Effectiveness of a mood management component as an adjunct to a telephone counselling smoking cessation intervention for smokers with a past major depression: a pragmatic randomized controlled trial Regina M. van der Meer 1 , Marc C. Willemsen 1 , Filip Smit 2 , Pim Cuijpers 3 & Gerard M. Schippers 4 STIVORO, Expert Centre on Tobacco Use and Tobacco Addiction, Den Haag, the Netherlands, 1 Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands, 2 Department of Clinical Psychology, Chair, Vrije Universiteit Amsterdam, Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands 3 and AMC, Divisie Psychiatrie PA 1–173, Amsterdam, the Netherlands 4 ABSTRACT Aims To assess whether the addition of a mood management component to telephone counselling produces higher abstinence rates in smokers with past major depression and helps to prevent recurrence of depressive symptoms. Design Pragmatic randomized controlled trial with two conditions, with follow-up at 6 and 12 months. Setting Dutch national smoking cessation quitline. Participants A total of 485 daily smokers with past major depression, according to the DSM-IV. Intervention The control intervention consisted of eight sessions of proactive telephone counselling. The mood management intervention was an integration of the control intervention with a mood management component. This component consisted of a self-help mood management manual, two more pre- paratory proactive telephone counselling sessions and supplementary homework assignments and advice. Outcome measurement The primary outcome measure was prolonged abstinence and secondary outcome measures were 7-day point prevalence abstinence and depressive symptoms. Findings The mood management intervention resulted in significantly higher prolonged abstinence rates at 6- and 12-month follow-up (30.5% and 23.9% in experimental condition, 22.3% and 14.0% in the control condition). The odds ratios were 1.60 (95% CI 1.06–2.42) and 1.96 (95% CI 1.22–3.14) for both follow-ups. The mood management intervention did not seem to prevent recurrence of depres- sive symptoms. Conclusion Adding a mood management component to telephone counselling for smoking cessation in smokers with a history of major depression increases cessation rates without necessarily reducing depressive symptoms. Keywords Cognitive–behavioural therapy, depression, mood management, smoking cessation, telephone counselling. Correspondence to: Regina M. van der Meer, STIVORO, Expert Centre onTobacco Use andTobacco Addiction, PO Box 16070, 2500 BB Den Haag, the Netherlands. E-mail: rvandermeer@stivoro.nl Submitted ••; initial review completed ••; final version accepted •• INTRODUCTION Smokers are not a homogeneous group. It is important to develop different smoking cessation interventions for spe- cific groups, such as people with past major depression [1,2]. Major depression is associated strongly with smoking: smokers are more likely to have past major depression than non-smokers, and people with such a past are more likely to be smokers than non-smokers [3,4]. Furthermore, some studies have shown that attempts to quit smoking fail considerably more often in smokers with past depression than in other smokers [3,5]. Whether this is true is the subject of debate [6–8]. A recent review showed that smokers with past major depression clearly have an increased risk for a new episode of major depression after quitting smoking [9]. Whether or not a new depressive episode can be triggered by smoking abstinence is not yet clear, although within- study comparisons suggest that abstinence from tobacco use increases the recurrence of major depression [9]. add_3057 RESEARCH REPORT doi:10.1111/j.1360-0443.2010.03057.x 3 3 © 2010 The Authors. Journal compilation © 2010 Society for the Study of Addiction Addiction 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 7 2 11