Introduction:
Aim: Smoking relapse is a frequent phenomenon, in which depressive symptoms, cigarette dependence, and craving play a significant role. Previous studies have shown that people with depressive symptoms have greater cigarette dependence and craving, and that greater cigarette dependence is related to craving intensity. The aim of this study was to explore whether depressive symptoms mediates the association between cigarette dependence and craving, among a sample of Spanish relapsers from the general population.

Methods:
Participants included 775 relapsed smokers recruited among the general population using a snowball method between January 2014 and December 2015. Inclusion criteria required: smoking ≥ 10 cigarettes per day, and an abstinence period of ≥ 30 days in the last ten years. Participants completed a survey including sociodemographic, smoking and psychopathological variables. We used the Fagerström Test for Cigarette Dependence for the assessment of cigarette dependence, the Beck Depression Inventory for depressive symptoms, and the Questionnaire Smoking Urges-Brief for craving. Bivariate correlations were performed to examine the associations between study variables, including sex and age. PROCESS, a statistical macro to test indirect effects, was used to conduct mediation analyses.

Results:
Participants’ mean age was 42.01 (SD = 11.3), and 53.2% were female. Bivariate correlations were statically significant between depressive symptoms and sex, and cigarette dependence and craving. Cigarette dependence was significantly correlated with craving and age, but not with sex. Results of mediation analysis showed a significant direct effect of cigarette dependence on craving (p = .000), and that depressive symptoms significantly mediated this relation (a*b = 0.175, SE= 0.065; 95% CI [0.069− 0.335]), after controlling for sex and age.

Conclusions:
These findings suggest that the relation between cigarette dependence and craving may be partially explained by depressive symptoms in this sample of relapsed smokers. So, depressive symptoms should be taken into account during smoking cessation interventions.

Funding:
This research was supported by the Spanish Ministry of Economy and Competitiveness (Project reference: PSI2015-66755-R) and co-financed by FEDER (European Regional Development Fund; pluri-annual plan 2014-2020).