Analysis of patient health questionnaire-9 (PHQ-9) based depression prevalence according to a discordance between quantitative urinary cotinine levels and self-report of second-hand smoke exposure among adults: A cross-sectional study

Background: Second-hand smoke (SHS) exposure appears to be more common among individuals with depression. However, self -report of SHS exposure is an inaccurate classification compared to confirming SHS exposure using urinary cotinine (UC). Additionally, the dose -response relationship between depression and UC is controversial. Methods: The severe stress rate and depression prevalence was estimated among 14530 Korean participants aged >= 19 years using data patient health questionnaire -9 (PHQ-9) and on UC from the Korean National Health and Nutrition Examination Survey. Measured UCs were divided into four categories: UC- ( <= 0.3 mu g/L), UC +/- (0.4 mu g/L-0.9 mu g/L), UC + (1.0 mu g/L-11.9 mu g/L), and UC ++ ( >= 12.0 mu g/L). Results: About 55.0 % participants were female and participants' mean age was 51.1 years. Nonsmokers were 80.3 %. Among non-smokers, non-SHS exposure participants (SR-) and SHS exposure participants (SR +) were 83.0 % and 17.0 %, respectively. When UC- was used as the reference subgroup, the UC ++ subgroup showed a higher depression prevalence, whereas the UC +/- subgroup showed a lower prevalence. In the same UC categories, the depression prevalence and severe stress rate were higher among females than among males. Furthermore, the SR + subgroup had a higher severe stress rate than the SR- subgroup. Conclusions: Our study showed a paradoxical reduction in the depression prevalence and severe stress rate in the UC +/- subgroup compared to the UC- subgroup. Additionally, the dose -response relationship between the SHS exposure biomarker and the depression prevalence was not linear. Our study indicates that an emotional stress -based model may be more appropriate for explaining the relationship between depression and SHS exposure.