.

Table 4. Smoking characteristics in smoking cessation patients and smokers
Smoking cessation patients [n = 7]

Smokers [n = 11]

Expiratory CO (ppm)

25.71 ± 16.4

10.27 ± 10.1

COHb (%)

3.31 ±

0.5

2.06 ±

1.8

4.42 ±

2.0

5.09 ±

3.3

Urinary nicotine and metabolites
Brinkman index

913.57 ± 448.7

282.18 ± 238.9**

Data are expressed in mean ± SD. *P < 0.05.
Urinary nicotine and metabolites, urinary nicotine and its metabolite concentration (NicCheck I, Mossman Associates, MA), this concentration expressed by 0–14 degrees.

Table 5. Rate of improvement in POMS
Smoking cessation patients [n = 7]

Smokers [n = 11]

Improvement

Aggravation

Improvement

Aggravation

n (%)

n (%)

n (%)

n (%)

Tension-anxiety

7 (100)0 (0)6 (54.5)5 (45.5)

Depression-dejection

5 (71.4)

2 (28.6)

4 (36.4)

7 (63.6)

Anger-hostility

3 (42.9)

4 (57.1)

5 (45.5)

6 (54.5)

Vigor-activity

4 (57.1)

3 (42.9)

6 (54.5)5 (45.5)

Fatigue

5 (71.4)

2 (28.6)

8 (72.7)

3 (27.3)

Confusion

3 (42.9)

4 (57.1)

7 (63.6)

4 (36.4)**P < 0.05. Aggravation, the increase from the baseline to the end point in each POMS points; Improvement,
the decrease from the baseline to the end point in each POMS points. POMS, short profile of mood states.

DISCUSSION
In this study, mean points of 5 subscales in POMS insmoking cessation patients and smokers at baselinetended to be higher than that of nonsmokers. As thispoint going up over the standard point of 50, the status
is considered to be serious.7 So we suspect that the status of mood in smoking cessation patients and smokers

at baseline is more serious than that of nonsmokers.
Therefore, in considering mood status, proper advice
from medical staff is required for smoking cessation.
Smoking induces both mental and physical dependence. Therefore restriction of smoking causes withdrawal
symptoms and a strong desire to smoke.8, 9 Brinkman indices and expiratory CO concentration were significantly83

A. Matsuda et al.

REFERENCES

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TDS points for smoking cessation patients tended to behigher than in those for smokers. On the other hand,smokers felt less difficulty in quitting smoking andstronger withdrawal symptoms than in smoking cessation patients. This may be caused by a lack of a true
intention to quit. Brown et al.10 suggested that it is necessary for medical staff to support patients with anxiety
from withdrawal symptoms. The present study also suggests that it is important for us to support patients withstrong withdrawal symptoms and feelings of difficulty insmoking cessation.
Changes of mood in smoking cessation patients andsmokers were investigated in this study. The rate of improvement on tension-anxiety points in smoking cessation patients was significantly higher than that of smokers. The rate of improvement on depression-dejection
in smoking cessation patients tended to be higher thanthat of smokers. It has been reported that smoking cessation may cause symptoms of depression11 and the rateof the appearance of anxiety symptoms in ex-smokers(short-term) is higher than those in smokers.12 It has
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In the present study, the number of subjects was too
small to be able to match for age and sex in order to exactly assess the association between the effect of smoking cessation treatment and the improvement of depression and anxiety. Our results may have some limitations.
In conclusion, counseling according to the standard program in treatment of tobacco dependence may be effective procedure to improve the mood status.

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Acknowledgments: We would like to thank all participants in ourstudy.
The authors declare no conflict of interest.

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